The Newcastle Deep Brain Stimulation Rehabilitation Project

Purpose

Deep brain stimulation (DBS) surgery is successfully used in people with Parkinson's disease (PwP) to manage symptoms. However, research has shown that activity levels post DBS often do not change significantly despite significant symptomatic improvement of motor symptoms.


This two-year PD-UK funded project aims to provide an enhanced physiotherapy programme for PwP undergoing DBS surgery. Currently no other UK DBS service offers rehabilitation. Objectives are to:

  • Develop an extended physiotherapy assessment to include innovative seven day monitoring of activity with accelerometer (Currently used in research projects but not in routine clinical practise).
  • Develop a prehab/rehabilitation programme for patients undergoing DBS.
  • Audit current rehabilitation practice in UK DBS services and develop good practice guidelines.
  • Develop region wide professional/voluntary sector links to aid implementation of rehabilitation guidelines.
  • Educate patients in the benefits of activity/rehabilitation via a patient lead focus group.

Approach

Patients undergo pre and post-operative physiotherapy assessment including seven-day real world activity and in-depth gait monitoring. Following assessment people receive individualised feedback and tailored advice.


Rehabilitation is provided before and after surgery, clinical outcomes and patient experience are evaluated.


A survey of UK DBS services has been completed to scope current rehabilitation provision and develop evidence based/best practice guidelines.


Regional models to support rehabilitation for PwP will be explored.


A patient-lead focus group will support other patients through DBS and encourage engagement in rehabilitation/activities.

Outcomes

This project is on-going: The audit is completed and results will be shared at national meetings and published. Pre-operative/post-operative assessments/rehabilitation programmes are embedded in the service and feedback from patients is being collated.

Assessment and rehabilitation programmes are feasible for this patient group and benefits to patients are under evaluation. The innovative use of seven-day real world data provides patients with in-depth tailored feedback aiding a self-management approach. UK DBS services lack direct access to rehabilitation; however several services are currently aiming to develop an enhanced rehabilitation service to this patient group.

Implications

This project will aim to identify rehabilitation best practice for PwP who undergo DBS surgery and will aim to establish National guidelines to support service provision and enhance patient outcomes. Research proposals linked to this work will be identified.

Funding acknowledgements

Parkinson's UK funded this two-year project.

Additional notes

This work was presented at Physiotherapy UK 2019