At Gondola too, we want to make your therapy easily and comfortably accessible from home.
Besides primary infection by COVID-19, the current global crisis has raised a series of indirect though serious concerns as a consequence of social isolation and the limitation of accessibility to healthcare services. Since the beginning of the pandemic, two pillars of Parkinson’s disease (PD) routine therapy, namely physical activity, and rehabilitation were strongly reduced in most countries, with subsequent severe effects on patients’ physical and mental health.
According to a recent review published in Nature NPJ PD, 10-28% of Parkinson’s patients, although not infected by the Coronavirus, reported a worsening of their physical symptoms due to restricted mobility during lockdown (1). Self-quarantining also had a significant psychological impact, with about 30% of patients reporting a clear deterioration of their emotional status, with a considerable exacerbation of depression and anxiety-related symptoms (1, 2). With social distancing becoming the new behavioral standard nowadays, there is an increased need for therapeutical strategies that can be administered at home without regular physical intervention from medical healthcare professionals.
The general trend of this past decade, relying on the development of personalized medicine, led to the quick implementation of a variety of remote rehabilitation (or telerehabilitation) approaches targeting PD and other chronic neurological disorders. Clinical studies have shown that the regular delivery of non-invasive sensory stimulation in PD patients, targeting different components of the nervous system, can significantly improve a number of neuromotor symptoms (4, 5, 6).
Telerehabilitation leverages a broad range of technological tools that enable efficient monitoring of patients and/or remote administration of therapy (7). Such devices and interfaces, specifically intended and designed for home-based rehabilitation confer unprecedented independence and flexibility to meet the patients’ unique clinical needs. Wearable sensors permit quantifying and tracking the evolution of performance, by recording relevant neurological and/or motor parameters without disrupting his daily activities (3). Already widely used in clinics to evaluate the success of physical therapies, sensors have also long been a reliable asset in health care practice in rural areas. Thanks to safe and user-friendly systems, the stimulation protocol is integrated in an ecological manner to the patient’s life while being carefully – and if applicable continuously – monitored.
The development of such remote therapies even made possible the integration of new, unprecedented features proven to enhance the efficacy of rehabilitation: interaction with virtual reality systems, embedded in the treatment for a wide range of neurological conditions – including PD, stroke, and MS – increase patient’s motivation and the immersivity of the training experience, integrating the cognitive and motor aspects of the proposed tasks (1, 8). As a consequence, neurological patients nowadays can rely on a wide variety of online resources covering nearly every aspect of their remote rehabilitation program thanks to playful scenari and motion/pressure sensors, from targeted physical activity training (aiming to improve gait, coordination, balance, speech) to videogames designed to strengthen brain connections and circuits that are particularly relevant for memory and cognition (1, 8, 9).
When needed, additional in-person training sessions are planned, in order to learn the correct use of the tools involved in each specific home-based therapy. However, most of the communication with the healthcare provider is integrated within a user-friendly internet-based app or platform, with options including live or recorded videos, as well as instructions and remote control of stimulation parameters. The continuous availability of exchange with professionals, but also with communities of patients online helps sustain the motivation and the engagement in their therapy, especially when other factors such as the pandemic tend to restrain in-person social interactions (1).
Remote rehabilitation is considered today a robust and appealing alternative to conventional medicine and is especially recommended for patients who can’t get regular access to therapeutical treatments out of home due to COVID-19 restrictions or any other personal constraint. A recent online survey performed on PD patients who experienced telerehabilitation highlighted some important advantages compared to conventional therapy. They reported advantages including easier access to qualified medical specialists, overall convenience, and significant time saving (10). Telerehabilitation is recommended by a number of institutions and associations (i.e. the American Physical Therapy Association, the World Confederation for Physical Therapy, the Chartered Society of Physiotherapy, the International Network of Physiotherapy Regulatory Authorities) and has been recognized to improve motor as well as cognitive disorders associated to a large number of neurological conditions (1).
The Gondola® Home Device is designed to deliver a tailored solution to ever-evolving patients’ needs. As such, it leverages the newest innovations and takes up the challenges revealed by the COVID-19 pandemic. Because we firmly believe that increasing the accessibility and ease-of-use of our therapy will pave the way to your better life.
REFERENCES:
- Langer A, Gassner L, Flotz A, Hasenauer S, Gruber J, Wizany L, Pokan R, Maetzler W, Zach H. How COVID-19 will boost remote exercise-based treatment in Parkinson’s disease: a narrative review. NPJ Parkinsons Dis. 2021 Mar 8;7(1):25. doi: 10.1038/s41531-021-00160-3. PMID: 33686074; PMCID: PMC7940641.
- Chaudhuri KR. COVID_19 and Parkinson’s disease. Kinetic. 2020;2:4–5.
- Miele G, Straccia G, Moccia M, Leocani L, Tedeschi G, Bonavita S, Lavorgna L; Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology. Telemedicine in Parkinson’s Disease: How to Ensure Patient Needs and Continuity of Care at the Time of COVID-19 Pandemic. Telemed J E Health. 2020 Dec;26(12):1533-1536. doi: 10.1089/tmj.2020.0184. Epub 2020 Jul 13. PMID: 32667839.
- Schulz R, Gerloff C, Hummel FC. Non-invasive brain stimulation in neurological diseases. Neuropharmacology. 2013 Jan;64:579-87. doi: 10.1016/j.neuropharm.2012.05.016. Epub 2012 Jun 9. PMID: 22687520.
- Stocchi F, Sale P, Kleiner AF, Casali M, Cimolin V, de Pandis F, Albertini G, Galli M. Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson’s disease. Int J Rehabil Res. 2015 Sep;38(3):238-45. doi: 10.1097/MRR.0000000000000120. PMID: 26164797; PMCID: PMC4662266.
- Pinto C, Pagnussat AS, Rozin Kleiner AF, Marchese RR, Salazar AP, Rieder CRM, Galli M. Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait: A Randomized Clinical Trial. Am J Phys Med Rehabil. 2018 Jun;97(6):383-389. doi: 10.1097/PHM.0000000000000890. PMID: 29309313.
- Dobbs, B., Pawlak, N., Biagioni, M. et al. Generalizing remotely supervised transcranial direct current stimulation (tDCS): feasibility and benefit in Parkinson’s disease. J NeuroEngineering Rehabil 15, 114 (2018). https://doi.org/10.1186/s12984-018-0457-9
- Isernia S, Di Tella S, Pagliari C, Jonsdottir J, Castiglioni C, Gindri P, Salza M, Gramigna C, Palumbo G, Molteni F, Baglio F. Effects of an Innovative Telerehabilitation Intervention for People With Parkinson’s Disease on Quality of Life, Motor, and Non-motor Abilities. Front Neurol. 2020 Aug 13;11:846. doi: 10.3389/fneur.2020.00846. PMID: 32903506; PMCID: PMC7438538.
- Srivastav AK, Samuel AJ. E-Rehabilitation: One solution for patients with Parkinson’s disease in COVID-19 era. Parkinsonism Relat Disord. 2020 Jun;75:128-129. doi: 10.1016/j.parkreldis.2020.05.021. Epub 2020 Jun 4. PMID: 32532625; PMCID: PMC7271872.
- Spear, Kelsey L. et al. ‘Patient Views on Telemedicine for Parkinson Disease’. 1 Jan. 2019 : 401 – 404.
