Valoración e intervención de terapia ocupacional en patología neurodegenerativa

Abstract

Abstract: Introduction: Neurodegenerative diseases represent a group of clinical diseases of important relevance due to their increasing incidence and the important consumption of socio-health resources that they generate. These gglutinate a lot of heterogeneous diseases, some of unknown cause, insidious onset and that have in common of being progressive diseases. Neurodegenerative diseases are classified according to the pathophysiology, topography lesion and clinical features more prevalence, including dementia syndrome; movement disorder and posture disorder, and muscle weakness and atrophy. Multiple Sclerosis and Parkinson's Disease are of the most prevalent neurodegenerative diseases and from the outset they resort to occupational therapy. The progression of clinical symptoms leads to patient a disability and a role change in their development. Patients need of occupational therapy interventions. Multiple Sclerosis and Parkinson's Disease are degenerative and progressive diseases associated with motor and nonmotor symptoms that imply an impact on the quality of life and the functionality of the affected individuals. This clinical situation ppears in the case of Multiple Sclerosis as a consequence of the presence of sclerotic plaques in the central nervous system involving an inflammatory response, demyelination and gliosis. In the case of Parkinson's Disease, degeneration and death of dopaminergic neurons occurs in the pars compacta of the substantia nigra, as well as the appearance of intracytoplasmic Lewy eosinophilic bodies in the remaining neurons. Motor and non-motor symptoms are associated with both diseases, frequently its causes disturbances of balance and gait, emotional alterations, cognitive impairment, and gross and fine motricity deficits of upper limbs. Although Parkinson's Disease and Multiple Sclerosis show a worsen progression of their motor symptoms as the disease progresses and they affect the overall condition of the subject, the therapeutic proposals are focused on the limb. Muscle weakness, involvement of uni and bimanual coordination, sensory disorders of the upper limbs and progressive reduction of functional independence are presented in clinical progression in patients with Multiple Sclerosis and Parkinson's Disease. The functional execution of upper limbs is crucial for the independent performance of activities such as eating, writing, dressing and carrying and manipulating objects. About therapeutic possibilities, in both diseases the pharmacological treatment is chosen firstly, accompanied in most cases by a frequent follow-up of clinical evolution. In addition, the multidisciplinary team of psychologists, physiotherapists and occupational therapists has shown promising effects on both motor and non-motor symptoms that present both pathologies. There are lots of studies developed in lower limbs, gait and posture demonstrating high rates of efficacy and clinical impact. However, only few studies have been conducted on upper limbs and their results are controversial. Objectives: The main objetive of this thesis is to evaluate the effectiveness of a domiciliary occupational therapy programme about functionality in patients with a diagnostic of neurodegenerative disease. Two experiments were carried out, one in patients with Multiple Sclerosis and another in patients with Parkinson’s Disease: Secondary aims are: - To design a domiciliary occupational therapy programme focused on functional and motor impairment of upper limb in patients with MS. - To evaluate effectiveness of a domiciliary occupational therapy programme in motor and functional impairment in patients with MS. - To design a domiciliary occupational therapy programme focused on functional and motor impairment of upper limb in patients with PD. - To evaluate effectiveness of a domiciliary occupational therapy programme in motor and functional impairment in patients with PD. Methodology: Two randomized controlled clinical trials were developed. In the Multiple Sclerosis study, patients with significant upper limbs impairment were included. Participants were randomized into two groups. The experimental group received a training program focused on the upper limbs at home for 8 weeks twice weekly. Patients in the control group received an informative dossier about upper limb exercises. The effectiveness of the intervention on functionality was assessed using the Finger Tapping Test and Action Research Arm Tests. Additionally, efficacy on manual dexterity was evaluated with the Purdue Pegboard test and hand grip strength was evaluated with dynamometer. In the Parkinson's disease study patients with Hoehn-Yahr stage II-III and significant impairment of manual dexterity were included. Participants were randomized into two groups. The experimental group that received a 4-week domiciliary intervention focused on achieving specific task-oriented goals involving upper limb activity. Control group received a standard intervention of occupational therapy. The effectiveness of the intervention was evaluated by the achievement of functional objectives related to tasks of upper limbs with the Goal Attainment Scale. In addition, Hand grip strength was evaluated with dynamometry and dexterity was evaluated with Purdue Pegboard Test. Results: Both studies showed significant improvements in upper limbs after an intervention of occupational therapy in the outcomes evaluated. The study carried out in people diagnosed with Multiple Sclerosis showed significant changes after the intervention in functionality measured with the Action Research Arm Test (p <0.05). Also, the intervention group showed a significant improvement in the other outcomes (p <0.05) in most affected the upper limb. The results obtained in the study of Parkinson's Disease, after the intervention program showed significant differences between groups in the achievement of the previously established goals measured with the Goal Attainment Scale (p <0.05). Significant improvements were found in the experimental group in dexterity, and hand grip strength (p <0.05). Conclusions: A domiciliary occupational therapy intervention programme in patients with Multiple Sclerosis focused on upper limbs improves upper limb function, strength of hand and coordination. A domiciliary occupational therapy intervention programme in patients with Parkinson's Disease focused on upper limb tasks improves achievement of goals, manual dexterity, and hand strength. Therefore, it can be concluded that a domicliary occupational therapy intervention in patients with neurodegenerative disease, specifically Multiple Sclerosis and Parkinson's Disease, is effective because it improves the function, manual dexterity and hand grip strength, with the consequent clinical impact and increased independence.