Introduction

This chapter presents an overview of rehabilitation in Parkinson's disease (PD) and in parkinsonism not due to PD, prior to a series of chapters reviewing specific types of nonmedical intervention. The first part of the chapter discusses conceptual issues relevant to progressive neurological conditions such as PD and parkinsonism. What counts as rehabilitation? How (if at all) can rehabilitation be distinguished from care and support? Is rehabilitation effective and cost effective? What are the general service requirements for people with PD and parkinsonism? The second part of the chapter considers how services can be designed to meet the needs of people with these syndromes. How specific are the needs? What resources are required? The chapter ends with an outline of rehabilitation interventions relevant to different stages of PD and to other syndromes resembling PD.

Rehabilitation concepts in PD/parkinsonism

What counts as rehabilitation?

If people with PD/parkinsonism (the two terms are used interchangeably in this section) are to benefit from health and social services their individual needs must always occupy centre stage: each medical and each nonmedical intervention must be relevant, in one way or another, to everyday life. All too often physicians forget this truism, for example in prescribing a drug to suppress a tremor that is unimportant to the patient or in mechanically continuing six-monthly outpatient appointments when neither the doctor nor the patient has clear objectives in mind. Unfocused, essentially aimless activities of this sort maintain a distinction that need hardly exist between medical management and rehabilitation.