507 - Aligning Therapy With Dopaminergic Peaks to Enhance Parkinson’s Rehabilitation

The patient underwent staged bilateral globus pallidus interna DBS implantation, followed two months later by complete hardware removal due to infection. He was started on multidrug antibiotic therapy. Prior to hospitalization, he was independent in ADLs and mobility but reported frequent falls. On rehab admission, DBS removal was associated with exacerbation of PD symptoms, presenting as impaired balance, reduced endurance, decreased activity tolerance, and intermittent confusion from infectious encephalopathy. Intensive PT, OT, and SLP began within 24 hours. Dopaminergic medication timing was prioritized, with therapy sessions scheduled to coincide with peak levodopa effect. Within two weeks, he progressed from maximum assistance for transfers and gait to supervised ambulation >150 feet with a rolling walker and moderate assistance for most ADLs.

Discussions: While many PT regimens exist for PD, research is limited on the ideal type, timing, frequency, and duration of therapy.1 This case highlights the importance of aligning therapy with dopaminergic “on” periods to optimize motor function. Initially, progress was minimal due to inconsistent medication timing before therapy. Adjusting the schedule to ensure sessions occurred during peak effect improved mobility, reduced bradykinesia, enhanced participation, and lowered injury risk. Dorsiflexion assist was used to address lower extremity rigidity and improve gait safety, while strict fall precautions mitigated his high fall risk. These combined strategies supported safe and timely functional recovery.

Conclusions: In PD rehabilitation, coordinating therapy with peak dopaminergic effect accelerates outcomes, expedites recovery, and can reduce length of stay. Incorporating targeted assistive devices and safety measures alongside medication-timed therapy may further enhance participation and functional recovery, especially in medically complex cases.