The Hamburg Parkinson day-clinic: a new treatment concept at the border of in- and outpatient care.

To close a gap between inpatient and outpatient care, the Hamburg Parkinson day-clinic (HPDC) has been developed as a new and comprehensive, individual, interdisciplinary type of treatment for patients with complex Parkinsonian syndromes (PS). First, we describe the HPDC concept, in which a multi-professional medical team of PD specialists provide a time- and personnel-wise intensive care and focuses on the patients' individual deficits and resources. Second, we present short-term outcome results of the first 184 PS patients enrolled during 16 months including objective clinical motor and non-motor scores taken before and after participation in the HPDC, as well as the patients' subjective evaluation of the HPDC. Out of the 184 patients with PS (aged 39-88 years with Hoehn and Yahr scores between 1.0 and 4.5), 169 were diagnosed to have Parkinson disease (PD). HPDC treatment led to improvement of all applied motor (UPDRS III, AIMS) and non-motor (BDI-II, MoCA, PDNMS, PDSS-2, King's PD Pain Scale, QUIP, PDQ-39) scores (p < 0.05) indicating benefits for akinesia, tremor, dyskinesia, cognition, sleep, pain, impulse control disorders and quality of life. Patients evaluated HPDC care positively with values from 1.39 to 2.79 ("very good" to "satisfying") with an overall grade of 1.69 ("good") on a 6-point Likert scale (1-6: best to worst). Patients with advanced PS benefit from the HPDC concept which is considered to close a gap between inpatient and outpatient care.

Dysphagia Screening in Parkinson's Disease. A diagnostic accuracy cross-sectional study investigating the applicability of the Gugging Swallowing Screen (GUSS).

BACKGROUND: Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES). METHODS: Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared. KEY RESULTS: Inter-rater reliability of GUSS ratings was high (rs  = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50%, and specificity of 51.35% (PPV 28%, NPV 73%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97% sensitivity and 35.71% specificity (PPV 75%, NPV 33.33%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (rs  = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant. CONCLUSIONS AND INFERENCES: The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination.

Gait Training in Virtual Reality: Short-Term Effects of Different Virtual Manipulation Techniques in Parkinson's Disease.

It is well documented that there is a strong relationship between gait asymmetry and the freezing of gait (FOG) in Parkinson's Disease. The purpose of this pilot study was to find a "virtual reality (VR)- based" gait manipulation strategy to improve gait symmetry by equalizing step length. Fifteen male PD patients (mean age of 67.6 years) with FOG were assessed on a GAITRite® walkway. Natural gait was compared with walking conditions during "VR-based" gait modulation tasks that aimed at equalizing gait symmetry using visual or proprioceptive signals. Compared to natural gait, VR manipulation tasks significantly increased step width and swing time variability for both body sides. Within the VR conditions, only the task with "proprioceptive-visual dissociation" by artificial backward shifting of the foot improved spatial asymmetry significantly with comparable step lengths of both sides. Specific, hypothesis-driven VR tasks represent an efficient tool to manipulate gait features as gait symmetry in PD potentially preventing FOG. This pilot study offers promising "VR-based" approaches for rehabilitative training strategies to achieve gait symmetry and prevent FOG.