The rehabilitation management of persons with progressive neurologic disease has undergone a substantial change over the last 25 years; persons with diseases such as multiple sclerosis (MS) and Parkinson disease (PD) are not only surviving for longer periods of time than they have previously but are doing so with higher levels of function than formerly might have been thought possible. The improvements in medical management have resulted in a relatively new patient population: the older adult with a progressive neurologic disease. Older adults with progressive neurologic diseases such as MS and PD represent a series of new challenges for the clinicians who treat them; not only are they treating the effects of the disease and the effects of aging, they are also treating the interaction of those effects.
The purpose of this special issue of Topics in Geriatric Rehabilitation is to assist clinicians who treat older adults with MS and PD, recognizing that this represents a distinct subcategory from younger adults with the disease. As an increasing number of persons are not only being diagnosed with PD and MS but are also surviving for longer periods of time, it is incumbent upon the rehabilitation professions to develop the specific expertise needed to care for these patients.
An understanding of the scope of preexisting evidence is needed before further study can occur. Accordingly, our first article by Karpatkin and Cohen is a review of information previously established by researchers on the topic of aging with a progressive neurologic disease. The article provides a summary of recommendations for persons with either MS or PD that may be of specific use to clinicians who are currently seeing patients such as this. Bollaert and Motl expanded on this in their review of physical and cognitive function, physical activity behavior, and physical activity interventions in older adults with MS, finding that older adults with MS demonstrate reduced physical and cognitive function as well as physical activity compared with healthy older adults. Next, Quinn and Coote investigated the impact of dual tasking on falls in older adults with MS. Barrera and O'Conner-Wells provided an in-depth discussion of normal and abnormal swallowing in older adults with either MS or PD.
In an article that compares different age groups of people with MS, Fritz and colleagues examined relationships between middle-aged and older adults with mild MS and found no significant differences between these groups in motor, cognitive, and behavioral performance, suggesting that these areas were not impacted by aging.
Looking at similar issues in PD, Gallagher and colleagues investigated the impact of age on cognition and balance in older and younger adults with PD. Research by Lapsely and colleagues found variable symmetry when comparing side-to-side muscle strength in persons with PD, emphasizing the importance of a detailed clinical examination in this population, as the side of greater PD severity did not always translate to the weaker side. Finally, Lehman and Ramsey utilized the case of an older adult with MS to illustrate the use of the International Classification of Function model to guide educating student physical therapists to examine and evaluate the person aging with a progressive neurologic pathology.
The topic of an aging population with progressive neurologic condition is of paramount importance for rehabilitation clinicians. As an increasingly larger number of these patients required physical rehabilitation, it is incumbent upon clinicians to become more knowledgeable about the needs of these patients so that appropriate and evidence-based care can be provided. We hope that with this special issue of Topics in Geriatric Rehabilitation, we may make a contribution to this process.
-Herb Karpatkin, DSc, PT, NCS, MSCS
Associate Professor Hunter College,
Physical Therapy Department New York, NY
-Evan Cohen, PhD, MA, PT, NCS
Associate Professor Rutgers,
The State University of New Jersey at Blackwood
Doctor of Physical Therapy Program
Blackwood, NJ