Rethinking Parkinson Care: The Role of High-Intensity Inpatient Rehabilitation

Author(s) Marco Meglio, NeurologyLive

Steven Markos, MD, a physician at Hackensack Meridian JFK Johnson Rehabilitation Institute, discussed a two-week inpatient rehabilitation program and its impact on functional and speech outcomes in Parkinson disease.

Rehabilitation remains an underutilized yet increasingly important component of Parkinson disease (PD) management, particularly as patients experience progressive functional decline affecting mobility, activities of daily living, and speech. A newly published retrospective cohort study now suggests that short-duration, high-intensity inpatient rehabilitation may offer meaningful clinical benefits across multiple domains, including both motor and vocal function.

In the analysis of 37 patients with PD admitted directly from home, participation in a two-week, interdisciplinary inpatient program resulted in significant improvements in AM-PAC Basic Mobility and Daily Activity scores (P < .0001), as well as Section GG self-care and mobility measures (P < .001). Additionally, vocal outcomes, assessed using the Voice Handicap Index (VHI), showed statistically significant improvement (P = .028), while cognitive domains remained unchanged. The program incorporated approximately 15 hours per week of Parkinson-specific therapy, including physical, occupational, and speech-language interventions.

In a Q&A with NeurologyLive®, Steven Markos, MD, a physician at Hackensack Meridian JFK Johnson Rehabilitation Institute, discussed the structure of this rehabilitation approach, key findings from the study, and how these results may inform future strategies for integrating intensive, multidisciplinary care into routine PD management.

Can you outline the structure of the two-week interdisciplinary rehabilitation program?

The first step is patient selection, as this program is not appropriate for every patient. Ideally, it is suited for individuals in the middle range of disease severity, where the intensity of a two-week inpatient rehabilitation program can be beneficial.

The core of the program is the therapy itself, both in quality and quantity. Patients receive three hours of therapy per day, five days a week, totaling about 15 hours weekly. All therapy is one-on-one and delivered by skilled, certified therapists trained in LSVT-based approaches specific to Parkinson disease. Compared with outpatient or home therapy, which may only involve a few hours per week, this is significantly more intensive. There appears to be a dose-dependent relationship, similar to medications, where increased therapy leads to greater improvement.

Patients are also under daily physician care, with attention to both Parkinson-related symptoms and general medical conditions. There is 24/7 nursing support, along with involvement from pharmacy, nutrition, and recreational therapy services. These additional components provide education, support, and cognitively engaging activities. Overall, the program is structured as a roughly two-week course, and we are consistently seeing patients leave in a better condition than when they arrived.

Is this model replicable across other institutions?

This type of program is already being implemented internationally, with similar models described in Europe and Asia, including countries such as Japan, Italy, and Germany. While this study is the first of its kind in the United States, the benefits of such programs have been documented elsewhere.

In terms of replication, it would not be something that can be implemented immediately, but with the appropriate infrastructure and resources, it is certainly achievable. A major advantage at our institution has been the existing infrastructure, including therapy departments, support programs, and community resources, which made it easier to build and implement this program.

One of the biggest challenges is the admission process, particularly insurance approval. Acute inpatient rehabilitation is typically reserved for patients who are hospitalized after an event, so justifying admission for patients coming directly from home can be difficult. However, the goal is to intervene earlier, before complications such as falls or hospitalizations occur, and to improve independence and quality of life proactively.

Can you walk through the study design and key findings?

This was a retrospective observational study using prospectively collected data. While it was not a randomized or large-scale trial, we were encouraged by the findings, which are consistent with prior research in this area.

We evaluated standard rehabilitation metrics, including AM-PAC scores across physical, occupational, and speech domains. These assess mobility, activities of daily living, and communication or cognitive function. We compared admission scores with discharge scores and observed statistically significant improvements in physical mobility and daily function.

In terms of speech outcomes, the Voice Handicap Index showed significant improvements in vocal function. While we did not see major changes in cognitive measures over the two-week period, this aligns with expectations and prior studies, as cognitive improvements typically require longer interventions.

Why has improving speech in Parkinson disease been challenging?

One of the main barriers is awareness. Patients and providers may not always recognize that speech and voice changes are part of Parkinson disease or may not know where to seek treatment.

However, speech therapy can be very effective. We often see rapid and meaningful improvements with intervention. Speech-related symptoms in Parkinson disease can include low voice volume, hoarseness, difficulty with articulation, and word-finding challenges. These issues significantly affect communication, social interaction, and overall quality of life.

With appropriate therapy and ongoing maintenance, we can see improvements in voice volume, articulation, and communication, with benefits that can persist even after the program is completed.

What lessons did you take away from this study and program?

One key takeaway is the importance of a team-based approach. Implementing and studying a program like this requires significant collaboration and effort across disciplines.

Another important lesson is that the program is worth the effort, even though there are barriers. These include insurance challenges and patient hesitancy, as committing to a two-week inpatient program can be difficult. However, when we believe the program will benefit a patient, we advocate strongly for it.

Ultimately, success depends on personalization—understanding each patient’s goals, barriers, and needs, and tailoring the program accordingly. When these elements align, the outcomes can be very meaningful.