Fast-track programming and rehabilitation model: a novel approach to postoperative deep brain stimulation patient care.
OBJECTIVE
To propose a new model of integrated, multidisciplinary postoperative care of the patients with deep brain stimulation (DBS).


METHODS
Observational cohort study with follow-up at 3 months and 1 year.


METHODS
Academic medical center movement disorder clinic.


METHODS
Seventy-three consecutive patients with medically refractory Parkinson's disease underwent bilateral DBS. Patients were then transferred directly to an inpatient rehabilitation facility.


METHODS
DBS and inpatient programming and rehabilitation. Simultaneous programming and rehabilitation was carried out by a multidisciplinary team.


METHODS
The FIM instrument, Unified Parkinson Disease Rating Scale (UPDRS), and levodopa dosage.


RESULTS
The average rehabilitation stay was 17.3 days, with a mean of 6.2 stimulator adjustments during that time. FIM scores improved from 62.1 (admission) to 98.5 (discharge), an average improvement of 36.4 (58.6%). Average UPDRS scores improved from 52.5 (preoperative off) and 30.1 (preoperative on) to 20.4 (3mo postoperative on-medication, on-stimulation), a 32.2% improvement from the preoperative on score. Levodopa dosages decreased by an average of 48.3% (all P<.001).


CONCLUSIONS
We describe our fast-track protocol, which allows for rapid DBS programming and tapering of Parkinson's medications. It also provides for treatment of concomitant medical and psychologic problems and optimized physical performance.
Cohen
David B
DB
Department of Neurosurgery, Division of Neuromodulation, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Oh
Michael Y
MY
Baser
Susan M
SM
Angle
Cindy
C
Whiting
Alex
A
Birk
Catherine
C
Whiting
Donald M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage; D002985:Clinical Protocols; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007902:Length of Stay; D007980:Levodopa / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000534:rehabilitation* / Q000601:surgery*; D010346:Patient Care Management / Q000458:organization & administration; D011182:Postoperative Care / Q000379:methods*
D000978:Antiparkinson Agents; D007980:Levodopa