title: Fast-track programming and rehabilitation model: a novel approach to postoperative deep brain stimulation patient care.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Division of Neuromodulation, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Cohen
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Oh
authors.forename: Susan M
authors.initials: SM
authors.lastname: Baser
authors.forename: Cindy
authors.initials: C
authors.lastname: Angle
authors.forename: Alex
authors.initials: A
authors.lastname: Whiting
authors.forename: Catherine
authors.initials: C
authors.lastname: Birk
authors.forename: Donald M
authors.initials: DM
authors.lastname: Whiting
mesh_terms: 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*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa