key: cord-0053167-7bc0acl3
authors: da Silva Rocha Paz, Thiago; Silva de Macedo, André Ricardo; Lemos Silva, Ana Elisa; Pessoa, Girlene; Macedo Martins, Núbia Isabela; Miranda, Humberto Lameira; de Britto, Vera Lúcia Santos; Corrêa, Clynton Lourenço
title: Challenges in treating people with Parkinson’s disease during the COVID-19 pandemic
date: 2020-11-25
journal: Bull Fac Phys Ther
DOI: 10.1186/s43161-020-00017-5
sha: ce8ac7e97d0611dbf06a05baa2f01a068381592a
doc_id: 53167
cord_uid: 7bc0acl3

nan

whether the strategies are meeting the therapeutic goals set by the plan.

Health workers must encourage communication between PwP and their families, caregivers, and friends to minimize the effects of social distancing and isolation. One strategy to monitor the activities of PwP is to adopt a therapy journal, in which health workers ask PwP to write on a page the date, time, and which activities were performed throughout the day. Health workers may promote and encourage social and emotional bonds through video calls, such as through WhatsApp. However, currently, WhatsApp has a limit on the number of participants of a given videoconference call. However, many PwP find it difficult to handle new technologies, which should be considered by the health professionals responsible for them.

The education on health for PwP, families, and caregivers during the COVID-19 pandemic cannot be understated. Health workers must provide information on self-care (handwashing, safe greetings) to minimize SARS-CoV-2 contamination. Additionally, health workers can hand the World Health Organization's communication materials about COVID-19 to PwP. A unique experience of our research group is that during the COVID-19 pandemic, we designed an online form for the awareness of the health conditions of PwP based on the Freezing of Gait Questionnaire (FOG-Q) and Parkinson's Disease Questionnaire-39 (PDQ-39). Thus, PwP are able to get their FOG-Q results and total PDQ-39 score and their domains via email. This form is free of charge to all Portuguese-speaking PwP (form available at https://bit.ly/2WWGfhX).

Health workers should also recommend activities that involve executive functions suggesting several activities for PwP that involve executive functions, such as reading, listening to music, and singing. It is also important for health workers to be aware of the impacts of negative news regarding COVID-19 on the mental health of PwP. There may be an increase in anxiety and/or depression, which may negatively impact the clinical picture. One way to minimize anxiety and depression symptoms is to advise PwP to avoid watching the news. During the COVID-19 pandemic, health workers must offer support to PwP through telemonitoring or teleconsultations. Although telehealth programs have been used in rehabilitation for many years, the implementation of telehealth programs to service PwP remain in its infancy [2] .

Physical exercises are excellent strategies for the management of PwP, resulting in significant benefits [3] , which are fundamental to PwP during the COVID-19 pandemic. There are apps with specific exercises based on the main symptomatic treatments for Parkinson's disease that physiotherapists, occupational therapists, and physical educators can recommend to PwP during teleconsultation and telemonitoring sessions [4] [5] [6] . Patients should be advised to practice only those exercises recommended by health professionals. With the large-scale exposure of free workouts through social media, PwP can select unsuitable physical exercises that can be hazardous, resulting in falls or fractures.

When prescribing physical exercises, we should also consider that Parkinson's may compromise balance in moderate and advanced stages of the disease [7] . PwP patients are a high fall risk with moderate and advanced exercises at home. Fallings place the patient at risk for hospitalization that carries the risk of SARS-COV-2 transmission. Whenever possible, the presence of a caregiver decreases the risk of falls and, consequently, allows for more variations in therapy prescribed to PwP [8, 9] .

It is imperative that health workers change their practices and behaviors in order to ensure the physical, psychological, and social well-being of PwP during the COVID-19 pandemic in order to avoid the aggravation of Parkinson's. Further research remains needed to fully establish the pros and cons of telehealth programs for PwP. 

Long-term neurological threats of COVID-19: a call to update the thinking about the outcomes of the coronavirus pandemic

Promoting physical activity via Telehealth in people with Parkinson disease: the path forward after the COVID-19 pandemic? Phys Ther:pzaa128

Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease

Remote physical activity monitoring in neurological disease: a systematic review

Feasibility and preliminary efficacy of a telerehabilitation approach to group adapted tango instruction for people with Parkinson disease

Effectiveness of homebased and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial

The natural history of treated Parkinson's disease in an incident, community based cohort

Can telerehabilitation games lead to functional improvement of upper extremities in individuals with Parkinson's disease?

Virtual reality telerehabilitation for postural instability in Parkinson's disease: a multicenter, single-blind, randomized, controlled trial

The authors would like to thank the health workers of the Grupo de Estudos na Doença de Parkinson-GEDOPA for their care to PwP. The authors would also like to thank the Academic Publishing Advisory Center (Centro de Assessoria de Publicação Acadêmica, CAPA-www.capa.ufpr.br) of the Federal University of Paraná (UFPR) for assistance with English language translation and editing. Janeiro, Rio de Janeiro, Brazil. 2 Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 3 Graduate Program in Neurology and Neuroscience, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.

None.Availability of data and materials Not applicable.

This manuscript is a "Letter to the Editor"; therefore, it is not necessary.

Not applicable.

All authors declare that they have no conflict of interest.Author details 1 Graduate Program in Physical Education, Federal University of Rio de