1. Introduction

The primary objective of that analysis was to acquire a thorough understanding of the current treatment modalities available for managing this pathological condition. Parkinson’s disease (PD) is a prevalent neurodegenerative disorder characterized by a range of clinical manifestations, encompassing both motor symptoms such as hypokinesia, resting tremor, stiffness, and postural instability, as well as non–motor symptoms including vegetative, emotional, psychological, and somatic disturbances. Over the course of its progression, Parkinson’s disease ultimately results in impairment and a substantial decline in the overall quality of life experienced by individuals affected by the condition. In recent years, a considerable body of scientific research has been undertaken to investigate the pathogenic mechanisms underlying the progression of the disease, establish clinical diagnostic criteria, and elucidate the principles governing medication treatment for Parkinson’s disease (PD).

2. The Main Results and Findings

Several studies are under conducted to investigate the efficacy of non–pharmacological interventions and rehabilitation techniques for individuals diagnosed with Parkinson’s disease. When considering a rehabilitation program, it is imperative to consider various factors that contribute to the onset of disability in patients. These factors include muscle weakness and reduced physical endurance, compromised posture, diminished speed and impaired coordination of movements, sensory deficiencies (such as weakened visual control, impaired sense of body position and movement, and reduced sensory sensations), cognitive and affective impairments, as well as any accompanying medical conditions [1]. In order to include all relevant variables, it is imperative to adopt a holistic approach to rehabilitation that addresses all problems while prioritizing patient safety.

As of the present time, a total of 38 randomized clinical trials have been published examining the efficacy of rehabilitation interventions in individuals diagnosed with Parkinson’s disease [1]. Most of the studies focused on utilizing motor rehabilitation techniques to address the primary manifestations of the condition, including gait impairments, balance deficits, and the mitigation of falls. In the year 2013, several reviews [1] were conducted to report the findings of the most notable studies conducted throughout the preceding decade. Nevertheless, despite the extensive body of research produced, there remain numerous unanswered matters pertaining to the selection of a rehabilitation program utilizing specific methodologies, the optimal duration and frequency of sessions, and the assessment of efficacy.

In 1965, physical therapy was initially introduced as a sort of rehabilitation treatment aimed at enhancing motor activity in individuals with Parkinson’s disease [8]. Subsequent to the identification of both motor and non–motor abnormalities in patients, alternative approaches to rehabilitation treatment were subsequently implemented [4,16,28].

Traditionally, rehabilitation treatment methods for Parkinson’s disease (PD) can be categorized into the following: a combination of diverse techniques aimed at restoring and preserving motor functions (physical rehabilitation); cognitive training to enhance cognitive abilities; psychotherapy; speech therapy interventions; employment of technologies involving biofeedback and virtual reality; occupational therapy to sustain and regain daily life skills.

The primary objective of rehabilitation interventions for Parkinson’s disease (PD) is to sustain functional autonomy and enhance the overall quality of life for individuals from the point of diagnosis and throughout the course of the illness.

Restorative treatment for Parkinson’s disease (PD) targets various issues depending on the disease stage. In the early stage, the focus is on preventing a decline in motor activity and enhancing endurance and tolerance to physical activity. In the advanced stage, the emphasis shifts towards reducing the severity of motor disorders, instructing individuals on effective motor strategies to maintain posture and stability, improving walking ability, and preventing falls. In the late stage, the primary objectives are to sustain vital functions, prevent purulent–septic complications, and manage contractures [10,17,25].

Previous research conducted on live organisms has demonstrated that engaging in physical exercise has the ability to directly impact the progression of neurodegeneration. Additionally, it can indirectly influence this process by modulating neurotrophic factors and neuroplasticity pathways [22]. The publication in 2013 included experimental data regarding the impact of restorative treatment on the initiation and enhancement of rehabilitation mechanisms.

In recent decades, there has been a significant increase in the quantity of literature pertaining to restorative treatment for Parkinson’s disease (PD), suggesting the continued significance of this issue [11]. The initial publication examining the efficacy of rehabilitation interventions for Parkinson’s disease was released in 1994 in the Netherlands [32]. As of 2010, a total of 38 randomized clinical trials examining the efficacy of rehabilitation treatment in individuals diagnosed with Parkinson’s disease have been documented [28]. Multiple studies have demonstrated that physical exercise in individuals with Parkinson’s disease (PD) can enhance essential motor functions, including balance, posture, muscle strength, walking ability, and overall quality of life [3,5,19]. Furthermore, there has been a recent emergence of novel techniques such as virtual reality technologies and computerized cognitive training programs, which are being integrated with conventional approaches employed in the treatment of Parkinson’s disease [14,17,20].

The topic of interest is motor rehabilitation. The primary modalities employed in motor rehabilitation encompass physical exercises (both group and individual), balance training, aerobic training, Nordic walking, dance therapy, and Chinese tai chi gymnastics.

The primary objectives of engaging in physical exercise are to enhance gait performance, encompassing stride length and walking speed, as well as to increase range of motion, and physical performance in terms of strength, mobility, and endurance, and to improve balance. This entails the utilization of a repertoire of exercises encompassing both active and passive movements of the limbs and spine, stretching exercises, strength training, and ambulation.

Over the past decade, research has shown the beneficial impact of balancing and walking training, such as the utilization of treadmills, on the mobility and performance of daily activities in individuals with Parkinson’s disease [14]. The evidence on the impact of these workouts on falls was found to be less compelling.

Balance training. In order to restore equilibrium in Parkinson’s disease (PD), a specific regimen of physical activities and stabilometric platforms are employed. In recent years, randomized clinical studies and subsequent meta–analyses have provided empirical evidence supporting the efficacy of balance training on several stabilometric platforms, with particular emphasis on the utilization of biofeedback [23]. However, it is important to note that in many instances, the utilization of balance exercises in isolation may not yield the intended outcome. Consequently, it becomes necessary to complement these exercises with strength workouts and gait training to get the desired result.

Aerobic exercises. Aerobic training is conducted on a treadmill, which includes obligatory fall protection, as well as an exercise bike and an elliptical trainer. Based on recent research findings, it has been observed that aerobic training has the potential to enhance exercise tolerance among patients. Furthermore, it has been found that irrespective of the intensity level, aerobic training has a positive impact on walking speed, height, and step length [27]. Furthermore, the patients demonstrated an augmentation in their everyday physical activity.

Nevertheless, it should be noted that the aforementioned training regimen does not have a substantial impact on stability, non–motor symptoms, quality of life, or the frequency of freezing, as indicated by previous research [27].

Cognitive training. The objective of cognitive training in individuals diagnosed with Parkinson’s disease (PD) is to address impairments in many cognitive domains, including memory (both visual and auditory–verbal), psychomotor skills (namely response time), visual–spatial abilities, executive functions, and linguistic fluency. There exist multiple approaches to cognitive training. In recent years, the implementation of this task has been facilitated through the utilization of specifically designed computerized applications. The findings from published randomized clinical trials [30] suggest that cognitive training has a positive impact on cognitive functions, particularly in the areas of regulation, neurodynamics, and psychomotor skills. In order to ascertain an appropriate cognitive training program, it is necessary to adopt an individualized strategy subsequent to conducting an initial neuropsychological assessment of the patient. This assessment serves the purpose of determining the nature and extent of cognitive impairment.

The utilization of virtual reality in conjunction with biofeedback techniques. These methodologies are widely regarded as being at the forefront of contemporary research and practice. The topic of discussion pertains to a sophisticated computational methodology involving real–time modeling and interactive engagement with multimodal sensory stimuli. In the context of training, a variety of sensory inputs, including visual, aural, and tactile modalities, are employed. The utilization of virtual reality technology enables the facilitation of integrated training in a recreational manner, thereby augmenting the individual’s ability to voluntarily regulate their motions and engage in intricate cognitive activities involving attention, action planning, and task switching. The positive impact of the approach in question on treating gait and stability abnormalities in Parkinson’s disease (PD) has been proven by randomized clinical trials [2]. According to a study [29], it has been shown that the duration of the effect of a rehabilitation program utilizing virtual reality technologies surpasses that of alternative rehabilitation approaches.

It is well acknowledged that a crucial aspect of rehabilitation pertains to the influence on non–motor manifestations of Parkinson’s disease (PD), particularly emotional disorders such as sadness, cognitive impairment, constipation, and sleep disturbances that manifest in the early stages of the condition. There is a scarcity of literature regarding the impacts of various rehabilitation approaches on non–motor symptoms. Previous research has indicated that engaging in aerobic training can provide beneficial outcomes in terms of regulatory functions, and age–related cognitive decline in healthy older adults, as well as enhancing the overall quality of sleep and life for senior individuals with insomnia [30]. Research has demonstrated that engaging in physical exercise has been associated with beneficial impacts on cognitive performance and sleep patterns. Nevertheless, up until now, there has been a dearth of extensive randomized clinical trials that have investigated the efficacy of rehabilitation interventions for non–motor illnesses.

When implementing rehabilitation interventions, it is imperative to consider that Parkinson’s disease (PD) frequently manifests in advanced age, coinciding with the presence of pre–existing chronic comorbidities that exhibit a gradual progression. Hence, the primary determinants impacting the efficacy of rehabilitation encompass non–modifiable factors, including advanced age, coexisting medical conditions, limited physical activity, and the extent of cognitive impairment. Additionally, partially modifiable factors such as the severity of affective and behavioral disorders, the level of support from family members or caregivers, and patient adherence also contribute to the overall outcome of rehabilitation. The significance of a cohesive approach to the established rehabilitation program and the dedication of the rehabilitation team to its implementation cannot be overstated [1].

The direct experiment, a multicenter study with 24 participants, employed a randomized and controlled design to evaluate the quality of life. This assessment was conducted through the utilization of conventional quality of life scales as well as a portable electronic diary. The research methodology employed in this study was a crossover design, wherein the effectiveness of LCIG therapy was compared to that of optimal oral medication across two consecutive 3–week intervals. The findings of the study indicate a notable enhancement in quality of life (QoL) through the administration of LCIG infusion. This improvement was observed on both the 15D scale and the PDQ–39 questionnaire, with statistical significance (p<0.01).

Following the conclusion of the study, a total of 16 patients made the decision to pursue ongoing therapy with duodenal levodopa infusion [24]. The findings of a 6–month follow–up study including 12 patients indicate that the previously observed improvement on the PDQ–39 scale remained consistent [15]. On average, the overall index on this scale was seen to be 10 points lower after an average duration of 4.3 months of infusion therapy in comparison to traditional therapy. However, it is important to note that these changes did not reach statistical significance.

The efficacy of transcranial magnetic stimulation (TMS), a non–pharmacological therapeutic approach, is now under evaluation. TMS has demonstrated efficiency in ameliorating both motor and non–motor symptoms.

Transcranial magnetic stimulation is a recently developed therapeutic approach for Parkinson’s disease (PD) that entails subjecting individuals to a pulsed magnetic field characterized by high levels of magnetic induction. The primary objective of this intervention is to induce alterations in brain plasticity through a process known as neuromodulation. Neuromodulation is a technique employed to directly manipulate certain regions of the nervous system through the administration of pharmaceutical agents, application of electric currents, or utilization of magnetic fields, with the aim of altering their level of excitability. Rhythmic transcranial magnetic stimulation (rTMS) is employed as a therapeutic intervention, involving the repetitive application of magnetic pulses to a specific region of the brain. Repetitive Transcranial Magnetic Stimulation (rTMS) has been identified as a secure therapeutic intervention for a wide range of neurological disorders [31].

A comprehensive review of the international literature yielded a total of over 150 papers pertaining to the utilization of repetitive transcranial magnetic stimulation (rTMS) in the context of Parkinson’s disease (PD). Among these publications, 15 studies were identified as placebo–controlled trials, collectively involving a cohort of 454 PD patients. The citation provided is incomplete and does not contain enough information to determine the source being referenced. One of the primary issues in their analysis pertains to the considerable diversity observed among patients with Parkinson’s disease (PD), even within the confines of a single study [9,21,26]. A comprehensive examination of ten scholarly papers, encompassing a total of 275 patients [12], revealed that the application of high–frequency stimulation to the primary motor cortex (M1) and the premotor cortex (PMC) is a viable approach for enhancing motor capabilities in individuals with Parkinson’s disease, in contrast to the utilization of low–frequency stimulation.

3. Conclusions

Therefore, it may be inferred that multiple scientific research presents conflicting evidence regarding the impacts of different non–pharmacological rehabilitation approaches for Parkinson’s disease (PD). The aforementioned factors necessitate ongoing research to identify the most efficacious and secure approaches for rehabilitating individuals diagnosed with Parkinson’s disease.