Acute Care Management of Parkinson’s Disease

I receive A LOT of questions pertaining to applications in neuro rehab. Emails, questions from neuro-specific FB groups, and through the contact features on this site. Today, I fielded one that I thought was worthy of posting, because of the unique nature of the question, moreso than my response. Thank you Brian!

I found you on Medbridge. I am an acute care PT. I want to learn how to better help patients who are admitted with Parkinsons. My colleagues and I are curious: Is there a way to ease the hypertonicity/rigidity in the hospital at bed-level? Any help would be appreciated.

My response:

Thank you for your email and intriguing question. I will begin by stating that my response is a combination of evidence and anecdote. 
That said, here are the best options, in no specific order:
1. Communicate patient and therapist expectations so that the patient can express their fears and preferences (here is how I get out of bed). 
2. Reduce fear in attempts at bed mobility (height, rails, confidence, presence). 
3. Positive Prediction Errors. Allow the patient to predict how much help they expect to need to get out of bed or up to stand or in gait. If they exceed their expectations, their alarm-based tone can reduce. Their reason for hospitalization should be considered here: pain, frailty, precautions. 
4. Restorator cycle at the bedside or (more likely) at a recliner chair in the room. 
5. Investigate dopamine replacement timing, treat at optimal window. 
 
Keep the questions coming, thank you all!