1.Introduction

Rob Skelly

Fiona Lindop

Other invited authors

. Overview of the book including o Benefits of an MDT for patient careo Working together as an MDT ? During each stage of Parkinson's? For patients with Atypical Parkinson'so What patients and carers should expect from an MDT

Definition of an MDT and MDT models

Brief introduction to :

. Setting out of the structure so people can find things quickly. Chapter Summary

2. Parkinson's' Disease

Dr Rob Skelly (Consultant Geriatrician) & another expert (not based in Derby)

. Aetiology,. Epidemiology,. Stages of the condition (diagnosis, maintenance, complex and palliative) - to link into later chapters. Also describing Hohen & Yahr staging. This will include explanation of how staging of Parkinson's can provide helpful guidance in determining the specifics of the MDT. Making an accurate diagnosis. signs and symptoms (Motor and non-motor) -More detail will be in the diagnosis phase chapters. Medication. Basal Ganglia/ rationale for cues and strategies. Bone health. Surgical intervention

3. Multidisciplinary Team Working in Parkinson's Rob Skelly, Lisa Brown, Fiona Lindop and Derby team and other invited authors . Why is an MDT needed - evidence, Data from Parkinson's UK Audits . why does it work/why is it recommended Evidence/recommendations for MDT working, "Core" MDT disciplines and their roles (not interventions - these will be covered in the stages chapters): o Neurologist/Geriatrician: Role o Parkinson's Disease Nurse Specialist (PDNS) Role: Post-diagnostic counselling; clinics ... o Physiotherapy: Role (covering gait, falls and balance, transfers, physical capacity/activity, posture) o Occupational Therapy: Role (covering ... sleep, mood, ADL, driving, dexterity, anxiety, fatigue, employment) o Speech & Language Therapy: Role -speech and swallowing, 4. Other/Wider disciplines Derby team and other invited authors . Chapter covering wider disciplines than may be involved in MDT working (). Include a brief outline of each one's role, (core team and wider team?) and how they interact - diagram could be included o Nurse/ continence advisor o Dietitian o Psychologist o Psychiatrist

5. Living with Parkinson's

Brian and Liz Greaves,

person with Parkinson's and spouse

. The impact of diagnosis. impact on vocation. impact on activity. Impact of having access to an MDT. Impact on the "carer". importance of signposting to support e.g. charities and resources (e.g. Parkinson's UK). Importance of access to MDT

6. Title can be "Working together in the.... " or "MDT Intervention in the- Diagnosis Phase " (Same format for each of the chapters covering these stages

Derby Team and other invited authors

. Receiving/giving the diagnosis (will refer to chapter on signs and symptoms as well as covering some of those here). Referral after diagnosis to MDT. Signposting to support. MDT working/signposting. Assessment & Intervention specifics for this stage, including. Importance of Exercise & physical activity advice. Non- motor symptoms. Driving/ sleep/mood/anxiety o Education and self managemento Post-diagnostic counselling. Psychological impact/adjustment/ COGNITIVE PROFILE. Living with Parkinson's o Employment issues

o Promoting living well with PD . Further signposting - including to research opportunities 7. Working together as an MDT - Maintenance Phase Derby team and other invited authors Jess Marsh and others Lisa Brown . Signposting to support . Medication/ Side effects - complications . MDT - the team in action o Assessment & Intervention specifics for this stage ? Physiotherapy -. Also use of music for cueing ? OT - ? SALT - o Nurse - o Education and self management ongoing . Psychological impact/adjustment/ COGNITIVE PROFILE (issues around accepting the progression of the condition from diagnosis phase . Living with Parkinson's o Sex and intimate relationship issues o Cues and strategies 8. Working together as an MDT - Complex Phase Derby team and other invited authors . Signposting to support . Medication/side effects/ etc . MDT - the team in action o Assessment & Intervention ? Physiotherapy ? Occupational Therapy (OT) ? Speech therapist

? Nurseo Carer issues (carer strain)o Dementia management

. Recommendations for Management of the hospitalsed patient with Parkinson's

. Outreach/in-reach services to wards. Education

11. Lewy Body Dementia/ Dementia and PD

Chris Taylor. Clare Johnson

& Another invited expert

. Definition of Lewy Body Dementia. Signs and Symptoms. Management. MDT Interventions

12. MDT approach to Atypical Parkinson's

Fiona Lindop and other members of the authorship team

Another invited expert

. Multiple System Atrophy (MSA): aetiology, epidemiology etc. MDT Intervention. Progressive Supranuclear Palsy (PSP): as above. Corticobasal degeneration (CBD): as above. Table of red flags

13. The Importance of Exercise in PD

Dr Bhanu Ramaswamy OBE (Physiotherapist, Sheffield), & Julie Jones ( - physiotherapist Aberdeen - both are authors of the Parkinson's UK Exercise Framework

. Evidence for importance of exercise. Outline of WHO recommendations for exercise and evidence for poor uptake by people with Parkinson's. Specific types of exercise. Resources: Exercise framework.

14. Practical Tips for building an effective MDT Nuts and Bolts!!

Members of the Author team

. Steering group. Education for Patients/Carers. Offering symposiums for patients. Liaising with support e.g. resources. Commissioning

15. Conclusion