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Parkinson's - Physiotherapy Management and Interventions

Dr Rohit Bhaskar
Dr Rohit Bhaskar
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If you or a loved one has had a parkinson’s disease diagnosis recently, chances are that you are now looking for treatment for Parkinsons. Parkinsonism is known to have highly varying parkinson’s disease symptoms and not often curable. That’s why parkinson’s disease treatment will focus on controlling the symptoms, which commonly include pain, stiffness and Parkinson tremor. Apart from medication, Parkinson’s treatment includes physiotherapy exercises for parkinson’s disease to maintain quality of life for the affected.

Parkinson's Disease

What is the best treatment for Parkinson disease?

Physiotherapy involvement along with medication for Parkinson’s Disease is supported by a growing evidence base of high quality research and leading best practice guidelines. Studies have also shown improved flexibility, strength, walking, balance and fitness in patients who participate in a physiotherapy program.

Physiotherapy for Parkinson’s disease focuses on the following:

  • Improving or maintaining fitness through exercise
  • Helping you to move about
  • Helping you to maintain independence in your daily life
  • Helping to prevent or manage falls
  • Maintaining or improving effective breathing
  • Providing pain relief
In the early Parkinson’s disease stages, your physio can give you advice, education and support in keeping up your fitness levels and good posture to help you remain independent. As the condition gets worse, your physio may focus on your walking, posture and balance.

Parkinson's Disease

Is physiotherapy good for Parkinson’s?

Yes, according to the study done by Parkinson Outcome Project that the person who suffers from Parkinson’s and took physiotherapy for at least 2.5 hours in a week experience slower decline in their mobility (activities required for daily living) and Quality of life. Exercises performed during the sessions:

Improve you physically

Help you mentally by reducing your mood swings, fatigue levels, & sleep problems.
There are different types of pain which could be associated with Parkinson’s, including:

  • pain in the muscles and bones (musculoskeletal),
  • involuntary muscle spasms (dystonic),
  • primary or central pain nerve pain (neuropathic) and
  • restlessness, or being unable to keep still (akathisia-related pain).
A physiotherapist can assess the pain and can then use methods such as manual therapy, heat, or cold, ultrasound to help relieve pain you may have.

What is Parkinson’s Disease?

Parkinson’s disease is caused by the deterioration of nerve cells in an area of brain known as the ‘substantia nigra‘. When functioning normally, the nerve cells produce a chemical known as dopamine which serves as a chemical messenger allowing communication between the substantia nigra and another area of the brain called the corpus striatum. This communication coordinates smooth and balanced muscle movement. A lack of dopamine results in abnormal nerve functioning, causing a loss in the ability to control body movements.

Parkinson’s is a progressive neurological disease which progressively leads to by motor and non-motor problems. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

What is Parkinson’s disease diagnosis?

Diagnosis of Parkinson’s is usually based on clinical examination. People with Parkinson’s might present with falling, loss of confidence and independence and reduced quality of life. Three main symptoms are:

  • bradykinesia (slowness),
  • rigidity (stiffness) and
  • tremor
In the early stages of Parkinson’s disease, your face may show little or no expression, or your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson’s disease symptoms worsen as your condition progresses over time.

What causes Parkinson’s?

Why Parkinson’s disease occurs and how the nerve cells become impaired is not known.

Symptoms of Parkinson’s disease also differ from person to person. The symptoms also change as the disease progresses. Symptoms that one person gets in the early stages of the disease, another person may not get until later-or not at all.

Symptoms typically begin appearing between the ages of 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them.

What benefit can Parkinson’s patient expect with Physiotherapy?

As the diseases progresses, the symptoms can get worse and it can become increasingly difficult for patient to carry out everyday activities. Many people respond well to treatment and only experience mild to moderate disability, whereas few may not respond as well and can, in time, become more severely disabled.

Parkinson’s doesn’t directly cause people to die, but it can make some people more vulnerable to serious and life-threatening infections. However, with advances in treatment, most people with Parkinson’s disease now have a normal or near-normal life expectancy.

Physiotherapy plays an important role in helping the patients manage the symptoms and the benefits to patients include:

  • Improving or maintaining fitness
  • Help in retaining independence
  • Help in movement/function
  • Managing fall risk and balance
  • Pain management
Studies have shown improved flexibility, strength, walking, balance and fitness in patients who participate in a physiotherapy program.

What is the best exercise for Parkinson's disease?
Some of the best exercises for Parkinson’s disease are those that will include:

Stretching of tighten muscles
Strengthening of weakened muscles
Therefore, you could choose from the following options in consultation with your physiotherapist.

  • Pilates
  • Swimming- Best to improve coordination
  • Dancing
  • Aerobics
  • Tai-Chi- A gentle way to fight stress & anxiety, and also helps in increasing balance & flexibility.

What helps Parkinson’s patients walk?

The most obvious changes related to Parkinson's are normally those that affect movement, including walking, falling and freezing. In particular, slowed movement, stiff muscles and changes to posture affect all people living with Parkinson's. Caution needs to be exercised to avoid falls while walking. Following measures are found to be useful to aid walking for parkinsonism.

  • Use a metronome- Metronome is a device that helps person to walk. It provides the beat to indicate that when the step should be taken
  • Count your steps as you walk
  • Rock in place from foot to foot to get moving again if you have become frozen
  • Take large, voluntary marching steps
  • Step over imaginary or laser pointer.
  • To prevent fall, Exercise is only intervention that reduces a person’s risk of falling.
  • Physiotherapists are experts in muscle and movement and therefore best placed to help you learn one of the many techniques for walking based on your specific assessment.

Fun Facts related to Parkinson’s Disease
  • Small handwriting and loss of smell are early signs of Parkinson’s
  • No two persons having parkinsonism have exact symptoms
  • Those affected with Parkinson’s can have good quality of living
  • Exercise can improve your function, even in case pf Parkinson
  • Managing your mood is crucial to your quality of life
  • Early detection may improve future treatment for Parkinson

More about Parkinson’s

It’s thought around 1 in 500 people are affected by Parkinson’s disease. An estimated seven to 10 million people worldwide live with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease.

Most people with Parkinson’s start to develop symptoms when they’re over 50, although around 1 in 20 people with the condition first experience symptoms when they’re under 40 and men are slightly more likely to get Parkinson’s disease than women.

Parkinson’s disease, in particular, can be profoundly frustrating, as walking, talking and even eating become more difficult and time-consuming. Although friends and family can be your best allies, the understanding of people who know what you’re going through can be especially helpful.

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