Millions of people are affected by Parkinson’s worldwide. Parkinson's Disease (PD) is a neurodegenerative condition characterized by a group of disorders that manifest as tremors, disturbances in voluntary movement, impairment in balance, and automatic responses. Some of the other less commonly associated features are loss of smell, sleep dysfunction, rapid changes in mood, excessive salivation, and constipation. This condition is often seen in individuals in their later stages of life. It is important to mention that currently Parkinson’s has no cure and is progressive.

So what would happen if there happens to be a dopamine deficiency?

It is simple, the nerve cells in the substantia nigra fire out of control making it hard for the individual to direct and/ or control their movements. This chain of events taking place cause the symptoms we mentioned earlier. The more the degeneration of the areas of the brain and nervous system, the increase in the movement disorder.

Management of Parkinson’s with Physiotherapy

Due to the progressive nature of the condition, physical therapy is a must for the management of Parkinson’s starting from the acute stages of the condition itself. During the therapy sessions, the prime goal of any Therapist is to maintain and improve functional performance in everyday life.

To obtain this goal the Therapist would mainly target key areas, the focus on these areas would change depending on the client for a more personalized approach. These areas are:

● Maintaining the flexibility of the musculoskeletal system

● Balance training

● Coordination

● Breathing

● Functional re-education or training

● Improving physical fitness

● Improvement in psychological wellbeing

Maintaining the flexibility of the musculoskeletal system

Flexibility is mainly maintained by encouraging a healthy and active lifestyle. The increase in the stretchability in a muscle also provides an increased range of motion to the joints. The range of motion differs in each joint and it is important to maintain these ranges for daily tasks.

Considering the prognosis of the condition, not all patients would be able to do this on their own. In this case, a Therapist might consider passively (the action is done by the Therapist, as the patient does not have the ability or struggles to do the action) stretching the key muscle groups 2-3 times a day. This is vital as individuals in the later stage of the condition would adapt to a more flexed posture. If the posture is severely flexed the Therapist may also recommend the use of a brace to assist in normalizing the posture. Likewise, active stretches would be taught by a Therapist to those who can perform the actions. Stretches such as standing with the arms above the head, against a wall or the corner of a room are advisable as they stretch the whole body well.

Apart from this, the Physio would promote maintaining the joint range of motion by performing active exercises. Calisthenics, a type of exercise that only requires your body’s weight, is on top of this list of active exercises. Once again, targeting that flexed posture common in PD, exercises can be tailored to be done whilst laying down facing up, seated, or when standing.

Balance Training

Falls happen when we lose our balance. Now how does this happen?

Simply, this is due to our line of gravity moving away from the base of support. So, for a Therapist to train an individual who already has poor balance, gradual steps must be taken from the patient’s current ability. For some balance, training may start in a seated posture. For example, the Therapist would attempt to gently throw his or her balance off by pushing them in a certain direction. This is done so that the body can get used to the sensation and react faster in an actual situation to regain its balance. As the patient does not move, this is known as static balance training.

Dynamic balance, on the other hand, would be taught to patients who have a decent sense of balance. Besides, exercises would be more progressive compared to static balance training. Some of the common exercises that would be taught by a Therapist to a patient would include weight shifting and reaching out exercises, sometimes combined with rotational movements to enhance the difficulty and train the sense of balance better.

Coordination exercises

A standard way of training coordination is to implement the use of Frenkel exercises. The Frenkel exercises are a set of exercises that range in difficulty and are used to bring back rhythmic, smooth, and coordinated movements. These exercises are very beneficial for PD patients as it is also based on the principles of concentration, repetition, and precision. Some examples of these exercises are:

● A straight leg raise, laying down

● Bending one leg whilst straightening out the other

● The heel of one leg to the opposite shin

● Bringing the hand up and touching the nose

● Taping the hands on the thighs whilst alternating the palm and the back of the hand hitting the thigh

Breathing

Breathing although an everyday task can become quite difficult to do. Sometimes patients may feel short of breath, unable to take a deep breath, or generally feel fatigued, particularly after activity. To help feel refreshed and experience unhindered breathing, your Therapist would bring diaphragmatic and segmental breathing into your sessions. In simpler terms, exercises like balloon blowing, blowing into a paper bag and spirometry would be taught to you.

Functional Reeducation or Training

A good Physiotherapist would push for patients to regain their independence as much as possible in a circumstance, this is done through functional training. Functional training refers to task-oriented training. It is all about the patient and what they require to complete their daily tasks. Therapists may have you clap your hands, pick up a spoon, turn in bed, walk a straight line, and pick up objects repeatedly. They would also assist by carefully providing visual (marking the floor where the foot should be placed) and auditory cues (“bend your knees, lean forward, and stand”). Tasks like this may be repeated daily over several months. This type of training helps symptoms such as freezing be managed by the individual.

Improving Physical Fitness and Psychological Well-being

Physical fitness would be gained through conditioning of the heart and lungs. This can be done by riding a bike, swimming, and calisthenics as mentioned previously.

Once the patient can lead a relatively active life, he or she would feel more confident in their ability. It is an important goal for a Therapist to assist as independence would reduce the likelihood of depression caused by dependency. A Therapist would constantly assist patients, making them feel reassured without the promise of false assurance. If the patient appears psychologically affected, the Therapist would also aid in the referral to the relevant healthcare professional promoting holistic care.

Likewise, what a Physiotherapist can do for individuals diagnosed with PD is immense and beneficial. A good relationship must be made between the Therapist and the patient for optimal recovery.

References:

Parkinson's. (2020, May 5). Physiopedia, . Retrieved 07:59, November 7, 2020 from https://www.physio-pedia.com/index.php?title=Parkinson%27s&oldid=236797.

Parkinson's - Physiotherapy Management and Interventions. (2020, October 24). Physiopedia, . Retrieved November 3, 2020 from https://www.physio-pedia.com/index.php?title=Parkinson%27s_-_Physiotherapy_Management_and_Interventions&oldid=257166.

Physical Therapy for Parkinson’s Disease. (2020). Retrieved 3 November 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/physical-therapy-for-parkinsons-disease

Mandal, D. (2020). Parkinson's Disease Pathophysiology. Retrieved 3 November 2020, from https://www.news-medical.net/health/Parkinsons-Disease-Pathophysiology.aspx#:~:text=Parkinson's%20disease%20is%20primarily%20associated,the%20brain%20to%20coordinate%20activity.

Samuel., R. (2006). Physiotherapy in Neuro-conditions (pp. 99-123). New Delhi: Jaypee Brothers Medical Publisher (P) Ltd.