Caregiving and Physiotherapy in Parkinson’s Disease Management

Parkinson’s disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing neurons in a specific area of the brain called substantia nigra. Dopamine levels reduce gradually as we get older but in Parkinson’s disease this happens at a faster rate. It is when 60-80% of the dopamine-producing cells are damaged that the symptoms of PD manifest.
Symptoms generally develop slowly over years, and the progression of these symptoms is often a bit different from one person to another due to the diversity of the disease. Parkinson’s disease is classed as a movement disorder, so the most obvious symptoms are those relating to motor function i.e. movements throughout the body.
1. The most common symptom is an involuntary resting tremor, normally seen in one hand or foot.
2. Bradykinesia (slowed movement) is also typical of Parkinson’s and will affect an individual’s ability to carry out daily activities, such as walking or dressing, at a normal speed (Walking may look like a shuffling or festinating pattern with intermittent episodes of freezing).
3. Rigidity or stiffness of the arms, legs or trunk caused by an increase in muscle tone is a third common symptom which can significantly impact someone’s ability to perform simple tasks such as getting in and out of bed independently.
In the later stages of the disease, postural instability may lead to problems with balance and falls. All of these symptoms decrease the ability to control and coordinate movements required to carry out all activities of daily living (ADLs).
Other symptoms
 Micrographia- small handwriting
 Hypophonia- low, monotonic or muffled speech
 Loss of facial expression
 Mood disturbances (Anxiety/depression)
 Sleep disturbances
 Swallowing difficulties
 Constipation
 Postural hypotension
The cause remains largely unknown, and there is no cure. Treatment options vary and include medications, surgery and rehabilitation. While Parkinson’s itself is not fatal, disease complications can be serious. The Centers for Disease Control and Prevention (CDC) rated complications from PD as the 14th cause of death in the United States.
The management of PD involves a multidisciplinary team approach. While physiotherapy concentrates on the physical manifestations of the disorder, other team players pay attention to how the other symptoms impact lifestyle. For example, a speech therapist can treat a patient who’s symptoms involve difficulty swallowing.
Optimal results can only be achieved through the collaboration of a team of health care professionals with expertise in all domains affected by Parkinson’s, this team includes participation from caregivers, family and friends as well.
 Maintain and improve levels of function and independence
 Improve mobility
 Correct and improve abnormal movement patterns and posture
 Maximize muscle strength and joint flexibility
 Improve coordination and balance to minimize risks of falls
 Maintain a good breathing pattern and effective cough
 Educate the person with Parkinson’s and their carer or family members
 Recommend appropriate devices and equipment as needed and instruct in their use.
 Encourage the effects of drug therapy

A caregiver may be a paid individual or may be the spouse, sibling, child, or other loved one of someone with a chronic and progressive disorder like Parkinson’s disease. Caregiving is defined as everything done to assist a friend/relative/client due to that person’s illness or disability, as well as what is done for a caregiver’s health.
 Preparing for your role as caregiver
The role of care-giving changes as your loved one’s disease progresses. People with late stages of a progressive disease need more assistance with everyday activities than those in the early stage of the disease.
It is very important to learn about the disease and how it progresses to create a plan for care, including what outside assistance you may need and when. While learning about it, remember that each person has their own unique experience, and not everyone experiences the same symptoms.
 Facing challenges
There are a variety of challenges caregivers face, including financial, health, and emotional. The caregiver is often the healthcare advocate for their loved one, managing medications and scheduling and assisting with daily care, like hygiene and getting dressed. In addition, the caregiver provides emotional support for their loved one as they deal with living with a chronic, progressive disease. It is important to note that caregiver’s often deal with a lot of stress as well as risk of physical injuries due to the demands of their role. It is important for a caregiver to be educated in how to keep themselves safe as well, as any injuries they sustain would then limit their ability to continue to provide support for another person.
 The progression of caregiving in chronic and progressive diseases
The role of the caregiver in chronic and progressive diseases (such as Parkinson’s Disease) is ever changing, with the demands increasing as the disease progresses and symptoms worsen. In the early stages of the disease, caregivers help to cope with the diagnosis and learning how to manage the medications. Caregivers may encourage and support their loved one in completing daily physical therapy exercises and assist them due to their disabilities.
As an individual’s disease progresses into mid-stage, and finally to end or terminal stage, the caregiver’s duties and burden significantly increase. Fatigue and excessive daytime sleepiness may derail daily plans, and frustrations around communication increase.
 Care for the caregiver
Research has shown that as disease progresses, the strain on the caregiver also increases. While the caregiver is generally focused on providing assistance and support, the caregiver also needs support. Taking time away from care giving duties, maintaining social connections, and asking for help from others are important steps to help the caregiver cope with their additional responsibilities and stress.

At PCA, we provide world class physiotherapy services, home and elderly care, and training of anyone that serves or work as a carer or caregiver.

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