Minimizing the Effects of Parkinson’s Disease

April is Parkinson’s disease (PD) awareness month, so we will be dedicating this week’s PT weekly to Parkinson’s Disease. We have discussed PD before but this article will mostly cover what exactly it is that we as physiotherapists do, and how this helps patients with PD.

Parkinson’s Disease Recap

PD is a progressive neurodegenerative disorder. It causes motor dysfunction with resulting difficulty in activities of daily living such as transfers, postures, balance and gait. This condition frequently leads to decreased independence, inactivity, social isolation and eventually reduced quality of life.

Features of Parkinson disease:

• Presence of abnormal gait pattern.
• Absence or reduced facial expression.
• Decrease control of fine movement such handwriting becoming smaller.
• Voice changes or presence of tremor in the voice.
• Impaired coordination and balance causing people to fall or suddenly drop an item they are holding.
In most people, symptoms usually appear at 60 years and above.
Physiotherapy Interventions
Physiotherapy treatments have been shown to improve the abilities of people with Parkinson’s Disease as an adjunct to drug therapy. The aim of therapy is:
• To maximize functional ability and reduce complications resulting from PD through movement rehabilitation and education.
• Improve mobility, correct postural and abnormal movement.
• Minimise the risk of falls.
• Educate the patient, family member and/or their carer.

The following are some of the rehabilitative programs that have been widely studied and have shown effectiveness in the management of individuals with Parkinson disease.

Exercise

Exercise therapy is one of the most important components of physical therapy in general, and there are a few programs that have been specifically developed for rehabilitative management of PD. For example, BIG exercises are a group of exercises designed to counteract the physical effects of PD that make movements uncoordinated and very small (i.e. talking softly, taking very small shuffling steps). Studies have shown that exercise in general improves both motor and non- motor deficits (behaviour, mood, cognition) related to PD. Even general exercise programs such as treadmill exercises, brisk walking, progressive resistive exercises, group aerobics and endurance training result in improved gait, balance, muscle strength, motor and functional performance among people with PD.
For people with early PD, exercise and physical activity in general is essential in delaying progressive loss of mobility.

Use of Cues

Cueing can be defined as a mechanism of applying a spatial or a temporal stimulus to facilitate initiating or maintaining motor activity. Auditory cueing using music facilitates more complex movements during challenging activities, thus improving postural responses to perturbation, dual-task walking, and muscle strength. Visual cueing presents lines or markers on the floor as targets for foot placement. Markers could be stripes/tapes on the floor, projections from laser pointers, or lights mounted on the user. Cues can facilitate the gait initiation and/or continuation process, by helping individuals with PD to focus on walking and/or shifting their attention back to walking when freezing of gait occurs.

Virtual Reality and Exergaming-Based Rehabilitation

Virtual reality intervention is a computerized simulation which allows the participants to interact in real-time with virtual images and objects through multiple sensory modalities. This training enables the users to perform large amplitude movements and challenging balance and functional activities and receive biofeedback on performance in a motivating but controlled virtual reality environment. This modality has been proven to improve the stride length and balance of people with Parkinson’s disease as well as other neurological disorders such as stroke.

Complimentary Exercises

This includes exercises such as tai-chi, yoga and qigong. These exercises involve the use of body and mind while training. These exercises also tend to be very low-risk for falls and other injuries and are therefore a top choice for older patients or anyone with a high fall risk. Surprisingly, boxing is another such exercise that has recently become a trend for the treatment of the physical manifestations of PD.
Tai-chi is characterised by a slow, circular and fluid movement pattern. TC is a common complementary exercise performed by PD participants possibly due to its relatively gentle movements and its well-recognized benefits on health in the elderly. This exercise helps in improving balance, walking, functional mobility and reduces time to rise from a chair.
Yoga and qigong are low-energy exercises performed with sustained movements of limbs and trunk, as well as breathing coordination. Studies have shown significant improvements in the quality of life and balance among individuals with Parkinson Disease.

Dancing

Dance is a sequential movement performed to music. The Argentinian Tango, Irish dancing, the waltz, ballet, etc are some of the most popular forms of training. During the dance practice, PD participants were guided by a healthy partner. Dance also promotes a range of cueing strategies, using auditory cues to promote initiation and execution of movements, and visual cues where an individual coordinates steps with a partner or follows the footsteps of the partner. This helps to increase the step size, and to link up movement sequences. Dancing regularly would lead to improvements in postural control, walking stability and aerobic endurance.

How do We Incorporate this into Physiotherapy?

Physical therapy contributes to the treatment of Parkinson’s disease, playing a preventive role and also maintaining physical fitness and health. Individuals with Parkinson disease are encouraged to sustain their training in order to maintain their physical ability and slow the progression of the condition. In physiotherapy sessions we try to guide the activities our patients do outside of the clinic for maximum benefit and safety. We also incorporate all of the above techniques into exercises that are safe and tailored to each individual at their current level of physical function. At PCA, our physiotherapists can evaluate you or your loved one to determine what program is right for you.