Physical Therapy Strategies For Parkinsons Disease
PT can improve daily functioning for people living with PD by:4
- Improving gait, or the way a person walks
- Improving transfers, like going from stillness to activity
- Improving balance
- Strengthening joints and muscles to improve physical capacity
One of the ways physical therapists help improve gait is through the use of cues. Cues are stimuli from the environment or generated by the person that they can use to facilitate repetitive movements, like walking. Cues can be:4
- Auditory, like using a metronome or music
- Visual, such as stepping over stripes on the floor
- Tactile, like tapping on the hip or leg
- Cognitive, like using a mental image of the length of a step
When And Why To Find An Occupational Therapist
Our occupational therapists can be helpful at all stages of PD. You may be interested in seeing an occupational therapist if you have experienced any changes in the ability to take care of yourself or fulfill any role/routines which are important to you.
Here are some reasons to find an OT:
- For skilled education and self-management
- To learn about adaptive equipment of medical equipment that can help you stay independent in all daily activities
- home safety/home modification/fall prevention/environmental modification education
- community engagement
- generalized strengthening and intervention for gross motor and fine motor coordination
- cognitive retraining
- family/caregiver training
Treatment will include learning compensatory strategies, modifications and use of adaptive equipment or durable medical equipment to keep you independent and safe in all your daily activities and roles.
Implications Of The Review For Practice And Research
Practice: The authors stated that it was unclear how the significant improvements reported in this review affected strength, balance scores, gait and activities of daily living , as well as the impact on patients’ safety .
Research: The authors stated that future studies should be larger, of higher quality and should differentiate clearly between experimental and control interventions and assess meaningful changes. Studies should aim to improve knowledge and understanding of the therapies and outcomes and their impact on Parkinson’s disease patients, and identify optimal schedules for physical therapy. The cost effects of interventions required investigation. Further studies in very mild, more severe Parkinson’s disease and Parkinson-related disorders were also warranted.
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How Can Occupational Therapy Help People With Parkinsons Disease
Occupational therapists can work with people with Parkinsons Disease and their families to provide advice, support and guidance during their journey. For some they may require advice on a specific item of equipment whilst for other clients we are involved in more substantial home modifications and support as their needs change with the progressing condition. Below are some ways that an occupational therapist can help:
How we can help
We aim to solve the difficulties associated with Parkinsons Disease. Some of the common ones we treat are listed below.
Light Therapy And Parkinsons
NIr therapy works by using infrared illumination to treat brain tissue affected by a lack of oxygen, toxic environments, and mitochondrial dysfunction. Mitochondria help to produce energy in cells and play a role in regulating cell function when working properly. NIr attempts to reduce cell damage and death by protecting the dopamine-producing neurons.2 NIr has been shown to reduce tissue inflammation and improve mitochondrial function.
It is not a targeted therapy because it works on the neural symptoms of many conditions by reducing the neurodegenerative process. Light therapy targets the brain and therefore it is likely to impact multiple facets of neural functioning. Studies have yielded results that show improvement in cognitive, emotional, and executive function.
Photobiomodulation is the ability of light to modulate biological processes at a cellular level.4 The use of controlled exposure of red to infrared wavelengths of light have successfully improved healing, reduced inflammation and pain. It has done this by improving mitochondrial function and stimulating antioxidant pathways in the brain. Photobiomodualtion has been therapeutically effective to improve the recovery rate for other medical conditions, and has shown promise in the lab for people and animals with PD.
Strategic use of specific light applied at a targeted time of day for a specific length of time should be able to attack melatonin, and reduce it, thus restoring dopamine balance.5
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Search Strategy And Selection Criteria
A systematic search of the literature to the end of January 2012 was undertaken using a highly sensitive search strategy as recommended by the Cochrane Collaboration. We combined text and, where appropriate, Medical Subject Heading terms for physiotherapy, physical therapy, exercise, or rehabilitation and Parkinson, Parkinsons disease, or parkinsonism. No language restrictions were applied. We identified relevant trials by electronic searches of general biomedical and science electronic databases , rehabilitation databases English language databases of foreign language research and third world publications conference and grey literature databases , and trial registries . We also hand searched relevant general and specific journals , abstract books, and conference proceedings , as well as examined the reference lists of identified papers and other reviews.
Finding Expert Pd Physical Therapy
It is important to find a physical therapist who has specialty training and experience working with PD. You may find experienced physical therapists working in hospital outpatient departments, home health agencies, nursing homes or within the community close to your home. Ask your neurologist for a referral at your next appointment.
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Training Future Physical Therapists In Parkinsons
Did you know the Parkinsons Foundation is working to better educate physical therapy students across the country to ensure better PD care for everyone?
The Parkinsons Foundation Physical Therapy Faculty Program is improving Parkinsons physical therapy care by training faculty leaders across the U.S. so they can, in turn, educate physical therapy students. The intensive course allows physical therapy educators to immerse themselves in learning the latest evidence-based findings in Parkinsons research and care. Physical therapy educators can make a great impact on the lives of people with PD by bringing this knowledge back to their students, our future practitioners.
Peer Review And Public Commentary
Following the formation of a final draft, the CPG draft was subjected to a 3-week peer review for additional input from external content experts and stakeholders. More than 250 comments from 12 societies were collected via an electronic structured review form. All peer reviewers were required to disclose any potential conflicts of interest, which were recorded and, as necessary, addressed.
After modifying the draft in response to peer review, the CPG was subjected to a 2-week public comment period. Commenters consisted of the APTA Board of Directors , the APTA Scientific and Practice Affairs Committee, all relevant APTA sections and academies, stakeholder organizations, and the physical therapy community at large. More than 47 public comments were received. Revisions to the draft were made in response to relevant comments.
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Ot Encompasses Several Different Areas:
- Activities of Daily Living . These are the basic self care skills of eating, dressing, grooming, bathing, toileting and toilet hygiene and personal care devices .
- Instrumental Activities of Daily Living . These include the care of others, care of pets, financial management, driving and community mobility, health and medication management, meal prep and clean up, religious and spiritual activities, shopping, safety and emergency maintenance, etc.
- Functional Mobility. This includes getting around your home and environment to perform your daily activities, transfers to bed, toilet, bathtub/shower, couch, recliner chair, wheelchair and car, etc.
- Adaptive Equipment. This includes long handle utensils to reach your feet or back, tremor management eating utensils, non skid mats, button hook, lidded cup with straw, scoop dish, adaptive pen, etc.
- Work Activities. This includes work station set-up/ergonomics, adaptive devices to make it easier to perform work tasks .
- Cognition. This includes activities to stimulate cognitive function to maximize performance .
Use Your Personal Strengths
How can you build on your strengths and minimize your limitations? For example, if you have the strength of helping children enjoy reading, you could exercise that strength by reading to your grandchildren, by listening to them as they read, or by playing a reading game that stimulates both your imagination and theirs.
One of your strengths may be thinking skills. One thinking skill is imagining doing the activity before doing it. For example, imagining writing big can actually help you write big. Another thinking skill is speaking the steps out loud. When combing your hair, try saying hold and comb, to avoid dropping the comb.
Make sure you are exercising. Improving strength, balance and endurance through exercise supports your participation in all sorts of activities. Whether it is dancing or walking to a neighbors house, find an enjoyable way to exercise.
Lastly, be positive. Think, I will do rather than Ill try to and you may be more successful.
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Speech And Voice Disorders In Parkinsons
There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered movement system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia and hypokinesia in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system and articulatory system .
Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may have reduced awareness that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as if they are shouting, even though they are perceived by listeners to be speaking normally.
People with PD may also have a problem with cueing themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue , but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and the family.
Health Economic Evidence Statements
The found no significant difference in mean increase in annual costs between groups from the year before the study to the second year of the study. This mean annual cost estimated the provision of nurse care to cost £200 per person per year and excluded the cost of apomorphine. The mean annual cost in the specialist nurse group increased from £4,050 to £5,860 and from £3,480 to £5,630 in the group based on 1,859 people from 438 general practices in nine randomly selected health authority areas of England.
It is not always clear whether care is substituting some or all of the consultant care or is serving as additional care. By varying the cost-savings of other health professional costs by PDNS care, costs for 1 year of PDNS care range from an additional cost of £3,289 to cost-savings of £4,564. Full details of these analyses are shown in .
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When To Find A Physical Therapist
Physical therapists can be helpful at all stages of PD. Movement impairments in the early stages of the disease may not be obvious. Talk to your doctor about getting a baseline physical therapy evaluation and then continue with periodic re-evaluations.
According to the Parkinsons Outcomes Project, the largest clinical study of Parkinsons disease through our Global Care Network, increasing physical activity to at least 2.5 hours a week can slow decline in quality of life. The Parkinsons Foundation has identified specific care approaches associated with better outcomes across people who seek expert care at our designated Centers of Excellence. Among others, best practices include early referral to physical therapy and encouragement of exercise as part of treatment.
Focus Of Pt For Parkinson’s
After collecting information about your current functional abilities and impairments, your physical therapist can start to formulate a treatment plan. Your plan of care will likely involve other healthcare professionals since PD affects so many different body systems. It is also important to include family members or friends in your treatment so that they can provide assistance if needed.
The main focus of your physical therapy should be on maintaining functional mobility and control. Specific strategies to help improve the smoothness of movement may also be necessary to maintain optimal functional mobility.
Since PD can cause many motor planning changes and mobility problems, exercise should be a primary component of treatment. The focus of exercise for PD should be to improve walking and balance, improve strength and range of motion, increase postural awareness and improve breathing and endurance. Be sure to speak with your healthcare provider and physical therapist before starting an exercise program to be sure that it is safe for your specific condition. Your healthcare provider and physical therapist can also work together to help you decide which exercises would be best suited for you.
- Carr, J. H. . Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
- Umphred, D. A. . Neurological rehabilitation. . St. Louis: Mosby.
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What Are The Common Difficulties Associated With Parkinsons Disease
The symptoms of Parkinsons can be categorised under three main headings and below are some of the functional difficulties they may cause.
- Tremors such as a trembling or shaking in the hands. This can affect the ability to write, eat, drink, prepare meals or use door keys
- Slow movement due to muscle stiffness this can mean that carrying out daily tasks such as getting out of bed, on and off the toilet, washing, dressing or using the stairs all become challenging
- Difficulty walking this can mean an increased risk of falling and a decreased ability to carry out daily activities
If you would like to learn more about how we as occupational therapists can help people overcome common difficulties associated with Parkinsons Disease, you will find some useful links at the bottom of this page.
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How Can Physical Therapy Help Parkinsons Disease
Parkinsons disease is a neurological disorder that causes problems with movement and coordination. Physical therapy can offer significant benefits for people living with the condition.
Parkinsons disease is a progressive condition of the central nervous system due to low dopamine levels in the brain.
Symptoms may include slow movement, rigid muscles, freezing episodes, tremors, and unsteady balance.
Physical therapy improves a persons range of movement, prevents further injury or disability, and improves the quality of a persons life.
This article explores the benefits of PT for people with Parkinsons disease. It also provides tips for finding a physical therapist and explains when to contact a doctor.
According to the Parkinsons Outcomes Project, PT can improve the quality of life for people with Parkinsons disease.
Research from indicates that regular PT treatment and exercise can have positive, long lasting outcomes for those with the condition.
Parkinsons UK notes that PT can help people with Parkinsons disease by:
- keeping joints and muscles flexible
- building strength
- improving mobility, movement, and bodily functions
- maintaining daily independence
- maintaining and improving effective breathing
- helping to prevent falls
- managing stress
Also, because PT encompasses self-management patient education, hands-on care, and exercise prescription, the Parkinsons Foundation notes that a physical therapist can:
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Setting Movement Goals With Your Therapist
Every client works with their physical therapist to set individualized movement goals. Physical therapists can help you optimize your exercise routine based on the latest research, re-learn challenging tasks or stay safe and independent in the home. Some of the most common movement goals for people with Parkinsons include:
- Learning about exercises
- Improving walking, balance or posture
- Addressing fall risk
Before your first visit, think about your movement goals and write down your problems and questions. This will help you to organize your thoughts. You can do this for future visits, too.
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What Are The Treatment Options For Parkinsons Disease
When a person suffers from Parkinsons disease, the nerve cells fail to produce enough dopamine to send signals to the brain to control conscious and unconscious actions. The condition gets progressively worse over time.
However, there are means through which one could reduce the impact of this condition to a certain extent. Such treatment options include medication, surgery, and physical therapy.
Medication
As the symptoms such as tremors, muscle stiffness, and walking issues start to appear, doctors may prescribe certain commonly regarded medications such as Levodopa, MAO B Inhibitors, Dopamine Agonists and Antivirals.
These medicines are, however, more useful at the initial stages of the disease. After time elapses, these medications start to lose the effectiveness they had at earlier stages.
The prescription and dosage depend on the severity of the condition.
Surgical Procedures
In the case of Parkinsons disease, a surgical procedure known as Deep Brain Stimulation has provided patients with good results.
A wire is placed inside of the patients brain and helps the brain more effectively receive electrical signals. If effective, this improves the functioning power of the brain.
Physical Therapy
Physical therapy can help patients deal with the effects of Parkinsons disease. Specially designed exercises such as breathing, stretching, rhythmic, static and dynamic exercises are implemented to relieve some of the pain experienced by the patient.
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Focus Of Pt For Parkinsons
After collecting information about your current functional abilities and impairments, your physical therapist can start to formulate a treatment plan. Your plan of care will likely involve other healthcare professionals since PD affects so many different body systems. It is also important to include family members or friends in your treatment so that they can provide assistance if needed.
The main focus of your physical therapy should be on maintaining functional mobility and control. Specific strategies to help improve the smoothness of movement may also be necessary to maintain optimal functional mobility.
Since PD can cause many motor planning changes and mobility problems, exercise should be a primary component of treatment. The focus of exercise for PD should be to improve walking and balance, improve strength and range of motion, increase postural awareness and improve breathing and endurance. Be sure to speak with your healthcare provider and physical therapist before starting an exercise program to be sure that it is safe for your specific condition. Your healthcare provider and physical therapist can also work together to help you decide which exercises would be best suited for you.
- Carr, J. H. . Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
- Umphred, D. A. . Neurological rehabilitation. . St. Louis: Mosby.