Physiotherapy in the Management of Parkinson’s

 

Grainne Quilter

Senior Physiotherapist,

Neurology/Gerontology,

Tralee General Hospital, Kerry

 

 

The aim of physiotherapy in Parkinson’s:

 

• Maximise independence and functional potential
• Minimise  secondary complications.

 

The processes:

 

• Assessment
• Treatment
• Education
• Liaising with carers
• Multidisciplinary team approach

 

The symptoms:

 

• Tremor
• Rigidity
• Bradykinesia

 

Bradykinesia in detail:

 

• Slowness in movement
• Difficulty initiating movement
• Lack of spontaneous movement
• Lack of associated movements
• Difficulty with repetitive movements
• Difficulty with two simultaneous movements
• Increased effort and concentration to achieve norm
• Two handed tasks more difficult
• Slowness of speech; difficulty raising voice

 

Main areas of Difficulty:

 

• Posture
• Balance
• Gait
• Fine movements – handwriting, buttons
• Automatic movements – blinking, swallowing, coughing, swinging arms

 

Posture:

 

• Excessive flexion (bending) of neck, trunk, hips, knees;
• Contractures (muscle shortening)
• Reduced rotation – difficulty turning, to sit in chair, tight corners
• Reduced arm swing
• Slumping in chair

 

Balance:

 

• Reduced rotation
• Increased flexion (stooping) leading to decreased balance and falls

 

Gait:

 

• Difficulty initiating walk
• Petit pas (small steps)
• Festination
• Freezing
• Difficulty turning
• Heel-toe gait

 

Home exercise programme:

 

• Lying supine/prone
• Standing back to wall
• General exercises – promoting extension/rotation
• Postural advice – in sitting position
• Breathing exercises
• Relaxation

 

Cues or Prompts:

 

• Verbal
• Visual
• Vestibular/proprioceptive

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Gait management:

 

• Visual clues – step over cracks, cue-cards
• Verbal cues – one/two, heel/toe, metronome, music, rhythm
• Proprioceptive clues – for freezing, heel down, rock backwards/forwards, take step back
• Turn in wide arc, forward

 

General:

 

• Break movement consciously into component parts
• Do one task at a time
• Use cues
• Stay active and involved and keep moving!

 

As time goes on:

 

• Advise family/carer re cues, handling, positioning
• Avail of community physiotherapy in own home
• Avoid the problem of hypomobility
• Encourage independence for as long as possible

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