Physiotherapy and Parkinson’s Disease

Introduction

Parkinson’s disease (PD) is a movement disorder. Symptoms a person may experience include some or all of the following:

– Muscle Stiffness

– Uncontrolled shaking or Tremor

– Slowness of movement

– Fatigue

– Poor Balance

These symptoms may affect performance in daily activities such as turning in bed, getting out of a chair, walking and hand based tasks (i.e. handwriting). It may have a major impact on a person’s work, family and leisure activities. Other problems may arise such as muscle weakness, stooping when walking, discomfort and pain.

What is a Physiotherapist?

Chartered physiotherapists are highly trained professionals who use physical treatments to help patients self-manage a medical condition. Just as doctors train further and specialise in different conditions, so do physiotherapists. Some work specifically with neurological conditions like Parkinson’s disease.

How can Physiotherapy Help a Person with Parkinson’s Disease?

In General, Physiotherapists can help by:

– Providing practical advice on physical management of the condition, including aids and adaptations that may help in the home or at work;

– Providing information on services available in the community, including information on specific support groups

Poor Balance and weak muscles

Physiotherapy can definitely help people with Parkinson’s disease who experience balance issues and muscle weakness. Chartered physiotherapists can provide strengthening exercises to reduce your risk of falls.

If you are at risk of having a fall, have noticed you are not as steady on your feet or are just interested in staying as active as possible a physiotherapists is the right professional to support you.

Stooped or poor posture

Physiotherapists can provide a range of techniques to improve stooped or poor posture. Techniques include stretching and strengthening exercises as well as taping to aid in correcting posture.

Muscle Stiffness

Although physiotherapy is unable to stop muscle stiffness a range of stretching techniques can help to alleviate pain and discomfort from muscle pain and stiffness.

Fatigue

It is unclear if physiotherapists can reduce fatigue in people with Parkinson’s disease however physiotherapists can recommend other support services. Exercise has the potential to alleviate fatigue in people with Parkinson’s disease and your physiotherapists can advise you on this also.

Slowness of movement

Physiotherapy cannot change your episodes of slow movement but will enable you to keep yourself as active as possible for as long as possible with a variety of techniques and exercises to help patients with slow movements

Tremor

Physiotherapy cannot help with any tremor symptoms

When Should I See a Physiotherapist?

Physiotherapists should be seen as soon after your diagnosis as possible. Early assessment allows the physiotherapist to support the patient with current problems and to identify strategies to avoid potential problems. A treatment program can be devised specifically for your needs.

How Long Will I Need to See a Physiotherapist?

This will really depend on your individual condition and the findings upon examination. The physiotherapist may recommend any of the following:

– A course if treatment, on a one to one basis, perhaps on a weekly basis for a period of time

– A tailor made exercise programme where you would carry out these exercises at home with the emphasis being on self-regulation. The physiotherapist may monitor your progress by arranging regular reviews from time to time

– Participation in an exercise group. Usually these address general body movements, flexibility, co-ordination, balance, breathing control and functional activities

– Referral to other services, e.g. consultant, support group, or other health professionals, e.g. speech therapist, occupational therapist

It is often the case that the physiotherapist will recommend one or more of the above, given the nature of PD and the changing needs of the person. It is recommended that your condition and progress are monitored on a regular basis through regular reviews and intervention as required to achieve your optimal functional potential.

What are the Benefits of Exercise?

There are many benefits of exercise. Exercise:

– Could potentially slow down the disease progression of Parkinson’s disease

– Reduces falls

– Reduces stress and anxiety

– Improves balance

– Improves muscle strength

– Provides a sense of achievement and empowerment

– And most importantly, it can be enjoyable

Exercise may promote your level of wellbeing and quality of life and help counteract the effects of the symptoms.

Available exercise

An exercise chart illustrating exercises routinely used as part of a treatment programme for PD is available from the Parkinson’s Association.

Gym exercise and personal trainers

Exercising in a gym or with a personal trainer is an excellent idea for any person with Parkinson’s disease who is able to do so. Always check with your GP or Physiotherapist or Neurologist or Clinical Nurse Specialist before starting a new exercise program.

How much exercise is enough?

3-5 days of exercise per week of between 30-60 minutes is recommended for people with Parkinson’s disease. Physiotherapists are the ideal professional to help you decide what exercise to do and when to meet these guidelines.

Safety in exercising

Always consult your GP and physiotherapist before commencing any new exercise programme to ensure it is suitable for your particular needs.

The Role of Carers in Rehabilitation

Involvement of carers is vital, as they can provide much information relating to problems faced at home. It is also important for carers to look after their own bodies. The physiotherapist can give practical advice on the most effective ways to stretch, and how to assist with movements such as transfers and walking to avoid hurting themselves or the person with PD. They can also advise on equipment that may be needed at home to help carers in their work.

How Can I Access a Physiotherapist?

You can access free community and outpatient public service physiotherapy treatment in Ireland through referral from a GP or Consultant e.g. Neurologist or Geriatrician. You will however have to go on a waiting list. Some neurologists and geriatricians now arrange physiotherapy classes for their patients.

Alternatively, you can refer yourself to a private physiotherapist, preferably one who specialises in the treatment of Neurological conditions. Some physiotherapists will provide private treatment at home as well as in a clinic.

You will have to pay for private treatment, however there is some reimbursement for physiotherapy treatment under private health insurance schemes. You will need to check your individual policy for specific reimbursement entitlements. Tax relief may be obtained on physiotherapy fees (see current revenue guidelines for applicable threshold and rates).

Acknowledgements

This leaflet has been authored by David Hegarty Chartered Physiotherapist

References

Parkinson’s Disease- National clinical guideline for diagnosis and management in primary and secondary care: National Collaboration Centre for Chronic Conditions (funded to produce guidelines for NICE for England and Wales). Published by Royal College of Physicians, 2006.

DISCLAIMER – The information on these pages is not intended to be taken as advice. No changes to your treatment should be made without prior consultation with your doctor or allied health professional.