Tuesday, March 28, 2023

Does Physical Therapy Help Parkinson’s Disease

Choose Activities You Enjoy

Physical Therapy Students Treat Parkinsons Disease

Make sure you choose exercises that are fun and challenging but not too difficult. For example, if you enjoy walking in nature, make that part of your exercise routine. It is important to enjoy appointments with your physical therapist, too. If your physical therapy program is not working for you, talk with your physical therapist so they can change your routine.

If you choose activities you like, you are more likely to stick to your plan and reach your goals.

Pathophysiology Of Parkinsons Disease

The progressive death of dopaminergic neurons in the Substantia Nigra pars compacta located in the midbrain, more precisely in the Basal Ganglia , promotes a significant decrease in the levels of the neurotransmitter dopamine, and as a consequence the functional impairment of the neural circuits . The chronic reduction in dopamine levels gives rise to the manifestation of the motor symptoms that characterize this disease. However, the pathophysiology of PD is not limited to the dopaminergic system, that is, neuronal degeneration of other areas of the brain such as the brainstem and cortex competes and even precedes neuronal death in BG. Thus, other neurotransmitter systems are compromised, thus making PD a multisystemic pathology manifested by a series of motor and non-motor symptoms .

Examples of experimental tests showing a high and a low data dispersion.

The cardinal motor signs of PD are: resting tremor, plastic-type muscular rigidity, bradykinesia , and postural instability. This set of symptoms associated or not, forges characteristic clinical signs in patients with the disease such as gait and balance disorders, mask facies and dysarthria. In addition to these symptoms, a set of sensory autonomic and cognitive-behavioral symptoms may manifest during the course of the disease .

How Can Occupational Therapy Help

OT intervention can assist the individual to function optimally in their activities of daily living and facilitate their engagement in occupations most meaningful to them. Four main areas targeted by OT intervention are:

  • Activities of daily living: teaching the use of adaptive techniques and tools to reduce the impact of tremors, and provide strategies to assist with managing medication routines. This may also include gait and balance-based activities
  • Sensorimotor: facilitating joint movement, maintaining range of motion and preventing contractures through impacted joints, and improving motor planning and task execution
  • Psychosocial: providing group-based interventions to enhance overall functioning and social participation in a supportive environment, providing education in self-management skills , promoting engagement in productive activities and leisure, exploring and discussing roles within the family and home unit, and providing education to individuals, families, and carers
  • Environment: assessing for and implementing appropriate assistive technologies and home modifications to enhance safety and accessibility within the home and community, assisting clients, families and caregivers to explore the community for support groups and resources
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Make It To Your Appointments

The number of physical therapy appointments you need depends on your condition and goals. Generally, your first appointment will include an evaluation and exercise recommendations. In following appointments, your physical therapist will check your progress and add or modify exercises according to your needs. Make sure you attend all of your appointments to stay on track.

Do Your Part Outside Of Therapy

Occupational Therapy Exercises For Parkinsons Disease

It is vital to practice the exercises you learn in physical therapy at home. Doing exercises at home will help you reap the most benefits from physical therapy and keep you strong. Your physical therapist will show you activities that are safe for you to do outside of therapy sessions.

In addition to doing planned exercises, consider ways to increase general physical activity. For example, doing housework, gardening or walking around a store are ways to increase physical activity every day.

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What Type Of Physiotherapist Should I See

Any physiotherapist you see should ideally specialise in Parkinsons.

Like many other healthcare professionals, physiotherapists specialise in different areas of practice. Some work specifically with people with neurological conditions like Parkinsons, and some have additional qualifications in exercise and fitness training, especially those working in gym settings.

Your physiotherapist will assess how Parkinsons affects your movement, whether youre newly diagnosed, or youve had the condition for some time. This means they can help to keep up your fitness levels, and maintain good posture and balance as your condition progresses. This will help you remain independent.

You may feel that your mobility is very good and that you are keeping active without any problems. But a physiotherapist can also help you maintain your mobility to help avoid any future issues.

Your physiotherapist should form part of your support network, involving your family and carers, in helping you manage your Parkinsons.

Seeing a physiotherapist can have a number of benefits for people with Parkinsons and their carers. These are outlined below.

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Walking Around The Grocery Store

One of the most challenging Parkinsons symptoms is the . This is called dual-tasking and, as you know, daily life requires dual-tasking constantly!

Walking around the grocery store searching for the ketchup aisle and avoiding fast-moving carts and people moving in all directions can trigger gait dysfunction, freezing and anxiety.

Fortunately, this is a skill that can improve with training. A Parkinsons physical therapist can identify exactly which exercise strategies would benefit you and your specific situation and challenge you accordingly without putting you at risk for falling or injury.

Motor Function Improvements From Exercise

Parkinson’s Disease Exercises: LSVT BIG Movements

Other exercise modalities have also been shown to improve specific motor functions in patients with PD. Cycling for 3 months improved gait in sedentary patients with PD.19,20 Forced exercise of the lower extremities during tandem cycling resulted in improvements both in global and fine motor function.21 Progressive resistance exercise training consisting of weight-bearing exercises 2 times per week for 24 months showed that long-term supervised exercise improved bradykinesia, overall motor scores, and general functional performance in patients with PD at a 24-month follow-up.22 A comparison of tai chi to stretching or strength training 2 times per week for 3 months demonstrated that tai chi reduced the incidence of falls. Compared to stretching, tai chi also improved UPDRS scores at 6-month follow-up .16 Various exercise modalities improve motor symptoms or delay worsening of symptoms in PD, and there is no clear single method that is superior.

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Promoting Physical Activity And Preventing Falls

Because PD is a chronic progressive disorder, it is probable that sustained exercise is necessary to maintain benefits. Indeed, follow-up data from a number of human exercise interventions have demonstrated a gradual return to baseline abilities after the supervised intervention is finished.7,25,38

Because weekly intervention with a physical therapist, throughout the entire course of PD, is neither realistic nor desirable, patients need to take responsibility for their physical activity and exercises. Methods have been developed, based on theories of behavior, for improving exercise habits. Strategies include exploration of the patients beliefs about exercise and barriers to regular exercise and discussing the possibility of looking at things differently to change beliefs and overcome barriers.4345 Together, the clinician and patient then establish reasonable goals that the patient thinks are attainable they build on those goals as exercise habits improve. Regular follow-up appointments also are important to monitor progression and provide support to the patient.

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Putting On Your Jacket

Getting dressed takes a lot of flexibility, balance and coordination. You have to be able to twist and reach into that jacket or shirt hole. You need some serious balance to lift one foot up to put inside a pant leg without having to sit on the edge of the bed. Exercise, in combination with smart clothing strategies, can save you a lot of time and frustration every day.

If youre struggling with getting clothes on your body, your Parkinsons physical therapist can help break down the movement into various exercises so you can get back to doing more on your own. If you struggle with the buttons, zippers and laces, make sure to include an occupational therapist in your treatment program and practice your hand exercises regularly.

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Pedaling For Parkinsons Viewed Favorably By Patients In Study

Despite disease-relevant treatments, Parkinsons patients experience declines in physical functioning and their capacity to participate in daily activities as their disease progresses.

Adding physical therapy to medication regimens is a common approach to help slow these declines. Physical therapy can encompass a range of activities, with most programs involving Parkinsons-relevant exercises to build muscle strength, improve balance, and restore or retain a more normal posture and gait, all with the goal of improving or maintaining functional abilities.

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The Basic Elements Of Exercising With Parkinsons

Why do physical therapy when living with Parkinsons?

There are four core elements of exercise that are important for people with PD:

  • Aerobic e.g. brisk walking, stationary cycling activities that get the heart pumping
  • Strengthening e.g. using weights or resistance bands to improve muscle strength
  • Balance e.g. tai chi, dance to help you be more steady on your feet
  • Stretching e.g. mat exercises, yoga to provide flexibility
  • Including all four of these elements in your exercise regimen is ideal .

    Aerobic activity or high-intensity exercise may be particularly important for Parkinsons and general health

    High-intensity exercise has been formally studied in PD with impressive results. The Study in Parkinson Disease of Exercise Phase 2 enrolled 128 people with early PD, who were not yet on dopaminergic medication into three groups:

    • a high-intensity treadmill exercise group, in which people exercised at 80-85% of their maximum heart rate
    • a moderate-intensity treadmill exercise group, in which people exercised at 60-65% of their maximum heart rate
    • a wait-list control group

    After six months, the high-intensity group had essentially no change in their motor scores, whereas the control group had a three-point worsening of their motor scores.

    Currently, the SPARX3 trial is enrolling participants and underway. This trial is similar to SPARX2, but with a goal of studying many more participants.

    Forced exercise

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    How Does Parkinsons Affect Movement

    Now you know more about what physical therapy can look like for Parkinsons patients. Physical therapy can use a lot of energy, and fatigue can be a barrier for some patients to stick with their therapy. But each therapist will find the balance of not exhausting the patient but also accomplishing enough during each session to make a difference. Parkinsons can affect movement in many different ways, but when a therapist can develop an individualized plan for you or your loved one to improve, it can make a world of difference in their quality of life.

    We work with our Parkinsons patients at EW Motion Therapy to make improvements where we can, while also providing education and working together to improve daily functional movement. If you are interested in our neurological therapies for Parkinsons disease, fill out the Request an Appointment form on our website, and someone from our staff will contact you within 48 hours with your next steps.

    How Occupational Therapy Helps Parkinsons

    Parkinsons disease is a degenerative disorder of the brain that impairs nerve cells that control movement. This leads to symptoms like shaking, stiffness and difficulty with walking and talking, that gradually worsen over time. Approximately 60,000 Americans are diagnosed with Parkinsons each year, with men being 1.5 times more likely to have the disease than women.

    Healthy Outlook spoke with occupational therapist Lorinda Hagstrom from Overlakes Outpatient Rehabilitation Services to learn more about this treatment.

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    How To Find Your Expert Physical Therapist For Parkinsons Disease

    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.

    The Parkinsons Foundation Helpline at 1-800-4PD-INFO can help you locate an experienced physical therapist near you who is trained to work with people with PD, and provide questions to ask a potential physical therapist to assess their experience.

    Some Of The Signs And Symptoms Include:

    Neuroplasticity, Exercise, and Parkinson’s
    • Tremor in the hands, extremities , head, and jaw.
    • Slowed movement As Parkinsons disease progresses, all movements begin to slow down. With walking, speed will decrease, and step length will
    • shorten. Getting out of a chair and performing tasks of daily living will be harder due to slowed movements.
    • Rigid muscles stiffness can occur in the muscles of the extremities and trunk. The stiffness can cause pain and limit the range of motion in the joints.
    • Poor posture and balance One of the signs of Parkinsons disease is a stooped forward head and shoulders posture. This can cause impaired balance and coordination which can lead to an increase in falls.
    • Loss of automatic movements movements that once were done without thinking become movements that require increased thought. Some of these automatic movements include smiling, blinking, and using your arms when you walk.
    • Speech changes voice changes occur as Parkinsons disease progresses. The voice becomes softer, and often speech becomes slurred. Inflection changes also occur with disease progression, with the person becoming more monotone over time.
    • Writing changes It becomes harder to write as the disease progresses with handwriting getting smaller and less legible.

    It is important to see a medical professional if you notice any of the signs and symptoms listed above. It is not only important for diagnosis but also to rule out other medical problems.

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    Forced Exercise In Parkinsons

    An important study in 2009 by researchers at the Cleveland Clinic compared two types of exercise groups: forced exercise and voluntary exercise. Forced exercise is different than voluntary exercise in that forced exercise involves a slower, more consistent pace for a longer duration whereas voluntary exercise involves a rapid pace and shorter duration. The study showed that forced exercise elicits improvements in motor function in Parkinsons disease patients. Forced exercise can be done on a tandem bike, using an able-bodied person as a pace-setter, pedaling at 80-90 revolutions per minute . Using forced exercise, patients can work up to 30% harder than they would work on their own.

    The forced exercise groups showed a 35% improvement in motor function scores, including improvements in upper-extremity dexterity after 8 weeks of training. This effect was not noted in the group that participated in the voluntary exercise. Both groups had improvements in their aerobic fitness, as both worked at 60-80% of their heart rate max. Both groups also showed similar or improved levels of rigidity and bradykinesia after exercise. These positive changes lasted for about four weeks.

    How Is Constipation An Early Warning Sign Of Parkinsons Its Such A Common Problem

    A: Its not as specific as other prodromal symptoms, like anosmia. The rate at which people with chronic and unexplained problems with constipation develop Parkinsons disease is not as easy to pin down. But if someone has unexplained, persistent constipation, it should at least be noted, as it could be considered prodromal.

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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.


    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.

    Who Is Lisa Warren

    Reducing Your Risk of Falling With Parkinsons Disease

    Lisa Warren graduated from the University of Texas Medical Branch with a B.S. in occupational therapy. She received a Masters of Health Science from the University of Florida. She has more than 30 years of experience as an occupational therapist. Lisa is the rehabilitation site manager for the UF Health Norman Fixel Institute for Neurological Diseases. She has been a member of this team since 2010. This rehab clinic provides occupational therapy, physical therapy and speech therapy evaluations and treatment for persons with neurological disorders. Lisa has lectured healthcare providers locally, nationally and internationally on therapy for Parkinsons Disease, Huntingtons Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups, teaches therapy students and provides community workshops.

    Lisa has lectured locally and nationally on therapy for Parkinsons Disease, Huntingtons Disease, dystonia, essential tremor and other neurological disorders. She frequently speaks to support groups and at community workshops. She has established a quarterly meeting of therapists across the US and Canada for information sharing on the treatment of patients with neurological disorders. She is considered a world expert on OT for Parkinsons disease.

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