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Physical Therapy Interventions For Parkinson’s Disease

Medicare And The Therapy Cap Removal

Parkinson Disease: Treatment by a Physical Therapist

Historically, Medicare has limited the amount of physical, occupational and speech therapy a beneficiary could receive in a given year. In some years, Congress created an exceptions process that allowed individuals to access therapy above the cap if the services were deemed medically necessary, but this process needed to be renewed by lawmakers every few years, creating uncertainty and the potential for coverage denials.

The Parkinsons Foundation has worked with the PD community to address Medicare challenges related to services such as physical therapy, occupational therapy and speech-language therapy since 2011, including advocacy in 2014 to remove the Improvement Standard, which meant that people with Parkinsons could no longer be denied coverage for therapy solely for lack of improvement. In February of 2018, this exceptions process was made permanent, meaning people on Medicare can no longer be denied therapy if they need it to manage their health conditions.

What To Expect From Speech

Changes in Voice or Speech: A speech impairment is called a dysarthria. These changes may include having a mono pitch, decreased loudness, variable rate of speech and decreased articulatory precision. Additionally, the vocal quality may be breathy and/or hoarse.

The recognized treatment for this disorder is the Lee Silverman Voice Treatment protocol. This is a four- or eight-week program depending on frequency of visits that targets improving the loudness and clarity of speech by participating in repetitive exercises.

Changes in Swallowing: A swallowing impairment is called dysphagia. Symptoms may include drooling, having a wet or gurgly voice, coughing/throat clearing/choking when eating or drinking, feeling food stuck in the throat, and having a type of pneumonia attributable to swallowing deficits called aspiration pneumonia.

Treatment is focused on improving the strength and speed of movement of the swallowing musculature. A patients diet may also need to be modified to improve safety. The patient will also be trained in swallowing strategies to optimize safety.

Cognitive Impairment: Cognitive impairment is a common non-motor complaint of people with Parkinsons. Changes may be seen in the persons attention, organization, memory, visual spatial skills and language.

Effects Of Physical Exercise On The Treatment Of Parkinsons Disease

Other therapeutic strategies have been evaluated clinically and scientifically in recent years in the search for an action to reduce clinical problems of PD, such as, non-pharmacological interventions like physiotherapy and physical exercise . Rehabilitation through physical therapy has a variety of goals and methods that generally promote benefits in parkinsonian mobility, posture, and balance. However, some limitations have been observed in a consensual way by some researchers in two topics: in relation to the benefits that seem to be more immediate , and the variety and low methodological quality of the studies . Other nonpharmacological approaches to rehabilitation in Parkinson’s disease are the practice of different modalities of physical exercises such as walking, running, strength training, whole body vibration and functional exercises, which are related to the reduction in the risk of falls, decreased motor symptoms, motor performance improvements, balance and gait improvements, positive repercussions in quality of life and executive functions .

Kurtais et al. investigated the effects of six weeks of supervised treadmill walking, three times a week for 40 minutes in patients with mild to moderate PD, and observed significant improvements in lower limb functional parameters such as walking, balance, and agility, and in related parameters, the adaptations promoted by aerobic exercise as increase of peak VO2 and caloric expenditure in METs .

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Occupational Therapy Modifications For People With Parkinsons

Along with physical exercises, occupational therapists often recommend modifications to help people living with PD maintain function and continue participating in daily activities. Modifications may include:1

  • Changing the nature, time, and duration of an activity
  • Simplifying activities by breaking complex actions into simple tasks
  • Arranging items to reduce situations that involve time pressure, like moving the telephone to an accessible location

How To Find Your Expert Physical Therapist For Parkinsons Disease

Parkinsons Disease Physical Therapy Assessment

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.

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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.

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
  • Treating pain

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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Occupational Therapy For Parkinsons

When you have Parkinsons disease, limited mobility can make simple tasks like getting dressed or taking a shower much harder. Occupational therapists teach you the skills you need for daily life whether youre at home, work, or out with friends.

A therapist will evaluate your home, office , and daily routine to pinpoint areas where you could use help. Some things an occupational therapist can teach you include:

  • how to use a walker, cane, and other walking aids if you need them
  • how to keep your balance when you walk
  • tips to stay focused when you walk to avoid falls
  • easier ways to get in and out of bed, and out of the shower or tub, without falling
  • tricks to get dressed, bathe, and do other self-care tasks with the help of grabbers and other assistive devices
  • tips to make daily activities such as cooking, eating, and housecleaning easier

An occupational therapist can also recommend useful changes to your home. These changes will make your home safer. Examples of these changes include:

  • a roll-in bathtub if you use a wheelchair
  • lower counters

Get Your Parkinsons Plan Of Attack

Physical Therapy and Parkinson’s Disease

If youre looking for help in getting your daily Parkinsons exercise program off the ground, you can get your Parkinsons Plan of Attack Foundations Checklist here. Designed to help you wake up each day confident and excited to take control of your Parkinsons and live well, the checklist will remind you of the actions you can take each day to live with greater health, energy and joy.

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Physical Exercise For Parkinsons Disease: Clinical And Experimental Evidence

1Institute of Psichiatry, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil

2Castelo Branco University, Rio de Janeiro, Brazil

1Institute of Psichiatry, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil

3Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program – Salgado de Oliveira University, Niterói, Brazil

4Physical Education Department, Faculty of Unidas de Campinas , Goiânia, GO, Brazil

5Politechnique Institute of Porto, Healthy School, Porto, Portugal

8Intercontinental Neuroscience Research Group, Yucatán, Mexico

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.

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Management Of Musculoskeletal Sequelae

Schenkman and Butler were among the first investigators to propose that physical therapy interventions targeting sequelae such as weakness, loss of range, and reduced aerobic capacity could assist some people with PD to improved balance, gait, and function. This concept recognizes that people with PD can develop sequelae to the disorder that might contribute substantially to their difficulty with activities and participation in societal roles. By using physical therapy interventions to reduce the sequelae, it should be possible to improve function despite the primary central nervous system disorder affecting the basal ganglia. Schenkman and colleagues have conducted a number of laboratory experiments designed to test whether improved flexibility, muscle strength , and cardiovascular condition can improve task performance, including gait, postural control, and overall function. Not all of these studies focused on gait specifically. We contend that the findings are of importance because these factors are intimately related to gait. Studies are under way to measure outcomes of gait more specifically.

Whichever approach to exercise is used, to sustain benefits, individuals should continue exercising at least a few times per week as part of their daily routine. They should be reassessed by a physical therapist at least annually in the early stages of the disease and more often in later stages of the disease to progress their exercise program.

Physical Therapy For Parkinsons

Parkinsons Disease Physical Therapy Interventions

Physical therapy is a program that helps you build strength, flexibility, balance, and coordination. It starts with an evaluation of your current abilities to locate the areas of movement causing you problems.

The therapist will teach you exercises and other techniques to improve your strength, coordination, balance, and movement. During physical therapy sessions, you might learn to:

  • get in and out of bed or a chair more easily
  • stretch your muscles to improve your range of motion
  • avoid a fall
  • walk more smoothly, without shuffling
  • go up and down stairs
  • use a cane or a walker to help you get around

To get the most out of your physical therapy sessions, find a therapist with experience treating Parkinsons or similar disorders. Therapists who are board-certified neurologic specialists should have this type of training. Ask your neurologist to recommend someone.

Certain types of physical therapy can help with movement issues caused by Parkinsons disease. Here are a few of them.

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What Can Be Advised Based On The Results Of This Systematic Review

Findings from the systematic review demonstrated that people with PD achieve greater short-term improvements in gait and balance with physical therapy intervention than with placebo or no physical therapy intervention. Because PD is a progressive condition, short-term benefits are important, but true benefits may be realized only if the patient develops the skills and strategies for long-term adherence to appropriate exercise and activity. Furthermore, the results were obtained with a range of intervention approaches, including general physical therapy, exercise, cuing, treadmill, dance, and martial arts. Hence, clinicians can consider any of a range of intervention approaches when working with people with PD, especially in the early and middle stages of PD, and can take into account people’s preferences. This finding is important given that people with PD likely need to develop long-term exercise habits to sustain benefits. People are most likely to adhere to an exercise regimen if they are doing something they enjoy. Furthermore, some people may be more likely to develop sustained exercise habits if they can vary their approach. At the same time, clinicians are cautioned to consider the impairments that are most limiting to their patients when deciding which intervention approaches to use.

Music Therapy Interventions In Parkinsons Disease: The State

  • Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

Parkinsons disease is a neurological disorder involving the progressive degeneration of the dopaminergic system, which gives rise to movement-related dysfunctions as well as other symptoms, mainly of cognitive and psychological nature. In the latter case, mood disorders prevails frequently causing anxiety and depression in all phases of the disease, sometimes even before the motor symptoms occur.

Aarsland and colleagues report that 35% of the patients affected by PD present depression, whereas Richard states that anxiety is to be found in 40% of the cases.

The literature shows that playing and listening to music may modulate emotions, behaviors, movements, communication, and cognitive factors, modifying the activity of the brain areas involved in the perception and regulation of these aspects .

Music can produce substantial effects on movement-related symptoms as well as psychological ones in PD treatment. Concerning the first aspect, rhythm has a crucial role in rehabilitation, enhancing connections between the motor and auditory systems .

Literature showed how a rhythmic auditory cues-based training can produce a compensation of the cerebello-thalamo-cortical network leading to beneficial effects, for example, improving not only speed and step length but also perceptual and motor timing abilities .

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Can You Apply The Results Of The Systematic Review To Your Own Patients

On the basis of the patient-intervention-comparison-outcome analysis, the results of the Cochrane review can be applied to patients such as Mr Jennings. Clinicians should, however, consider several limitations of the data. First, the outcomes were related to gait and balance but not to overall functional ability. This fact is important because improvements in gait do not necessarily lead to improvements in basic activities of daily living, such as dressing and hygiene, or overall household activities, such as cooking, cleaning, and managing laundry. Second, only short-term outcomes were examined. Parkinson disease is a progressive condition, and although short-term benefits are important, true benefits may be realized only if the patient develops the skills and strategies for long-term adherence to appropriate exercise and activity. Data regarding the best strategies for assisting patients in developing appropriate activity and long-term exercise habits are needed.

Furthermore, evidence is not yet available to determine the best intervention strategies on the basis of subgroups of PD or H& Y stages of PD. Finally, many patients have substantial comorbid conditions that should be taken into account in the design of a plan of care, both because of safety implications and because they can contribute to deficits in movement and function.

What This Study Adds

Parkinsons Disease Thinking Changes: Engaging Physical Therapy
  • A variety of physiotherapy methods currently exist for treating Parkinsons disease

  • Physiotherapy could provide clinically meaningful benefits in the short term for patients, although many relevant trials have been of low methodological quality, small size, and short duration. Indirect comparisons indicate little difference in treatment effect between interventions

  • It is uncertain whether physiotherapy is beneficial in the longer term, and if so, which type of physiotherapy is best to deliver

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Physical Therapy Guide To Parkinson Disease

Read Time:

Parkinson disease is the second most common degenerative brain disorder affecting adults. People of all ethnic groups can develop PD, but it occurs less among African American and Asian populations. Parkinson disease was first defined as only a “motor” disease, but research has shown that it also causes nonmotor symptoms in other systems of the body. People with PD are at risk of falling and sustaining other injuries due to their movement and balance challenges. Treatment includes a combination of medication and physical therapyand in some cases surgery. Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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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Illustrations Of Physiotherapy Interventions In Parkinsons Disease


This paper is divided into two parts. The first part contains illustrations of physiotherapy interventions according to the evidence-based Clinical Practice Guidelines for Physical Therapy in Patients with Parkinsons Disease developed by the Royal Dutch Society for Physical Therapy 1 and endorsed by the Association of Physiotherapists in Parkinsons Disease Europe.2 The second part concerns the new catalogue of coping strategies discovered by patients and collected, compiled and disseminated by the European Parkinsons Disease Association .3

Physiotherapy with a special interest in PD is quite a recent development: Professor Robert Iansek and his group from Australia have pioneered this field. The KNGF guidelines were developed according to the best available evidence at the time. They were published in English in 2006.4 They were the first guidelines to be written according to the international criteria of guideline development.5,6

Physiotherapy for Parkinsons Disease Physiotherapy aims at improving activities of daily living by maximising functional ability and minimising secondary complications, based on an understanding of basal ganglia function and encouraging the persons participation in society.7 The core areas of physiotherapy practice are:

  • physical capacity and prevention of inactivity
  • gait
  • reaching and grasping and
  • balance and falls.

Figure 1: Disease Stages According to Hoehn and Yahr ScaleFigure 3: Freezing at the Doorway

Late Phase

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