Upper Limb Function Can Be Improved With Appropriately Prescribed Exercise In People With Pd
Upper limb difficulties are commonly reported by people with PD but only recently have interventions to address these been the focus of research.
Recent trials have shown improvements in handwriting and dexterity following 46 weeks of intensive training in people with PD . There is a clear task-specific training effect of upper limb interventions in people with PD . However, speedaccuracy trade-offs are also apparent .
Physiotherapy to improve upper limb function in people with PD should consider the individuals activity limitations and goals, and prescribe exercise of sufficient intensity, as lower dose exercise appears to have less benefit . Importantly, physiotherapists should pay attention to the speed and accuracy requirements of each prescribed exercise and balance these factors when prescribing upper limb exercise to address the individuals functional limitations. Upper limb training for people with PD may be effectively carried out at home with minimal supervision using basic equipment or incorporating technology such as exergames .
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About the authors
Colleen Canning, APAM, is Emeritus Professor of physiotherapy at the University of Sydney. Her research investigates the contribution of motor and cognitive impairments to disability and falls in Parkinsons disease as well as the effectiveness of interventions designed to reduce disability and falls.
Qualitative Analysis Of The Effect Of Physiotherapy Interventions On Different Outcomes
The effects of postural adjustment, fall prevention strategies, and balance training exercises on near falls and quality of life have been done by a study done in Southampton. The results showed that there was a tendency towards a reduction in fall events and injurious falls .
An RCT conducted in Italy brought that balance training showed significant improvements in declining PI and improving balance in patients with PD .
Another study conducted in the USA showed that Gait and step perturbation training can result in a reduction in falls and improvements in gait and dynamic balance for patients with PD .
According to a RCT conducted in Sweden, a HiBT regimen that incorporated both dual-tasking and PD-specific balance components significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living .
Another comparative RCT done in Germany found that it is effective to use both coordinated resistance and balance training to improve balance and postural control for patients with PD .
A study done in china on the effectiveness of technology-Assisted Balance and Gait training found that the balance and gait training program assisted by technological devices reduced the number of fallers and the fall rate compared with the strength training program. It supported the clinical use of balance and gait training for reducing fall events in people with PD .
Physical Therapy Guide To Parkinson Disease
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.
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Comparison Of Different Physiotherapy Interventions
A recent Cochrane review provided evidence on the shortterm benefit of physiotherapy in the treatment of PD . However, it did not identify whether any specific type of physiotherapy intervention provides greater benefit. This review aimed to assess this by comparing the effectiveness of one approach of physiotherapy intervention with a second approach of physiotherapy intervention. The various physiotherapy interventions used in the trials included in this review were categorised according to the type of treatment administered to aid comparisons . However, despite categorisation, the techniques employed within each category were diverse. Therefore, it was not possible or appropriate to combine the results by metaanalysis as any such analysis would be difficult to interpret. It is also difficult to summarise such large amounts of heterogeneous data using a qualitative approach. Consequently, we conclude that there is no robust trial evidence to support any one approach of physiotherapy over another in the treatment of PD.
Quality Of The Evidence
There has been an improvement in the trial methodological quality and reporting since the last Cochrane review . The use of more robust randomisation methods, blinding and intentiontotreat analyses has increased since the previous review, although it was still inadequate. Of the 43 trials, only 24 trials provided information on the randomisation method and only four used a central independent randomisation procedure to ensure concealment of treatment allocation 23 trials used blinded assessors and only 10 stated that they used intentiontotreat analysis methods. The lack of information in many trial reports may not necessarily indicate lack of implementation within the trial, but without this information provided in the trial publications the level of bias within the individual trials is difficult to assess. The need for further improvement in the methodological quality of trials in physiotherapy for PD was noted recently . Future trials must be methodologically sound, large, randomised, and controlled with reporting following CONSORT guidelines .
It should also be noted that only 18 of the 43 trials discussed participant compliance. This is surprising as compliance can be an important determinant of the outcomes measured and the acceptability of the interventions being assessed in the trials. Therefore, it would be beneficial if the level of compliance is measured in future trials.
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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.
Data Collection And Analysis
2.4.1. Selection of studies
All authors will be trained to reduce human factors in carrying out this review. During search period, EndNote X8.2 will be used for records management. According to the predetermined inclusion and exclusion criteria, 2 authors will screened studies separately by title, keywords, abstracts, and full texts if needed. Each article excluded will be given a reason and recorded in summary. Any discrepancy will be resolved through discussion or consultation a third author . The selection process will be detailed in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart shown in Figure .
Flow diagram of the study selection process.
2.4.2. Data extraction and management
Two authors will separately extract the important data, according to a premade collection form. If discrepancies encountered, a consensus will be reached by consulting an expert reviewer . If the data needed in the records were not given, we will contact the author for more. The following information will be extracted: study details , participants , study methods , the interventions and the outcomes .
2.4.3. Risk of bias assessment
2.4.4. Data synthesis
Data analysis will be carried out using RevMan 5.3 software. Dichotomous data will be presented as relative risks, continuous variables measuring with the same scale will be presented as with mean differences or the standardized mean differences. Effect sizes will be indicated by 95% confidence intervals.
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Inclusion And Exclusion Criteria
2.1.1. Types of studies
Clinical randomized controlled trials taking EA combined with L-dopa therapy for PD will be included.
2.1.2. Types of participants
Patients diagnosed of PD will participant without restrictions of age, gender, race, or duration of disease.
2.1.3. Types of interventions
The intervention of the experiment group will be EA adjuvant with L-dopa, and of the control will be the L-dopa alone.
2.1.4. Types of outcome measures
18.104.22.168. Primary outcomes
Overall symptom scores using The Unified Parkinson Disease Rating Scale and Webster scale
Motor symptom scores utilizing UPDRS III scale
Nonmotor symptom scores employing UPDRS I scale
Activities of daily living using UDPRS II
Complications of treatment applying UPDRS IV
Antioxidant ability: SOD activity and LPO content
Content of inflammatory cytokines: tumor necrosis factor- and interleukin-1
RCTs with any following conditions will be excluded:
Participants diagnosed with a parkinsonian syndrome or with severe complications
Combined with other therapy.
How Do I Find A Physiotherapist
As Parkinsons is complex to manage, it is important to be seen by a physiotherapist who has experience of the condition. If you cannot find a physiotherapist with Parkinsons experience, you may want to share with the physiotherapist the European Physiotherapy Guideline for Parkinsons Disease and Pre-Assessment Information Form .
Referral procedures depend on the country in which you live in some countries physiotherapy is prescribed by a doctor but in others you can contact a physiotherapist direct. Depending on where you live, treatment may or may not be accessible through your countrys national health system. In some countries you need to be referred by your neurologist in order to get the cost of physiotherapy reimbursed.
Training and accreditation varies throughout Europe so you should always check the experience of anyone you consult and the likely costs before treatment starts.
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Physiotherapy For Parkinsons Disease
Physiotherapy is part of the multidisciplinary approach taken to manage Parkinsons disease symptoms. Patients can benefit from two areas of physiotherapy: exercises to build and retain muscle strength, and conditioning to lessen difficulties with movement and to target problem areas like stiffness in the hands and legs, tremors, and balance.
After a thorough evaluation of evident disease symptoms, the doctor will refer the patient to a physiotherapist. A physiotherapist with experience in Parkinsons disease will review the symptoms and plan an exercise program tailored to the patients abilities and disease status.
Starting physiotherapy early can help to slow Parkinsons progression and symptom severity.
How Psychology Can Help
There are many reasons why someone living with Parkinsons might benefit from seeing a psychologist. A diagnosis of Parkinsons can bring with it many psychological and emotional challenges. For instance, anxiety, depression and stress affect a large proportion of people diagnosed with Parkinsons. Assessment and treatment by a psychologist can help to address these issues for people living with Parkinsons, their carers, family and friends.
The psychologist may:
- Help you to deal with your emotional reaction to diagnosis
- Undertake assessments, and suggest strategies to manage memory and cognitive difficulties
- Teach strategies to manage anxiety and stress
- Talk with you and develop strategies to overcome depression
- Suggest strategies to help you cope with the ongoing challenges of Parkinsons.
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Physical Therapy For Parkinsons Disease
Its well-known that exercise of all kinds is beneficial for patients with Parkinsons disease. But physical therapy, in particular, is key. Why? A professional can guide you through the right moves to increase mobility, strength and balance, and help you remain independent, says Denise Padilla-Davidson, a Johns Hopkins physical therapist who works with patients who have Parkinsons. Here are things a therapist may work on:
Note: Please discuss any exercise program with your physician/neurologist and get a referral to a physical therapist or trainer with expertise in Parkinsons disease before starting any specific program.
Hyperbaric Therapy As Treatment For Parkinsons Disease
Hyperbaric Oxygen Therapy decreases inflammation, oxygenates the entire body, stimulates the growth of new healthy blood vessels, and releases stem cells, up to 800% more after twenty sessions! Research suggests that HBOT can improve neurological outcomes by increasing enzymes in the body that protect cells and prevents neuronal damage. It has also been shown to decrease depression, anxiety, and tremors in patients with Parkinsons Disease.
Parkinsons disease is a progressive neurodegenerative disorder in the elderly that is characterized by typical motor symptoms such as resting tremors, rigidity, bradykinesia, and gait disturbances . The conventional therapy using levodopa and dopamine agonists for Parkinsons disease focuses primarily on relieving motor symptoms. Another therapy for Parkinsons disease includes chronic exercise . However, it is difficult to completely prevent the degeneration of dopaminergic neurons with these therapies.
Exposure to mild hyperbaric oxygen at 12661317 hPa with 3545% oxygen increases the level of oxygen in blood, especially the oxygen dissolved in blood plasma, and facilitates oxidative metabolism in the mitochondrial tricarboxylic acid cycle in cells and tissues . Metabolic syndrome , lifestyle-related diseases , and arthritis are inhibited and/or improved when rodents are exposed to mild hyperbaric oxygen.
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Seeing A Parkinsons Nurse
Unfortunately, there are very few Parkinsons nurses in Victoria. However, Parkinsons Victoria is committed to lobbying the Victoria Government to increase funding for Parkinsons nurses.
In Melbourne, there are several experienced nurses working in neurology clinics. There is also a Parkinsons nurse working within the team at Parkinsons Victoria. For residents of regional areas, there is a Parkinsons nurse working in the Mildura region and another in the Goulburn Valley.
Support for you
How Can A Physical Therapist Help
Because PD affects each person differently, your physical therapist will partner with you to manage your specific situationnow and as your condition changes. You are not alone!
Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.
Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:
- Improve your fitness level, strength, and flexibility.
- Develop more effective strategies to get in and out of bed, chairs, and cars.
- Turn over in bed more easily.
- Stand and turn to change directions more efficiently.
- Improve the smoothness and coordination of your walking.
- Improve your ability to perform hand movements.
- Improve your ability to climb and descend stairs and curbs.
- Perform more than 1 task at a time more efficiently.
- Participate in activities that are important to you.
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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 exercising 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.
Can This Injury Or Condition Be Prevented
To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.
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Getting The Most Out Of Physiotherapy Appointments
Your physiotherapist will assess your mobility, and specifically if you have difficulties with walking, transfers, balance and falls, your manual dexterity and your physical capacity, and why these problems occur. He or she may assess your ability to perform activities of daily living. This may take one or two appointments and your physiotherapist may want to assess you at home if problems mainly occur there.
Your physiotherapist, with your input, will set goals according to your specific needs and jointly you will agree a treatment plan. Generally this will be a combination of advice and education, plus an exercise programme and strategies to better manage your daily activities. When and how often you see your physiotherapist will depend on your individual goals and treatment plan.
Medicare And The Therapy Cap Removal
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.
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