Physical Therapy Exercises For Parkinsons Disease
It is common for Parkinsons patients to completely give up exercising due to the pain involved in moving muscles and joints. Unfortunately, doing so actually worsens the pain. Thus, patients are stuck in a vicious cycle of avoiding exercise to avoid pain but actually causing more pain by not exercising.
Parkinsons disease makes it difficult for patients to perform complex motor programs. However, the loss of automatic response in patients can be countered with exercises that demand attention, repetition, progression of difficulty and promote learning.
Symptoms of Parkinsons disease get worse over time but physical therapy can help to make them more manageable. A trained physiotherapist will develop an exercise program to help patients handle day-to-day chores and activities as well as address balance issues, lack of coordination, fatigue, pain, gait, posture, immobility and weakness.
A physical therapy plan for a patient with Parkinsons disease involves a combination of exercises that promote posture, biomechanics, increased strength and flexibility and stimulates cognitive abilities in patients.
Here are some examples of exercises a physiotherapist may develop to help a patient with Parkinsons disease:
Who Should I Talk To Before Starting Physical Activity
Kinesiologists are health professionals that specialize in physical activity. They use movement as a means of prevention, treatment and performance.
Before starting physical activity or an exercise program, they can evaluate your physical condition and develop a safe and personalized plan adapted to your needs.
They will then accompany you in carrying out your program and help you adopt an active lifestyle. If you attend training sessions with coaches or instructors, talk to them about your condition and make sure they know your limits.
How Hard Should I Exercise If I Have Parkinsons Disease
A rating of perceived exertion is a good way to measure intensity. On a scale from 0 to 10, 0 would be how you feel while sitting or lying down, while 10 would be the maximum effort you can give. Building up to an effort between 5 to 8 means you are exercising at a high intensity. A good gauge is, if you can have a conversation with someone while exercising, you should probably increase your intensity.
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How Do You Entertain Someone With Parkinsons Disease
When you are wondering about the best hobbies and fun activities for Parkinsons patients, it is important to remember that Parkinsons can affect many aspects of the patients life. However, with careful planning, the effects of Parkinsons can be managed and the patient can continue to live a full life. Here are a few tips to conserve energy so Parkinsons patients can continue to choose daily entertainment they enjoy:
- Plan activities, including exercise, recreation and chores, ahead of time so they can be spaced out throughout the day.
- If you need to rest, allow yourself to rest before and after participating in activities. Allow yourself to stop during an activity if you begin to feel over-tired.
- Avoid rigorous physical activity. If you arent sure if something is safe, ask your health care provider.
- Ask for help when needed, and allow friends and family to pitch in.
- Avoid planning activities directly following a meal.
- Set realistic expectations for yourself and for your daily activities. Allow yourself to make small changes to reduce the strain on your body.
- Always get a good nights sleep.
I Do Not Feel Like Doing Physical Activity Is This Normal
Age and Parkinsons reduce physical resistance and energy levels, which could make physical activity more painful. As time goes by, the exercises become less and less engaging. You may also have less time to do these activities that you enjoy less and less. This lack of interest is therefore very common, especially in very sedentary societies like ours. Lack of physical activity can accelerate physical and cognitive decline.
Adapted physical activity is currently the only therapeutic option available for everyone at an affordable price. It helps to improve your life with Parkinsons disease, prevent the appearance of the most severe symptoms and slow the progression of the disease.
You can always participate in adapted physical activity no matter your age and limitations. For example, those with joint problems can participate in aquatic activities and those with balance problems can enjoy the stationary machines available in gyms.
Changing your lifestyle is not easy. Start by making active choices in your daily life:
Your outlook on physical activity will change once you have implemented these habits. It is not only for young athletes in gyms.
All activities that increase your heart rate, make you sweat and tire you out are beneficial. These aerobic exercises are at the heart of your treatment.
You can also find activities that increase your mobility and help you improve your balance and gait.
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How To Start Exercising If Youre Living With Parkinsons
Safety is key. The first thing you need to do is talk with your neurologist and primary care doctor to make sure that the exercise regimen that you embark upon is safe for you.
Next, ask for a referral for physical therapy. A physical therapist will be able to figure out what movement challenges you may have and design a program to help you improve. There are certain physical therapists with additional training in Parkinsons. Your physical therapist will work with you for your allotted sessions, and then can help you plan your ongoing exercise regimen that is tailored to you. You can contact the APDA National Rehabilitation Resource Center for Parkinsons Disease for help finding resources in your area.
Additionally, physical therapy can help counteract the tendency for people with PD to reduce the size of their movements. The Lee Silverman Voice Technique has designed a program called LSVT-BIG which trains participants to make big movements. You can search for an LSVT-trained professional near you.
Anyone starting out on an exercise program could benefit from APDAs Be Active & Beyond exercise guide which includes clear photos with simple instructions that are easy to follow, with exercises that address all levels of fitness.
What Kind Of Exercise Can I Do If I Have Trouble Standing Or Walking
Even with advanced Parkinsons symptoms, you can still reap the benefits of some activities. If you have trouble walking or balancing, hold a bar or rail to exercise and stretch. If standing or getting up is tough, exercise and stretch in a chair or bed. Physical exercise performed in a seated position, such as biking on a recumbent bike can allow you to exert yourself in a safe manner.
Facial exercises may help combat difficulties speaking or swallowing:
- Chew your food longer and more vigorously.
- Exaggerate your face and lip movements when you speak.
- Make faces in the mirror.
- Sing or read out loud.
Mental exercises give your brain a workout and can improve memory. For example:
- Name as many animals as you can in 1 minute.
- Play brain games and do puzzles.
- Solve math problems in your head.
You can also add activity in small bits throughout your day:
- Park further away from stores so you walk longer distances.
- Stretch or do leg exercises while watching TV.
- Swing your arms more when you walk, and take long strides.
- Take the stairs instead of the elevator.
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How Can Physiotherapy Benefit Those With Parkinsons Disease
Apart from medication and surgical procedures, it has been established that physical therapy for Parkinsons disease yields great results. Physiotherapy can benefit a patient suffering from Parkinsons in resisting the regressive changes that follow this disease and in recovering from it.
Physiotherapy can have many positive effects on patients with Parkinsons disease:
Playing A Percussion Instrument
Music therapy has long been used to help people with Parkinsons maintain their abilities. Percussion instruments, such as drums and cymbals, are fairly simple for seniors with Parkinsons to play, since most can be placed on the ground or a table. Your loved one can choose between using an open hand or a tool such as a drumstick to make the sounds. Keeping a rhythm can help your loved one retain the ability to start and maintain a series of movements, and it can also help with freezing.
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What Type Of Exercise Should I Do If I Have Parkinson’s Disease
Exercise is a planned, structured, repetitive activity that is intended to improve physical fitness. There is no right exercise for people with Parkinsons. Everyones regimen will differ, depending on overall health, symptoms and previous level of activity. Any exercise helps, and a variety of exercise types may provide well-rounded benefits.
Aerobic exercise involves activities that challenge your cardiorespiratory system such as walking, biking, running, and activities in the pool. Participating in aerobic exercise at least three days a week for 30-40 minutes may slow Parkinsons decline.
Strength training involves using your body weight or other tools to build muscle mass and strength. Strength training two days per week, starting with low repetition and weight, may be beneficial in Parkinsons disease. A focus on extensor muscles, or muscles in the back of the body, can help with posture.
Stretching two or more days per week can be beneficial to maintain range of motion and posture. Holding each stretch of major muscle groups for 30 to 60 seconds can improve muscle length.
Balance and agility training
This type of training often combines aerobic exercise, strength training, and flexibility training. Examples include:
- Tai chi, yoga or Pilates.
Other Tips For Those With Parkinson’s Disease
- Purchase a small battery-powered alarm pillbox to help you remember your medication schedule.
- Use a speaker phone or telephone headset to ease the problem of hand tremors while talking on the phone.
- Install an intercom system or purchase walkie-talkies to make contact within the home easier.
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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.
What Is Parkinsons Disease
Parkinsons disease is a neurological disease that involves the gradual and sustained degeneration of the central nervous system. Since our nervous system is the primary medium through which the grain sends sensory information to our body parts, having an affected nervous system impacts our mobility.
This happens when our nerve cells lose the ability to produce dopamine and, as a result, the internal communication within our bodies is affected. This causes great difficulty in keeping up with routine functions such as walking across the room.
There is no cure for Parkinsons as of yet, but there are certain procedures that can ease the pain and make the condition tolerable.
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Physical Therapy Strategies For Parkinsons Disease
PT can improve daily functioning for people living with PD by:4
- Improving gait, or the way a person walks
- Improving transfers, like going from stillness to activity
- Improving balance
- Strengthening joints and muscles to improve physical capacity
One of the ways physical therapists help improve gait is through the use of cues. Cues are stimuli from the environment or generated by the person that they can use to facilitate repetitive movements, like walking. Cues can be:4
- Auditory, like using a metronome or music
- Visual, such as stepping over stripes on the floor
- Tactile, like tapping on the hip or leg
- Cognitive, like using a mental image of the length of a step
Tip: Enhancing Hand Coordination
We use our hands throughout the day in all activities. People with PD may notice changes in the ease in which they perform hand and finger motions. An occupational therapist can help evaluate and make recommendations to improve hand coordination:
- Exercise hands and fingers regularly
- Engage in enjoyable and stimulating hand exercises, such as gardening or knitting
- Use toothbrushes, hairbrushes, silverware and writing tools with larger handles
- Use both hands in tasks – dont favor one hand over the other
- Schedule tasks that require greater hand control for times when you are well rested and medications are working well
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Reach Out For Support
It can be challenging living with Parkinson’s disease, but you do not have to manage the symptoms alone. If you find yourself feeling discouraged or frustrated, share your feelings with others. Spend time with supportive friends and family members, or consider joining a support group. You might also speak with a counselor to address depression, anxiety or any other mental health issues you experience. By taking care of your mental and emotional health, you will be better positioned to reach your physical health goals.
Vision Issues And Art Therapy
It is well known that vision issues can be prominent in PD. This includes difficulty with visuospatial perception Poor visuospatial skills affect depth and distance perception as well as navigational skills, which can directly translate into difficulty with activities such as reading, driving, and even walking. As visuospatial challenges increase, so do gait dysfunction and falls.
Problems in a number of eye and brain areas affected by PD can contribute to these difficulties including the retina, the eye movement apparatus and the thinking parts of the brain that process vision and integrate it with other cognitive functions.
Exploring how art therapy may help PD
Currently, rehabilitative strategies in PD do not typically address visuospatial deficits, and this may hamper how much improvement a person can expect from his/her therapy. Whether art therapy, through art creation, can improve these deficits is a promising avenue of investigation. A study underway at the Marlene and Paolo Fresco Institute for Parkinsons & Movement Disorders at NYU Langone in New York City exploring the effects of art therapy on visuospatial deficits was recently described .
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Shortcomings Of Animal Models
One of the major issues in devising neuroprotective therapies is limitations of the in vivo models. Currently, there are no available animal models that will mimic the full spectrum of PD pathology. Commonly, in vivo studies have been conducted in chemically induced models such as 6-OHDA or MPTP. These in vivo models display significant TH loss in the substantia nigra of the midbrain however, the amount of time it takes to destroy dopaminergic neurons and pathogenesis is not similar to PD patients . Recently, genetic models have been used in various studies to evaluate the role of different neuroprotective agents that have the ability to prevent DA degeneration. Although those genetic models add value to the studies with additional features, they still fall short of a model that will encompass all the features of this debilitating neurodegenerative disorder. Due to variation in displaying several important features of PD such as a-synuclein inclusion or TH loss and inability to show significant loss of TH neurons in the substantia nigra, these genetic models are not suitable for PD study .
At this time, most of the neuroprotective studies are being carried out on variety of in vivo models and we hope that results from these studies will pave the way for future clinical trials in humans involving PD patients.
Neuroprotection In Clinical Trials: Recent Updates
Although a plethora of putative drugs have shown promise in animal models of PD, the results have not translated into therapies that can be used for neuroprotection in human PD. The main hurdles to establish a neuroprotective strategy are: the inherent complexity of the clinical tools that are currently available to evaluate the disease progression, the precise time when one should start this kind of drug as an intervention and last but not the least whether this kind of intervention has any beneficial effect.
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Parkinsons Home Exercise Program
You dont need to join a gym or purchase expensive fitness equipment to stay active with Parkinsons disease. On the contrary, there are many great exercises that you can do from the comfort of your home, regardless of which stage of the disease you are in. Take a look at some great examples in the sections below.
Choosing The Right Exercise Class For Parkinsons
When trying to find an exercise class to join, it can be hard to know which ones to try because there are many different types of classes that are marketed to people with PD. When you are evaluating a class, it is important to remember the following:
- It is the components of the exercise class that are important . You do not need to specifically do boxing or dance if you can achieve these elements of exercise in other ways.
- The instructor should have expertise in PD. APDA offers a training for fitness professionals which helps them better understand how to create exercise programs best suited for people with PD.
- The ratio of class members to instructors should be low enough to maintain safety.
- The class should be adaptable for people of different abilities and mobility. Many classes will offer seated options or other modifications.
It may take a few tries to find the types of exercise that suits you best so dont give up! Feel free to try different classes in your area to see what types of exercise appeal to you. It can also be motivating to take classes together with a friend or family member. You can hold each other accountable, and also have some fun together. As you find classes you enjoy, you can incorporate those modalities into your exercise schedule. For help in finding classes in your area, you can contact one of our Chapters or Information & Referral Centers. There are also many virtual classes that you can join from home.
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