Parkinson’s Disease

Parkinson’s Disease is a slow, chronic, progressive disease of the nervous system that was first observed and recorded by James Parkinson in 1817. (Physical Dysfunction Practice Skills for the Occupational Therapist, M.B. Early) 

4 main signs that present and lead to a diagnosis are:

• Resting Tremor 
• Rigidity in Muscles
• Bradykinesia
• Postural Instability 

Tremor:

An involuntary repetitive movement that often begins in the hands, but sometimes the feet.  It can be exacerbated by stress and calmed through intentional movement.  

Rigidity:

A resistance to movement caused by an imbalance in the innervation of agonist muscles to their antagonist (opposite) muscles. An example of this relationship is the hamstrings paired with the quadriceps. As the quadriceps contracts and extends the leg straight, the hamstring relaxes and lengthens.  In normal functioning when a muscle is working, its antagonist eases to allow the execution of a controlled motion. With Parkinson’s the antagonist muscle will tense up instead, affecting or stopping the movement from happening. It is this reaction that causes the slow, shuffling gait of Parkinson’s Disease (PD) patients.  It is also why a “festering gait” can develop where a patient takes small fast steps forward that can culminate in a faster and faster gait with a greater risk of falls. The patient with this gait is rarely able to stop the forward propulsion unless assisted through cues and support.

Bradykinesia:

This is the slowing down of general voluntary and automatic movements the body uses to complete activities of daily living. Bradykinesia makes simple, everyday tasks difficult to perform and time-consuming. For example, PD patients may find that bathing and dressing become increasingly challenging. One of our clients reported “forgetting” how to don his pants one day.  He reported that it took him 15 minutes to accomplish this task. When things like this happen it can be a very worrying experience. Increasing support in a non-judgmental way is essential to keep stress to a minimum.

Postural Instability:

When posture is compromised, balance becomes impaired and the risk of falls increases. In Parkinson’s patients, a stooped posture and head forward position is often observed. As the spine curves forward, hip mobility is affected and small, fast stepping in ambulation starts to appear. Not only does forward propulsion speed up but the patient is not able to stop it and is therefore at greater risk of falls. In more severe cases, episodes of freezing occur where ambulation simply stops when a sudden difficulty such as walking through a doorway or turning is experienced.   

As Parkinson’s Disease progresses, oral and facial muscles are affected causing drooling, dysphasia (difficulty swallowing) and monotone, low-volume speech. Dementia symptoms such as memory and slow thinking develop. Depression with this condition is common. Muscle cramps, pain, fatigue and loss of energy are reported throughout the stages.  

With so much to contend with regarding Parkinson’s, it is imperative that a strong multidisciplinary healthcare team is in place to support the individuals living with it every day.  Physiotherapy plays an important role.  

Management of Parkinson’s Disease

Promising stem cell research may result in a cure one day, but as no cure yet exists, treatment for Parkinson’s focuses on managing symptoms. Dopamine drugs are used to help calm symptoms. Surgical procedures such as deep brain stimulation are an option, but it is not a cure either. Physiotherapy has no negative side effects and should be used in conjunction with medicines. While staying active in body and mind helps generally, Physiotherapy will target loss of balance, gait problems and postural deficits to increase confidence and help prevent serious falls causing life-changing injuries. 

The problems for people living with Parkinson’s are not just physical and cognitive, but also social and emotional. Limiting activities that provide a healthy well-rounded life is often self-imposed due to the fear of falling and the increased time and energy it takes to try. (Early, p. 522)  Isolation can lead to worsening depression and a further decrease in physical ability.  

While physical movement stimulates positive endorphins and increases confidence in everyone,  it can also decrease the prevalence of tremors in Parkinson’s patients. If a person’s ability to participate in the pleasures of life, or even perform basic daily tasks is impacted, it is time for Physiotherapy intervention. Through education and support, people can learn how to move more safely, giving control back to the Parkinson’s patient.  

Time to Assess and Evaluate

At the first Assessment Appointment the Physiotherapist will:

1. Evaluate functional physical performance levels related to work, leisure and activities of daily living. 

1. Take measurements of flexibility, strength, quality of movement, rigidity, standing and sitting balance, cognitive skills and coordination.  

Once this information is recorded, a treatment plan is drawn up that includes clinic-based and/or home-based appointments, supplemented with virtual support through online care that can be a lifeline available any time if needed.  

Intervention with Purpose

Physiotherapy treatments and rehabilitation plans are designed to fit the individual. They aim to improve life through focused practice and meaningful exercise. Parkinson’s patients can gain confidence to combat their symptoms by learning strategies that increase efficiency, safety and independence. A quality rehabilitation program provides gait training using visual and verbal cues that remind the patient to correct posture, lift feet, elongate stride and slow pace.  Stretching and massage help to release rigidity while regular range of motion exercise keeps joints move more freely and with greater control.  

Physiotherapy teams face this challenging disease with an optimistic outlook. The purpose of Physiotherapy is to “help people with PD keep moving well, as long as possible, while enhancing the ability to move. Research shows that it may help improve or hold PD symptoms at bay.” (www.parkinsons.org)

At Physio for Seniors, we have seen that it does. We have often had the privilege to share this with our patients. There is power in knowledge and positive, caring therapeutic relationships.  

References:

Physical Dysfunction Practice Skills for the Occupational Therapist, M.B. Early

http://www.parkinson.org/living-with-parkinsons/treatment/physical-occupational