Parkinson’s Disease and Physical Therapy

Parkinson’s disease impacts more than a person’s health; it steals their independence, depriving those afflicted of the ability to rely on their own faculties. But, while there is no known cure, patients diagnosed with Parkinson’s are not powerless.

Through education and physical therapy, Parkinson’s disease patients can learn to manage symptoms, sometimes remaining active for years following their diagnosis.

Health visitor and a senior man during home visit. A nurse or a physiotherapist helping a senior man exercise with dumbbells.

Symptoms Of Parkinson’s disease

Parkinson’s affects the cerebellum and central nervous system. Neurons begin to break down, leading to a range of symptoms that impact almost every aspect of the patient’s life.

Common symptoms include:

Tremors: The patient’s hands tremble when they are at rest. Early in the disease process, patients will also manifest pill-rolling tremors (rolling the thumb and forefinger together repeatedly).
Balance and coordination problems: Parkinson’s damages brain regions responsible for movement and equilibrium, making it hard for patients to remain steady when standing.
Stiff muscles: Moving arms and legs becomes difficult or even painful. Patients move slower and have trouble getting up or sitting down. This stiffness extends to facial muscles as well, leaving patients with a rigid and unchanging expression.

Additional symptoms

Poor posture: Stooped shoulders are an early sign of Parkinson’s. As patients lose control of their back muscles, they slump forward instead of standing upright.
Speech problems: Due to loss of motor control, patients talk slower, slurring or stumbling over their words. Their voice changes as well, becoming quieter and hard to understand.
Smaller handwriting: As Parkinson’s progresses, patients begin to write using smaller letters. Their words become crowded together as well, making them hard to read.
Dizzy spells: Parkinson’s interferes with the body’s ability to regulate blood pressure, sometimes leaving patients feeling faint or lightheaded.

Wellbeing, Parkinson’s disease, and physical therapy

Quality of life is the overriding concern of Parkinson’s disease and physical therapy. Though patients cannot reverse their symptoms, with the help of their therapist, they can remain independent and functional. By moving and staying active, they can make good days more productive and bad days less challenging.

Sadly, no amount of physical therapy can reverse Parkinson’s disease. Eventually, there will come a time when the patient cannot maintain their independence and will require someone to look after them full-time. Despite this, physical therapy still plays a useful role by reducing the burden of care.

Therapists can help patients re-learn basic physical skills, such as rolling over or raising their arms. Simple movements can make the patient more of a partner, able to assist their caregiver with the activities of daily living such as bathing, grooming, and dressing, improving outcomes for both caregiver and patient alike.

Parkinson’s disease and physical therapy

Health visitor and a senior man during home visit. A nurse or a physiotherapist helping a senior man exercise.

Parkinson’s disease and physical therapy needs are highly individual. For some, symptoms remain mild for a long time, while others experience a far more rapid progression. As a result, instead of working off a script, therapists try to meet patients where they are. During their initial meeting, therapists evaluate the patient’s physical abilities in order to determine their level of function.

Regardless of whether the patient is bed-bound or mobile, the goal is to help them do as much as they can on their own by working on three key areas: strength, balance and movement.

Strength

Parkinson’s patients frequently experience pronounced bodily weakness. They tire easily and strain lifting their arms and legs, increasing the likelihood they will suffer a fall and making ordinary activities like walking almost impossible.

Strength training helps patients push back and regain their stamina. Strong muscles let patients move freely while also reducing fatigue. They also improve posture and reduce the risk of osteoporosis, which often accompanies Parkinson’s.

Building muscle has mental benefits as well. It boosts production of dopamine, an important neurotransmitter. Low dopamine is endemic to Parkinson’s, responsible for tremors, rigidity, and weakness throughout the body.

Strength training is most effective when it is tailored to the individual. If symptoms do not progress far, patients might be asked to work with free weights. However, most are given simpler exercises, such as leg lifts, heel raises, arm raises, squats, seated marches, or wall push ups.

If the patient is doing well, the therapist might push them a little further by adding a heavier dumbbell or resistance band to their routines. Patients can also exercise sitting down if they feel shaky on their feet.

Balance

An alarming 70% of Parkinson’s patients fall at least once in the span of a year. To help keep them stable, physical therapists look for ways to challenge their balance, gradually making each exercise more strenuous as the patient improves.

These are the most common exercises used to help support Parkinson’s patients:

Static balance challenge: The patient stands for 30 seconds with their feet shoulder-width apart. Once they’re stable, they repeat the exercise with their feet closer together. For an even greater challenge, patients stand heel to toe.
Leg stand: Standing on one leg forces it to do the work of two. Patients do not have to raise their leg far, just an inch or two off the ground. To prevent injury, this exercise should always be performed gripping a countertop, balance bar, or other heavy object.
Weight shift: This exercise puts more force on one leg without requiring the patient to lift their feet off the ground. They stand with their feet shoulder width apart and slowly lean to the side until all their weight is on one foot.

Additional symptoms

Side steps: From a normal stance, the patient takes one step to the side and then brings their other foot over. The narrower their stance, the greater the challenge.
Walking: Regardless of whether it is performed with a cane or a walker, walking may be the best way to strengthen equilibrium. Patients can try walking heel to toe for an added challenge.
Visual targets: The therapist places circles on the floor and asks the patient to reach them with their feet or when they step. To challenge their stance and their reflexes, they may toss a balloon into the air and ask the patient to reach out and tap it.

Regardless of the exercise, patients should go at their own pace, and should always try to work with specialized physical therapists who are sensitive to their unique needs. Because exhaustion affects productivity, therapists should always check with patients to ensure they’re not becoming overly tired during every session.

Movement

Slow movement is one of the hallmarks of Parkinson’s, but patients rarely perceive it. To them, they are moving and speaking the same way they used to. Learning to compensate is one of the biggest obstacles facing successful physical therapy efforts.

To help patients adjust to their new normal, therapists encourage patients to make wide, exaggerated movements, swinging their arms and legs further than what feels comfortable. In the same manner, they must also learn to write with what may seem like exaggerated lettering to ensure that people can read their words.

Therapists adopt the same approach with gait training. Parkinson’s patients move with small, shuffling steps. These are not only slow, but also dangerous. If they’re trying to step over an obstacle, like a sidewalk curb, they run the risk of tripping and falling. At times, mobility is so compromised that patients freeze in place without realizing it.

To correct this, instead of relying on their instincts, therapists teach their patients to walk in a rhythmic pattern. Patients may feel discomfort, or unnatural, but the only way to stay active is by developing a new sense of motion. To help them along, the therapist might hang a target on the front of the patient’s walker and ask them to kick it every time they take a step. They may also count a tempo and ask the patient to keep time as they walk.

In-home physical therapy vs. clinics

Patients with Parkinson’s disease can choose to receive treatment in a clinic or at home. Clinics are generally more intense, and have more sophisticated equipment, but home settings may be more ideal for certain patients.

Depending on their insurance, patients can meet with their therapist in clinics up to five or six times a week. Most home healthcare agencies meet with patients two to three times per week; Parentis Health’s Home Care is unique because it offers light daily exercises that can be tailored to meet individual patient needs.

Home Care services are also inherently more personal than clinics. Because they are conducted in a familiar environment, therapists can focus on the specific skills that patients need every day, such as getting out of bed, navigating tight hallways, or walking downstairs.

Oftentimes, the patient will be living with a spouse or family member, which gives the therapist a chance to train them as well—an opportunity not typically available through a clinic.