Parkinson’s disease takes more than our health. It steals our independence. No one likes being a burden, but it extends beyond that. There is a real satisfaction that comes from relying on our own faculties, free to go, do, and live how we please. While there is no cure for Parkinson’s, patients are not powerless. Even under such dire circumstances, they can fight back. Through education and physical therapy, Parkinson’s disease patients can learn to manage symptoms, sometimes remaining active for years following their diagnosis.
Symptoms of Parkinson’s Disease
Parkinson’s affects the cerebellum and central nervous system. Neurons begin breaking down, leading to a range of symptoms that impact almost every aspect of the patient’s life. These include:
- Tremors. The patient’s hands tremble when they are at rest. Early in the disease process, patients will also start rolling their thumb and forefinger together (known as a pill-rolling tremor).
- Balance & Coordination Problems. Parkinson’s damages brain regions responsible for movement and equilibrium. As a result, patients have a hard time remaining steady on their feet.
- 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.
- 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. Patients write in 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 faint or lightheaded.
Anyone experiencing these symptoms should see their doctor immediately. They will be able to work out a plan of care that may help slow the progress of the disease.
Parkinson’s Disease and Physical Therapy
Parkinson’s disease and physical therapy are highly individual. For some, symptoms remain mild for a long time, while others quickly become severe. Therefore, instead of working off a script, therapists 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.
Parkinson’s patients frequently complain about bodily weakness. They tire easily and strain lifting their arms and legs, like they were moving through wet concrete. This increases the likelihood they will suffer a fall and makes ordinary tasks, 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 have not progressed far, patients might be asked to work with free weights, like they were at the gym. Generally, however, they are given simpler exercises, such as leg lifts, heel raises, arm raises, squats, seated marches, or wall pushups. If the patient is doing well, the therapist might push them a little further by adding a dumbbell or resistance band. Patients can also exercise sitting down if they feel shaky on their feet.
Seventy percent 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. They start small and scale up, gradually making each exercise more strenuous as the patient improves.
- Static Balance Challenge. The patient stands for 30 seconds with their feet shoulder-width apart. Once they have accomplished this, 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.
- 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. If they find it too easy, patients can try walking heel to toe.
- 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 might toss a balloon into the air and ask the patient to reach out and tap it.
Regardless of the exercise, patients are encouraged to go at their own pace. Because exhaustion affects productivity, patients should speak up if they feel themselves becoming overly tired.
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 for this misapprehension is one of the biggest obstacles facing physical therapy and Parkinson’s disease.
In order to compensate, therapists encourage patients to make wide, exaggerated movements, swinging their arms and legs further than what feels comfortable. In the same fashion, they must learn to write with what seems like overstated letters so 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 are trying to step over an obstacle, a sidewalk curb for example, there is a good chance they will catch their foot and possibly trip. At times it is so bad they 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. It feels unnatural, but the only way to stay active is to develop 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. Or they might count a tempo and ask the patient to keep time as they walk.
In-Home Physical Therapy vs. Clinics
When dealing with Parkinson’s disease and physical therapy, patients have the option of receiving treatment in a clinic or at home. Clinics are generally more intense. Depending on their insurance, patients can meet with their therapist up to five or six times a week. Whereas with a home health agency, they only meet two or three times. Home health also has access to less equipment.
On the other hand, home health care services are more personal. Because they are conducted in a practical environment, therapists can focus on the specific skills patients need every day, such as getting out of bed, navigating tight hallways, or walking downstairs.
In many cases, 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.
Caregivers, Parkinson’s Disease, and Physical Therapy
Sadly, no amount of exercise 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 like these make the patient more of a partner, able to assist their caregiver with the activities of daily living such as bathing, grooming, and dressing. And because their wellbeing is so closely tied together, anything that helps the caregiver correspondingly improves the patient’s quality of life.
Good Days and Bad Days
Parkinson’s symptoms fluctuate. Some days, the patient will be able to move quickly, smoothly, and confidently, like their old self has returned. Other days, they will hardly be able to move, eat, or talk. It is a seesaw and the only way to cope is to approach each day as its own. Determine where you are and make it work as best you can. If it is a bad day, focus on rest and recovery, knowing you will be ready to take advantage of good days when they come.
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 of a burden.
Brooke McFerren is a Physical Therapist Assistant who works with older adults in Southern California. Through her personal approach to therapy, she has helped countless seniors remain strong, active, and independent during their advancing years.