Parkinson’s Disease and the Role of Physiotherapy

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Parkinson’s disease is a very common, progressive disease of the neurological system which affects the ability of the brain to control body movements. Currently there is no cure for this condition however symptoms may be slow to progress and can be well controlled with medications for many years. Currently there are approximately 9,000 people in Ireland and 120,000 in the U.K living with the condition. Based on health statistics, it is estimated that the incidence of PD will double over the next thirty years as the ageing population increases.

The condition is characterised by degeneration of the nerve cells in the part of the brain which is responsible for controlling movement, called the Substantia Nigra. These cells normally produce a chemical called Dopamine which relays signals to other parts of the brain to produce movement. Dopamine levels become depleted as we get older but in Parkinson’s disease this happens at a faster rate. It is when 60-80% of the dopamine-producing cells are damaged that the symptoms of PD manifest.

What are the symptoms?

As PD is classed as a movement disorder, the most obvious symptoms are those relating to motor function i.e. movements throughout the body. The most common symptom is an involuntary resting tremor, normally seen in one hand or foot. Slowing of movements called Bradykinesia is also typical of PD and will affect an individual’s ability to carry out daily activities, such as walking or dressing, at a normal speed. The secondary effects of bradykinesia include a shuffly or festinating walking pattern with intermittent episodes of “freezing”. Freezing can be described as a temporary inability to initiate movement where your feet may feel stuck in place or you may have difficulty rising from a chair. Freezing is a common cause of falls in people affected by PD.

Rigidity or stiffness of the arms, legs or trunk caused by an increase in muscle tone is a third common symptom which can significantly impact on your ability to perform simple tasks such as getting in and out of bed independently. In the later stages of the disease, postural instability may lead to problems with balance and falls. All of these motor symptoms impede the generation of controlled and coordinated movements required to carry out all activities of daily living.

 

Other symptoms

 

  • Micrographia- small handwriting
  • Hypophonia- low, monotonic or muffled speech
  • Loss of facial expression
  • Mood disturbances (Anxiety/depression)
  • Sleep disturbances
  • Swallowing difficulties
  • Constipation
  • Postural hypotension

Who is affected?

PD may only become evident in the later decades of life as the condition progresses. Typically the average age for onset and diagnosis is 60, however, It is possible for PD to develop as young as 40 at which stage it is referred to as Young-onset PD. PD can affect both men and women but is more commonly seen in males for unknown reasons.

What are the causes?

The exact causes of PD are not well understood and research continues in this area. The most common type of PD is idiopathic (of no known cause), however, there is thought to be a link with environmental and genetic factors in atypical cases. Exposure to industrial chemicals, pollutants, pesticides and heavy metals has been shown to have a weak association while a family history or mutations to specific genes have been found in a small percentage of cases.

Pharmacological Management

The mainstay of all treatment for PD is through pharmacological means i.e. drug therapy. Each individual will be placed on a specific drug regime to give optimal control of symptoms throughout the day and to minimise “off” periods. An “off” period is a state of reduced mobility when the medications have least effect. Fluctuations in motor control.

Drugs for use in Parkinson’s act to temporarily increase the dopamine levels in the brain or to mimic the effect of dopamine. Levodopa, Dopamine agonists and MAO-B inhibitors are among the common drugs used in PD. Although Medications are the most effective method for controlling the symptoms of PD, several therapies are beneficial for the long-term management of the condition.

Physiotherapy Management

Physiotherapy is a vital component of the long- term management of PD. National clinical guidelines recommend that Physiotherapy is incorporated into any multi-disciplinary management plan for PD.

It can specifically address the movement related characteristics of the condition with the aim to maintain mobility and balance and maximise functional independence and quality of life.

Physiotherapy will focus on mobilising joints that have become stiff to help regain normal movement, particularly in the trunk. Exercises to improve the flexibility of tight muscles will also help towards moving more freely. A gentle stretching programme may form part of your treatment plan. Posture re-education is a key component to prevent the stooping posture seen in PD sufferers. Restoring postural stability will also have a subsequent effect on balance, however, specific balance re-training will form an important part of the programme.

Aside from dealing with problems with mobility, flexibility, posture and balance, physiotherapy will focus more specifically on the daily activities you are struggling with at home whether it is getting in and out of bed, climbing stairs, rising from a chair or walking the dog. It is important to incorporate this more functional approach to rehabilitation to make it more meaningful to you and to achieve the greatest gains from your treatment. The Physiotherapist can advise you on how best to carry out these tasks, simplifying where necessary. An occupational therapist may also be involved at this stage to provide assistive devices in the home to help with certain activities.

Lastly, the Physiotherapist will assess and retrain your walking pattern with or without the use of mobility aids to optimise safe and independent ambulation around your home and community. Where difficulties with turning or “freezing” are evident the Physiotherapist may advise on different coping strategies such as auditory or visual cues to alleviate these issues.

Other health professionals such as an Occupational therapist, Speech and Language therapist or dietician may be beneficial to you. Your GP or Parkinson’s nurse will recommend what is best for you and make a referral as required.

If you suffer from Parkinson’s disease and are experiencing difficulties with day to day activities, or if you have a recent diagnosis and would like advice on how to cope with and manage your condition at home, then the Physiotherapists at Portobello Physiotherapy can help. We will perform a thorough interview and assessment to see how Parkinson’s affects you and tailor a customised management plan to keep you healthy and active as your disease progresses.

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