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Atypical Parkinsonian Presentations


Overview and symptoms

Parkinson's Plus, or Atypical Parkinson's, is an umbrella term for conditions that present with symptoms similar to Parkinson's Disease, however they are separate conditions. Those include:
- Multiple System Atrophy (MSA)
- Progressive Supranuclear Palsy (PSP)

- Corticobasal Degeneration (CBD)

Those conditions are progressive neurological conditions meaning they are conditions affecting the neural system (in particular the brain) that progress over time. Often those conditions are diagnosed as Parkinson's Disease at first as the initial presentation can be very similar. However, as time goes on, the development and progression of symptoms will indicate the condition is not in fact Parkinson's. One of the features of the above conditions is the limited response to Parkinson's medications. Some of the characteristic features of each are:


In MSA, the autonomic nervous system (the part of the nervous system that controls internal functions such as heartbeat, blood pressure, bladder and bowels and digestion) tend to be affected more than it does in PD.

Symptoms include: 

  • Slowness, stiffness, and walking and balance problems

  • Clumsiness and incoordination

  • Slurred speech

  • Low blood pressure, constipation and bladder problems

  • Difficulty controlling emotions (laughing or crying at inappropriate times)

  • Acting out dreams (REM sleep behavior disorder)

  • Breathing problems, especially at nigh


PSP causes movement symptoms, eye movement problems, and memory and thinking changes. The main symptoms include: 

  • Walking and balance problems

  • Falling backward

  • Slurred speech and swallowing problems

  • Difficulty moving the eyes down (or up), which can cause blurred vision and difficulty reading

  • Mood problems, such as depression

  • Behavioral changes, such as lack of motivation


CBS typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space.

Symptoms include:

  • Slowness and stiffness

  • Dystonia (muscle contractions causing abnormal postures such as an inward turned hand )

  • Myoclonus (rapid muscle jerks)

  • Difficulty paying attention or concentrating, or other cognitive changes 

  • Language problems, such as trouble finding words or speaking in full sentences

  • Behavioral changes, such as acting or speaking crudely


How physiotherapy can help

Exercise for Atypical PD and strategies

Just as MSA, CBD and PSP don't respond to PD medications as much as PD does, those conditions don't respond to exercise as much as PD does. However, there are still two main areas physiotherapy can assist with namely exercise therapy and compensatory strategies. Because every individual is different and every situation is different, you should always seek expert advice from a qualified therapist. What is included below should only be taken as informative rather than guide you through an exercise program.


Exercise therapy may include input to improve strength, balance, flexibility, posture, breathing and many other impairments. This also aims at decreasing risks of other complications such as falls, pain and stiffness, pressure areas and chest infections. You can expect to notice some improvement particularly by increasing strength and balance if those were in fact issues you experienced, however the gains won't be as pronounced as for PD.


Physiotherapy can assist in adapting your movements in order for you to still be able to effectively complete a task. There are a range of strategies specific to PD that will assist you with mobility, especially with things like moving and rolling in bed, coming to standing, initiating walking, turning especially in confined spaces or walking through doorways.

Physiotherapy also assists with recommending assistive devices to optimize movement, function and to complement rehabilitation. Examples include braces, mobility aids, postural supports and orthotics or referral to other specialized services such as orthotists or occupational therapists.


What we offer and how we can help

Neuro Spark Rehab services for Atypical PD

As outlined, the effects of physiotherapy on these conditions is not as pronounced as with PD, however exercise is still beneficial. The treatment of those conditions from a physiotherapy/physical point of view requires a comprehensive understanding of the pathology of its symptoms, a thorough ability to help individuals implementing and sustaining a lifelong program with support and motivation and a good network of practitioners and groups given the number of specialized practitioners that may be involved in your care at one stage or another (i.e. neurologist or geriatrician, movement disorder nurse, occupational therapist, speech therapist, nutritionist or dietitian, counsellor, etc...).


Anna has been involved in the development and implementation of programs for movement disorders since 2014 in metropolitan and regional Australia. She has completed the PD Warrior training and participated to movement disorders international conferences and summits which lead to a strong shift in practice with a strong focus on improvement and rehabilitation.

Anna is a committee member of the Darnley Montgomery Foundation in Shepparton and has been involved with a number of support groups in Vic. Anna also has a strong local network having worked with Dr Arup Bhattacharya and Sheree Ambrosini in their roles working with individuals with movement disorders in the Goulburn Valley as well as with numerous allied health and health care clinicians.


The services that we offer will of course be tailored to your needs. Because the best way to have an impact on your condition is to establish lifelong programs and changes, the first few sessions include a lot of education and discussions on what exercises are best and how to implement them to allow you to be as independent and as motivated as possible with the program. PD specific group sessions are also offered and individuals with a diagnosis of a Atypical Parkinson's are also encouraged to attend if interested to help maintaining an exercise regime whilst being supported by others within the community.

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