Parkinson's Disease

Background

Overview and symptoms

Parkinson's Disease (PD) is a progressive neurological condition meaning it is a condition affecting the neural system (specifically the brain) that progresses over time. In PD, certain nerve cells, or neurons,  in the brain gradually die. In particular, the cells that die are located in a certain area of the brain called basal ganglia. Those cells are responsible for producing a chemical messenger in the brain called dopamine which is responsible for relaying messages throughout the brain. By relaying those messages, dopamine helps a person to begin movements and speech among other functions.

In PD, the cell death in the basal ganglia causes a decrease in the amount of dopamine available in the brain. Consequently, the brain isn't able to work as it needs to and the person will experience difficulties with initiating and completing movements among a wide range of other symptoms, some of which are listed below. Presentation in Parkinson's Disease vary greatly from person to person and you may experience only a few or a multitude of symptoms.

POSSIBLE SYMPTOMS IN PARKINSON'S DISEASE- you may experience a few or a number of those

Slow movements (bradykinesia)

Tremor

Muscle stiffness (rigidity)

Impaired balance and posture

Difficulty initiating movements

Loss of automatic movements (i.e. smiling, blinking, swinging arms)

Difficulty with dexterity (i.e. writing, doing up buttons and shoe laces)

Cramps and restless leg

Sleep disturbances

Fatigue

Blood pressure changes

Speech changes

Swallowing difficulties

Chewing and eating difficulties

Loss of sense of smell and taste

Bladder and bowel dysfunction

Depression and emotional changes

Sexual dysfunction

Thinking difficulties

 

How physiotherapy can help

Exercise for PD and strategies

Physiotherapy can help an individual with Parkinson's Disease in two main areas, namely exercise therapy and compensation 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

Because PD is a condition affecting the brain, the best types of exercises are the ones that are able to target the brain specifically for PD. A number of studies have investigated the effects of exercise on the brain in people with PD, in healthy individuals and in animal studies. Emerging from these studies is the notion that exercise has neuroprotective and neuroregenerative properties meaning exercise can protect the brain and help the brain to optimally function. As a result, exercise may lead to improved motor and cognitive functions. Specialized physiotherapy input that incorporates exercise for PD principles has the potential to slow down the progression of symptoms and to significantly improve your function. In particular, the earlier you start PD specific therapy the more effective it will be.

When specifically looking at what exercise a person with PD should do, there a three main components to look at: the exercise should be enjoyable, it should be intensive and it should provide a cognitive challenge.

Exercise should be enjoyable because it needs to be performed a minimum of 3/week (with the most benefits at 6/week) for 30 min/day and it should be intensive, so it is going to be hard work. This being the case, you need to find something you enjoy that you will be able to sustain, perhaps build a routine or have variety, have a support network such as an exercise group or a club or have something you can do with your spouse, family or friends.

Exercise should be intensive to lead to the most benefits in the brain, specifically targeting deficits caused by PD. This is key. This is the point you need to take away. High intensity exercise, where safe, is what will make the most difference. Everyone is different and you need to make sure you have a program that is safe for you and should consult a professional before undertaking this type of activity.

Exercise should also be providing mental challenges to have even more beneficial effects. Any exercise that you have not done before will be challenging your brain. However, t is also important to maintain the challenge. For example, if you have been doing running sprint training for a while and this is no longer a novel practice for you, you may add obstacles or you may start playing tennis where you will be continually challenged by having to follow the tennis ball. Dancing is another example where you will need to be focused on each step whilst completing the activity. 

Exercise therapy may also include less specific neurological physiotherapy input to strengthen certain muscles or movement patterns and optimize function. Two common examples are improving the movement and positioning of the shoulders to limit neck and shoulders pain and to strengthen the hip muscles to allow for better walking and balance.

COMPENSATION STRATEGIES

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 PD

As you can see, the treatment of PD from a physiotherapy/physical point of view requires a comprehensive understanding of the pathology of PD and 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 PD since 2014 in metropolitan and regional Australia. She has completed the PD Warrior training and participated to PD 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 Victoria, Aus. 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 PD is to establish lifelong programs and changes, the first few sessions include a lot of education and discussions on what exercise for PD is, what it involves, how to implement it and how to progress it to allow you to be as independent and as motivated as possible with the program. PD specific group sessions are also offered once you are comfortable with your program to help you maintaining your exercise regime whilst being supported by others within the community.