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Parkinson’s Disease

Parkinson’s disease is a degenerative nervous system disorder affecting movement and belongs to a group of conditions called motor system disorders.

It affects an area of the brain known as the basal ganglia which is responsible for regulating movement and coordination.

Parkinson’s disease causes the degeneration of nerve cells in the basal ganglia which causes decreased production of the neurotransmitter dopamine.

The most noticeable characteristic of Parkinson’s disease is tremors or shaking when standing, sitting or lying still.

Parkinson’s disease is both chronic and progressive, meaning that it worsens over time. It may eventually affect other aspects of brain function as the illness progresses.

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 shuffle 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.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 shuffle 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 these motor symptoms negatively affect the generation of controlled and coordinated movements required to carry out all activities of daily living.

Other symptoms include:

  • Micrographic- small handwriting
  • Hypophonia- low, monotonic or muffled speech
  • Loss of facial expression
  • Mood disturbances (Anxiety/depression)
  • Sleep disturbances
  • Swallowing difficulties
  • Constipation
  • Postural hypotension (a drop in blood pressure when going from sitting/lying into standing)

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.

The Role of Physiotherapy in the management of PD
Physical therapy/physiotherapy cannot cure Parkinson’s disease, because at this time, neurological damage cannot be reversed. But therapy can help you compensate for the changes brought about by the condition. These “compensatory treatments,” as they’re called, include learning about new movement techniques, strategies, and equipment. Physical therapy/physiotherapy cannot cure Parkinson’s disease, because at this time, neurological damage cannot be reversed. But therapy can help you compensate for the changes brought about by the condition. These “compensatory treatments,” as they’re called, include learning about new movement techniques, strategies, and equipment.

A physical therapist/physiotherapist can teach you exercises to strengthen and loosen muscles.  The goals of physical therapy are to improve independence and quality of life by improving movement and function and relieving pain. Another goal, is falls prevention and safety. You would also receive guidance and education with regard to safety in the home environment. This could include suggested alterations or the use of assistive devices. When necessary could also conduct a home visit to determine problem areas in terms of accessibility and we could offer solutions/alternatives i.e. assistive devices or alterations.

Physical therapy/physiotherapy can help with:

  • Balance problems
  • Lack of coordination
  • Fatigue
  • Pain
  • Gait/walking pattern
  • Immobility
  • Weakness

 

  • 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, psychologist or dietician may also be included as part of the team.
The Role of Occupational Therapy (OT) in the Management of PD
  • Mobility: This includes helping people with PD concentrate on walking, avoiding all non-essential talking when moving, pausing when speaking, and touching something solid to aid balance while walking and standing. Occupational therapists also teach patients how to change direction without abrupt turns to optimize stability. They may also check for the need of walking aids and home modifications.
  • Prevention of falls: Aimed at reducing the risk of falls, therapists recommend that people with PD pay full attention and concentrate on walking and using alternative equipment when carrying items, such as pockets, diagonal shoulder bags, body belts, or trolleys.
  • Sit-to-stand transfers: Sit-to-stand transfers from chairs, toilets, and the bedside may present difficulties for people with PD. Occupational therapists can provide appropriate strategies such as using suitable worded verbal cues and suggesting equipment to aid transfers including chair risers, riser recliner armchairs, and level-access showers instead of a bath.
  • Bed mobility: The OT trains movement methods for turning over in bed, adjusting a position, and getting out of bed.
  • Posture and seating: The OT helps increase awareness and self-correction of postural problems, assesses the need for postural support, and reviews wheelchair suitability.
  • Eating and drinking: OT can recommend good sitting posture, adequate lighting, and ways to have fewer distractions while eating and drinking. Occupational therapists also assess if modified eating and drinking equipment are required to minimize difficulties.
  • Self-care routines: This helps people with PD whose personal care routines have become slow and tiring, which may increase the risk of falls.
  • Domestic skills: Meal preparations, housework, and shopping may be affected due to loss of coordination and balance, and a reduced ability to multitask. Small items of equipment may be introduced to help promote domestic skills, such as non-slip latex for easier jar opening, lever taps to reduce effort when using taps, and a wire mesh to help drain pans or vegetables. Extra assistance for housework such as ironing, maintenance tasks, and management of paperwork may be required.
  • Fatigue management: People with PD find that they become tired more quickly, which may be due to the effort of staying upright and inefficient movement strategies. Occupational therapists can review routines and help prioritize tasks, restructure activities according to energy levels, and introduce regular resting periods, including good sleep.
  • Handwriting: People with PD tend to have micrographic or handwriting where letters are smaller and sloping toward page corners instead of straight across. Visual or auditory cues as well as sitting comfortably and in an upright position at a table with good lighting may help with handwriting.
    • Occupational therapists may also help with changes in relationship dynamics by promoting the maintenance of normal roles, daily routines, and social habits as much as possible. They provide support to patients to continue working and serve as a link between a patient and the workplace.
    • Occupational therapists also help with social, recreational, and leisure activities, and driving. (People with PD must notify the appropriate licensing agencies and car insurance companies about their condition).
The Role of Speech -Language Therapy (SLT) in the Management of PD
Most people with Parkinson’s disease (PD) will experience changes in speech, voice and swallowing at some point during the disease. The same PD symptoms that occur in the muscles of the body – tremor, stiffness and slow movement – can occur in the muscles used in speaking and swallowing. This can cause the following issues:

  • Soft voice
  • Mumbled or fast speech
  • Loss of facial expression
  • Problems communicating
  • Trouble swallowing

While PD medications help improve many symptoms, they are not as helpful for speech and swallowing problems. Many people report little improvement in speech and voice with changes in medication. Still, some people do report that their voices are stronger when PD medicines are at peak effectiveness. Most people get the best improvement with speech and swallowing when medications are paired with a speech therapy program. Speech-language therapists are trained to evaluate and treat speech, language, memory and swallowing problems. Every person who has speech or swallowing changes associated with PD, whether mild or severe, is encouraged to consult with a qualified speech-language therapist. Early intervention is best to maintain good speech intelligibility and to foster and entrench a safe and effective swallowing/feeding regime. Early intervention helps to prevent complications and setbacks and is far more effective as adaptive methods and skills become well-entrenched sooner.

At Rita Henn and Partners we have therapists who are familiar with the principles of LSVT BIG and LSVT LOUD which are therapy programmes designed specifically to assist with improving and maintaining physical movement and with improving and maintaining speech intelligibility.

How can we help?