General Information

Although medication therapy is generally effective in the clinical management of Parkinson's disease (PD), additional improvement of some gross motor symptoms may be achieved through the use of nonpharmacological treatments, such as physical therapy and exercise rehabilitation. Despite the fact that PD is a neurological disorder, successful rehabilitation has been demonstrated with treatments that combine cognitive and physical approaches. While the exact mechanism through which these therapies obtain successful outcomes is still largely unknown, it is worthwhile to explore these adjunctive approaches to treating the motor output symptoms of PD.

What can the physiotherapist do to help someone with Parkinson’s?
Physiotherapists are trained to provide an assessment to see how Parkinson’s affects the individual. This can be done with newly diagnosed, as well as those who have been diagnosed for some time. In the earlier stages, the emphasis of treatment will be mainly focused on understanding the condition and how a person might keep up their own general levels of fitness and maintain independence for them. In the later stages of the disease, the emphasis will include a support network for the individual, involving the family and carers as part of the treatment. The assessment will indicate to the physiotherapist what combination of education and intervention is required, some examples of which are listed below:

• Teach techniques that help make some automatic movements easier. For example, the activities of walking, sitting down and standing up are some of the tasks that may become difficult as Parkinson’s progresses, but can be improved by learning new ways of doing things.

• Help the patient to maintain independence in his daily life if he is having difficulty with certain actions, such as getting up out of a chair or turning in bed. The physiotherapist may visit your home and be able to teach the patient a different way of doing the action, or could give advice on aids and adaptations that might be of use. (In many places, it is the occupational therapist that deals with this sort of problem.) The PDS recommends that advice is sought first from a physiotherapist before patient buys any piece of equipment, as no two individuals with Parkinson’s are quite alike, and what might benefit one person might be unsafe for another. See the PDS information sheet, Equipment and Disability Aids and PDS leaflet Occupational Therapy and Parkinson’s.

• Work on stiff muscles and joints to maintain a posture, keep your joints flexible and help relieve the effects of rigidity that might occur. This will help to make patient’s actions more smooth and efficient. The physiotherapist can also teach patient and his carer to do this.
• Improve or maintain muscle strength by the use of general or specific exercises, or by providing an exercise programme for the patient to follow in the hospital, or at home. A physiotherapist may help to maintain the patient’s level of fitness or advise you take up a sport, such as golf or swimming, or a class like yoga or tai chi, where the additional benefits of relaxation help to decrease stress that can worsen the symptoms of Parkinson’s.

Parkinson's Disease

Parkinson's disease is a progressive disorder of the central nervous system that affects movement, muscle control, and balance. It is part of a group of conditions known as motor systems disorders. Parkinson's disease was named for James Parkinson, a general practitioner in London during the 19th century who first described the symptoms of the disease. Symptoms describing Parkinson's disease are mentioned in the writings of medicine in India dating back to 5000 BC as well as in Chinese writings dating back approximately 2500 years.

The hallmark symptoms of Parkinson's disease are asymmetric tremors at rest (tremors affecting a limb on one side of the body), rigidity, and bradykinesia (slowness in movement). There is currently no cure for Parkinson's disease; it is always chronic and progressive, meaning that the symptoms always worsen over time. The rate of progression varies from person to person as does the intensity of the symptoms. Parkinson's disease itself is not a fatal disease and many people live into their older years. Mortality of Parkinson's disease patients is usually related to secondary complications, such as pneumonia or falling.

According to the American Parkinson's Disease Association, there are approximately 1.5 million people in the U.S. who suffer from Parkinson's disease which is approximately 1% of the people over the age of 60. Approximately 50,000 new cases are diagnosed annually. That number is expected to rise as the general population in the U.S. ages. Onset of Parkinson's disease before the age of 40 is rare. All races and ethnic groups are affected.

There are three types of Parkinson's disease grouped by age of onset:

· Adult Onset Parkinson's Disease - This is the most common type of Parkinson's disease in which the average age of onset is approximately 60 years of age. The incidence rises noticeably as people advance in age into their 70's and 80's.

· Young Onset Parkinson's Disease - The age of onset is between 21-40 years of age. Though the incidence of Young Onset Parkinson's Disease is very high in Japan (approximately 40% of cases diagnosed with Parkinson's disease), it is still relatively uncommon in the U.S., with estimates ranging from 5-10% of cases diagnosed.

· Juvenile Parkinson's Disease - The age of onset is before the age of 21. The incidence of Juvenile Parkinson's Disease is very rare. Parkinson's disease can significantly impair quality of life not only for the patient but for their family as well, especially the primary caregiver. It is therefore important for caregivers and family members to educate themselves and become familiar with the course of Parkinson's disease and the progression of symptoms so that they can be actively involved in communication with health care providers and in understanding all decisions regarding treatment of the patient.