Parkinson's Rehabilitation

Welcome to FYZICAL Ballantyne’s patient guide for Parkinson’s Disease Rehabilitation.

What is Parkinson’s Disease?

Parkinson’s Disease, or sometimes just called Parkinson’s or PD is a chronic degenerative disorder of the nervous system. It occurs when a system in the midbrain (substanstia nigra) which produces the chemical called dopamine, stops producing this chemical. It is still unknown why the cells stop producing dopamine. The chemical dopamine is required in the body for many things including coordination, mood, memory and motivation. It is interesting to note that usually by the time someone is diagnosed with PD, around half of the dopamine-making cells have already died.

There is no single symptom that determines that one has PD. Nor is there one single test that is used to delineate that you have the disease. Everyone who is diagnosed has a unique disease but there are a constellation of signs and symptoms that can develop which cumulatively point to the suspicion of PD. The most common signs and symptoms are:

• muscle tremors
• postural instability and impaired balance (difficulty remaining upright especially when standing still or rising from a chair)
• difficulty with walking, often taking shuffling (festinating) steps,
• slowness of movements (bradykinesia)
• inability to get movements going (akinesia)
• sustained or repeated muscle cramp (dystonia)
• stiffness of muscle movement (rigidity)
• stooped posture (due to being postural unstable so then subconsciously lowering one’s center of gravity to compensate)
• increased postural sway (body motion when standing still)
• loss of smell
• sleep disturbances; can include sudden movements during sleep
• constipation
• loss of automatic movements such as blinking, or swinging arms when walking
• decline in automatic facial expressions (facial masking)
• drooling
• regular dizziness
• problems projecting one’s voice (only able to speak softly)
• handwriting changes (may become too difficult to coordinate) and/or can become very small (micrographia)
• fatigue
• depression
• loss of motivation
• psychosis episodes (seeing, hearing, smelling items that are not there)

There are several factors that appear to play a role in the development of PD: There are several factors that appear to play a role in the development of PD:

• Age: The biggest risk factor for developing PD is advancing age.  Most commonly people are diagnosed with PD around the age of 60, but your risk for getting PD increases as you age and is considerably more by the time you reach the age of 85. It is uncommon that people are diagnosed before the age of 60, but it does occur, in which case it is termed ‘young onset PD’.
• Sex: It is well supported by data that men are more likely to be diagnosed with PD than women.
• Heredity: Having one or two close relatives who have PD does increase your chances of having PD, however, this risk still remains relatively low unless there are several family members who have been diagnosed.  About 10-25% of people diagnosed with PD have a genetic link; most people with PD have no genetic link. There are some genetic variations that can increase your chance of developing PD but most people with these variations do not develop PD.  Research is ongoing into genetics as an instigating factor for the disease.
• Environmental Factors: Some environmental factors such as air quality or circulating viruses may play a role in instigating the disease; research is ongoing.
• Exposure to toxins: Ongoing exposure to some pesticides, herbicides or other toxic chemicals has been linked to some patients who have been diagnosed with PD. That being said, toxin exposure is likely more of a triggering factor to the development of the disease rather than a sole cause of developing the disease. Research is ongoing.
• Head trauma: There is some evidence to support that repeated head traumas (i.e. boxers) may have an increased chance of developing PD. There is not a causal link as not all people who have suffered several head traumas develop the disease but there is some evidence to link this as a risk factor. Research is ongoing.
• Ethnicity: Data regarding ethnic risk of acquiring PD is ongoing but has some significant gaps in the scope it has covered, and therefore ethnic risk is still difficult to confidently determine. It is known, however, that PD is much more common in Caucasian populations, however, it does appear that those patients of Hispanic or Black ethnicity who acquire PD, have a higher risk of more severe cognitive impairment. 

How can physical therapy for Parkinson's Disease help?

Engaging in rehabilitation is a very important part of living with PD. As stated previously, the goal is not to reverse the effects of PD, but rather to slow down the degenerating effects of any symptoms you may have and maximize your ability and function despite symptoms. Your Physical Therapist will aim to keep you as independent as possible for as long as possible. You may also have other specific lifestyle goals that your Physical Therapist can help you with.

Regular exercise is important for anyone but it has been shown to be particularly effective in people living with PD as it can affect how efficiently dopamine is used in the brain.

Every PD journey is different so your Physical Therapist will focus on developing an exercise program for you that minimizes the effects of your specific symptoms. Exercise for PD will include a combination of exercises for strength, balance, endurance, flexibility and coordination. Several methods of exercise may be used by your Physical Therapist to develop and individualize a program for you:

Cardiovascular (aerobic) exercise: Several studies have shown the benefits of high intensity exercise slows the general aging of the brain in anyone (high intensity exercise is defined as exercise that raises your heart rate and makes you breathe heavier).  In patients with PD, high-intensity aerobic exercise has also been shown to slow down motor skill degeneration, protect against depression, and improve quality of life. 

Your Physical Therapist can advise you on what type of high intensity exercise might be best for you, how much, and how often.  The general thought overall is that the more cardiovascular exercise you can do, the better!  That being said, even small amounts count!  As a guide and to have something to aim for, one study showed that 2.5 hours of physical activity per week slowed the decline in quality of life in people living with PD. It is wise to choose something that you enjoy doing as it has also been shown that consistency is the key; more benefits have been shown with exercise programs after 6 months versus those that just last weeks or a few months.  

Strength training: Using weights can be very beneficial to improve strength, particularly lower body strength, which has a direct effect on one’s ability to balance. In addition, both upper and lower body strength training has been shown to help decrease slowness of movement (bradykinesia) that may be a symptom for some, and can improve the ability to more easily do regular daily activities.

Balance, posture and fall prevention:  As noted earlier, the lack of dopamine affects the ability to initiate or continue movements. Sometimes it is difficult to start a movement (akinesia), or movements are slow (bradykinesia).  Often movements that are normally automatic are also affected such as blinking, swallowing, walking while talking, or arm swinging with walking. Patients with PD may have to be reminded to continue these types of movements.

A change in the ability to initiate movements or having slower or less automatic movements can directly affect one’s posture and balance.  This can in turn increase one’s chance of falling. It has been well proven that balance can improve with training! For this reason your Physical Therapist will work on posture and balance exercises with you. They will also discuss strategies to make your home and your regular activities less risky for falls.

Movement strategy training: Different types of movement training can assist with maintaining regular motion and regulating automatic movements. Your Physical Therapist may work on reciprocal training, which aims to reintegrate the normal reciprocal movements such as arm swinging and trunk rotation with walking. It has also been shown that training with oversized movements, such as exaggerated arm or leg swings, or using extra-large steps when practicing can then help maintain the smaller, similar movements that are normal with everyday activities. Your Physical Therapist may also actively train by practicing two tasks at once (dual-task training) such as walking and carrying a cup of water, walking and talking, or walking while doing mental tasks. Using mental imagery to imagine the perfect movements may also be used to assist your rehabilitation.

Other exercises and group exercise: Other specific activities such as dancing, non-contact boxing, tai chi, qi-gong, biking, and yoga have all been shown to have positive effects on the symptoms of PD, so your Physical Therapist may incorporate these activities into your exercise routine.  In addition your Physical Therapist may encourage you to partake in a group exercise or support group. It is well proven that group activities can positively benefit one’s overall well-being; this is true also for PD. 

Other Interdisciplinary Team Therapy

Your Physical Therapist may suggest that you also work with other health care professionals in order to best address your rehabilitation needs.  They may suggest you see an occupational therapist (OT) who can more finely address your activities of daily living such as getting dressed, bathing or showering, writing, cooking and any other activities of daily living that you may be having difficulty with. They can also assist greatly with advising any home modifications to reduce falls risks, or provide support to foster independence. 

Your Physical Therapist may also encourage you to see a speech language pathologist (SPL) if you have symptoms of poor voice projection, speech difficulties, swallowing concerns, diminishing facial expressions and/or communication problems.

Physical Therapy services at FYZICAL Ballantyne can help you manage your Parkinson’s  Disease; we will assist you to maximize your functional potential and delay any physical declines as long as possible.