Parkinson’s Disease

Parkinson’s is a neurological condition in which the brain function becomes gradually more impaired. The main cause is thought to be a loss of the chemical called dopamine that helps to regulate the body’s movements.

The main motor (movement) symptoms are bradykinesia (slow movements), tremor (involuntary shaking of parts of the body) and rigidity (experienced as muscle stiffness). Symptoms that aren’t specifically related to your movement can include disturbed sleep, altered mood, changes to the way that you process thoughts and to your speech and memory, as well as to some physiological processes such as swallowing.

The cause of the main type of Parkinson’s (called idiopathic) isn’t known, but most experts believe that both genetic and environmental factors are involved. Other types of Parkinsonism can be caused by a series of mini strokes, by certain drugs or by trauma.

Diagnosis can be difficult because of the wide variety of symptoms, but is usually based upon the bradykinesia and any of the other symptoms, the results of brain scans and sometimes by seeing how the person responds to drug treatment. In some cases, an individual may have just one or some of the symptoms and so is treated as having Parkinson’s – this is sometimes referred to as Parkinsonism.

Your Physiotherapist will start by assessing how the condition is affecting you, whether you are newly diagnosed or have been diagnosed for some time. They will carry out a full assessment of what you can do and will discuss your goals. This might include looking at your posture and your ability to reach and grasp objects and to change positions; for example, turning in bed, getting up from a chair and walking. Your Physiotherapist will also look at your general physical activity and endurance. You may be asked to wear shorts and a t-shirt during the consultation so that your movement can be properly assessed.

Physiotherapists can play a vital role in supporting people with Parkinson’s to review their situation, make choices about how their condition is managed and will help you plan how to look after yourself and best manage the life you would like to lead. This can involve giving you information about Parkinson’s and answering your questions about what you are experiencing and what the future may hold. They will discuss your priorities with you and how you plan to manage your condition, offering advice based on your individual needs. Your Physio will problem-solve with you, suggest how you can maintain your physical activity, consider what you need when you are out and about, and teach you and your family and friends strategies to help you move better. The emphasis is on helping you to stay active and safe.

Physical activity is important for strengthening your muscles, improving your mobility and keeping fit. Your Physiotherapist can discuss ways in which you can maintain and develop your fitness as well as suggesting methods of pacing yourself and learning to complete everyday tasks in more efficient ways if required. A regular exercise routine can reduce stress, anxiety and low mood. Evidence also shows that if people with Parkinson’s do enough exercise, their nervous system becomes more efficient at using dopamine (the chemical that is reduced in people with Parkinson’s), helping them to remain physically and mentally active for longer.

Joining a gym that offers a flexible exercise programme, or a local self-care group, or a course to help cope with Parkinson’s is a good way to get out of the house, find new friends and put in place an important strategy for managing some of the symptoms. Ask your healthcare professional about what is available locally.

As you get older, and as the condition progresses, some of the symptoms of Parkinson’s can have a bigger impact on your day-to-day life. Your Physiotherapist will support you in making decisions about how you cope with these changes. Again, the emphasis is on helping you and your support network to make decisions about the best way to keep you active and safe.

Weight fluctuations are common in Parkinson’s as some foods can affect how your medication is absorbed. It’s important to maintain a balanced, nutritious diet, but you may need to adjust the time you eat and the time you take your medications. Parkinson’s UK has detailed advice on eating well and also about the medications you may be prescribed.

Your Physiotherapist will create a personalised home exercise plan which may include exercises to prevent falls, to maintain your balance, and, improve strength and flexibility. Resistance training will help keep your muscles in shape for activities that require strength; for example, strength in your legs to climb stairs and walk up and down hills, and in your arms to carry items such as shopping bags. Physiotherapists are highly skilled in exercise prescription and will provide you with a progressive exercise plan that will help maintain and improve your function and strength. Your Physiotherapist will check your progress and will carry out regular re-assessment to ensure your exercise plan remains effective and challenging.

• You will benefit most from seeing a specialist neurological Physiotherapist as early as possible, once your symptoms have been identified and you have been diagnosed. They can help you to stay active and manage your condition.

• Arrange to see your Physiotherapist if you experience new physical symptoms that affect your mobility. Try to remain positive and concentrate on the activities that you can do.

• Find physical activities that you enjoy and do them daily. If you are not used to exercise, use walking as a way to help with balance, stamina and confidence, as well as getting you from A to B.

• Maintaining a good posture will help with your balance and general movement as well as your breathing, voice and swallowing. Monitor your posture and ask your physiotherapist to show you some flexibility stretches to add to your exercise routine.

• Some Parkinson’s UK local groups have group physiotherapy sessions: ask your local group for details and join in. Exercising in company and socialising with friends is good for us all!

Leaflet on evidence and research for Parkinson’s and Physiotherapy – Click here

NICE Guidelines – Click here

Parkinsons UK website – Click here