By Karolina Kozlova, PT, DPT
What causes Parkinson’s Disease (PD)?
Parkinson’s disease is caused by loss of a neurotransmitter called dopamine that’s produced deep within an area of your brain called the basal ganglia. This chemical helps control movements. With the diagnosis of PD, first symptoms typically include tremors (shaking), muscle stiffness, and slow movements especially demonstrated by short steps (shuffling gait) and decreased arm swing.
Diagnosis/functional limitations summary
Diagnosis of PD is conducted by a neurologist who performs a detailed examination of movement, muscle tone, gait, balance and looks for abnormalities in posture or expression and presence of tremors or stiffness. With prescription of dopaminergic medications (to replace the missing dopamine), your physician can comprehensively assess the effect of medication and track progress.
Functionally, a patient with PD can demonstrate poor posture, complain of neck/back pain, have poor balance and increased fall frequency, have increased fatigue and difficulty with activities of daily function such as standing from a chair or moving in bed.
Recommended activity levels/precautions
With physical therapy, patients with PD can achieve better posture, balance, walking and overall function. In early stages, it is recommended that patients engage in aerobic exercises (walking, stationary bike) as well as stretching, strengthening and range of motion activities.
Most recent evidence to support exercise
There is strong evidence that supports physical therapy to address improvement of physical function, especially with aerobic exercises, as it showed immediate beneficial effects in improving motor activity, balance and gait in patients with PD. However, there is no evidence of follow-up effects, hence if a patient does not continue to engage in exercises post therapy, function will most likely decline over time. There is also recent evidence that modalities such as visual and auditory cues are beneficial for patients with PD who experience freezing of gait.
Breakdown of types of exercises that will be addressed with therapy
In addition to stretching/strengthening and postural activities, sessions will address walking, turning and balance. Episodic “freezing”, frequent falls and tools to address speed and size of movement as well as home safety will also be addressed. All programs are individualized based on need that is evaluated at the start of therapy via functional outcome measurements that have strong supporting evidence to help asses gait speed, freezing of gait, fatigue, endurance, functional balance, cognition, and overall level of activity limitations. Outcome measures are periodically re-assessed as treatment progresses. Most PD programs will include training to increase speed and quality as well as amplify the size of movement in order to give the patient and/or caregiver the skills to help maintain gains made during duration of therapy.
Summary of progression/therapy expectations/outcomes
Upon evaluation, depending on functional limitations and needs, therapy may require 1- 3 high-intensity training sessions/week up to 3-4 months, depending on progress and recovery. Most individuals who engage with therapeutic exercises can improve their mobility, walking speed, balance, and overall functional movements with consistent daily engagement via a customized home exercises program. Since PD is a progressive neurodegenerative disorder, a lifelong commitment to exercises is important to help maintain your functional mobility and allow for greater duration of independence.
Karolina Kozlova, PT, DPT, is a Board Certified Neurologic Clinical Specialist with advanced training in neurological and vestibular disorders. If you or a loved one is suffering from Parkinson’s Disease or other neurological condition, call our office today and schedule an appointment with Dr. Kozlova. 603.644.8334
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