Physiotherapy and Parkinson's disease

Physiotherapy and Parkinson’s Disease

Mary Connell
Senior Physiotherapist,
Mullingar Community Rehabilitation Team


This article contains many practical suggestions that might help you as a patient or carer, in many different activities that make up your day!

The main areas in which physiotherapists help people with Parkinson's Disease are:
· posture,
· range of movement,
· walking and turning,
· balance and
· transfers.


Safe and effective performance in these areas is a basis for all activities in daily life.

To check or correct a stooped posture, try standing with your back against a wall, heels touching the wall then try to get your shoulder blades back against the wall and tuck your chin in so that the back of your head touches the wall. Or try facing the wall, with your feet a few inches back from the wall, place hands overhead , palms on the wall and lean into it – hold the stretch for 20 to 30 seconds.

To improve function during transfers, try thinking about the task before you do it. Turning off the television or radio may also help your concentration.

Break the movement sequence down into simple parts and try to memorise these parts, e.g. to sit down in a chair,
· first walk right up to the chair,
· turn around,
· place hands on arms of chair,
· lean forwards,
· and then sit down ;

or to move over in bed,
· first bend both knees,
· then raise your hips,
· and then move across.

Doing only one task at a time, and visualising the ideal movement, can also help. Cue cards (pieces of card with simple instructions eg 1-2-3 UP) placed on walls or furniture at eye level or higher can act as a visual cue.
TOP

Common problems with walking include
· festination or shuffling (this is made worse by a stooped posture), where steps become shorter and you have to take lots of quick steps to stop you from losing your balance because your centre of gravity is too far in front ;
· freezing, where the feet get stuck to the ground and knees may be flexed and heels are off the ground;
· getting started and turning can also be problematic for some.

To help overcome these difficulties, focus only on walking:
1. Try to concentrate on taking long steps, placing heels down first (saying to yourself – HEEL – HEEL with each step can help).
2. Eliminate sharp turns in the environment. When you have to turn, keep the feet apart and turn in a semicircle, always moving in a forwards direction.
3. The use of rhythm (a tape or CD with a catchy beat, or a metronome) can help you get started and to keep going.
4. Visual cues such as lines or tiles on the floor, or a strip of tape at a doorway can help prevent freezing.
5. A laser pointer aimed at the ground a few feet ahead of you can also help you to keep moving, or point it at the ground just in front of you and try stepping over it if you get stuck.
6. If you feel yourself starting to freeze, stop walking, put your heels to the ground (don't lean backwards), straighten your knees, stand tall and when you're ready start off again.
7. If you can't get started try rocking gently side to side, march in place first or take a step backwards followed by a quick step forwards.

If necessary, physiotherapists can provide mobility aids.
· Wheeled frames tend to help the flow of movement.
· Baskets and trays can often be attached and can eliminate the need to walk and carry items at the same time.

If falls are a problem, a physiotherapy assessment can help determine the cause. In some cases balance activities and strengthening exercises can help to reduce the occurrence of falls. For some people, wearing hip protectors (specialised undergarments with padding over the hip areas) can be useful in protecting the hip bones from fracturing as a result of a fall.
TOP

Exercise is important in helping you manage your condition. Ideally you should try to exercise daily, when your medication,( if you are on any) is peaking.
Exercise will not only help you to keep fit but will improve flexibility, co-ordination, strength and endurance.
It can have added psychological benefits including stress reduction and helping you to feel more positive about yourself, and giving a sense of achievement.

Activities you enjoyed before diagnosis should be continued for as long as is possible or practical. Modifications may be necessary as your disease progresses e.g. substitute cycling an ordinary bicycle for an exercise/stationary bicycle or simple set of pedals (also useful for exercising arms if placed on a table).

Strengthening exercises should emphasise the extensor or antigravity muscles as these become most weakened.
Flexibility exercises should focus on rotation (neck, trunk, hips and shoulders) and stretching the flexor muscles (e.g. the hip flexors - front of hip, hamstrings - back of knee and calf muscles at the back of the leg) , as these tend to become tight.
Facial exercises can also be helpful in improving facial expression.
Breathing exercises aid relaxation and also help maintain good lung function.
Balance activities can also be included in your exercise program.

Exercising in groups can be fun and ideas and tips can be shared, so try to link in with any sessions being run in your area. This can help to keep up motivation and to get feedback on your performance if you are not attending individual therapy sessions.
TOP

Finally, use common sense and don't exercise if you are unwell, are on antibiotics, or if it brings on or increases dizziness. It is best to consult your GP or physician before commencing any new exercise program. If you have any further queries on exercise or physiotherapy contact your local physiotherapy department for advice.

This article contains many practical suggestions that might help you as a patient or carer, in many differe

Safe and effective performance in these areas is a basis for all activities in daily life.

To check or correct a stooped posture, try standing with your back against a wall, heels touching the wall then try to get your shoulder blades back against the wall and tuck your chin in so that the back of your head touches the wall. Or try facing the wall, with your feet a few inches back from the wall, place hands overhead , palms on the wall and lean into it – hold the stretch for 20 to 30 seconds.

To improve function during transfers, try thinking about the task before you do it. Turning off the television or radio may also help your concentration.

Break the movement sequence down into simple parts and try to memorise these parts, e.g. to sit down in a chair,
· first walk right up to the chair,
· turn around,
· place hands on arms of chair,
· lean forwards,
· and then sit down ;

or to move over in bed,
· first bend both knees,
· then raise your hips,
· and then move across.

Doing only one task at a time, and visualising the ideal movement, can also help. Cue cards (pieces of card with simple instructions eg 1-2-3 UP) placed on walls or furniture at eye level or higher can act as a visual cue.
TOP

Common problems with walking include
· festination or shuffling (this is made worse by a stooped posture), where steps become shorter and you have to take lots of quick steps to stop you from losing your balance because your centre of gravity is too far in front ;
· freezing, where the feet get stuck to the ground and knees may be flexed and heels are off the ground;
· getting started and turning can also be problematic for some.

To help overcome these difficulties, focus only on walking:
1. Try to concentrate on taking long steps, placing heels down first (saying to yourself – HEEL – HEEL with each step can help).
2. Eliminate sharp turns in the environment. When you have to turn, keep the feet apart and turn in a semicircle, always moving in a forwards direction.
3. The use of rhythm (a tape or CD with a catchy beat, or a metronome) can help you get started and to keep going.
4. Visual cues such as lines or tiles on the floor, or a strip of tape at a doorway can help prevent freezing.
5. A laser pointer aimed at the ground a few feet ahead of you can also help you to keep moving, or point it at the ground just in front of you and try stepping over it if you get stuck.
6. If you feel yourself starting to freeze, stop walking, put your heels to the ground (don't lean backwards), straighten your knees, stand tall and when you're ready start off again.
7. If you can't get started try rocking gently side to side, march in place first or take a step backwards followed by a quick step forwards.

If necessary, physiotherapists can provide mobility aids.
· Wheeled frames tend to help the flow of movement.
· Baskets and trays can often be attached and can eliminate the need to walk and carry items at the same time.

If falls are a problem, a physiotherapy assessment can help determine the cause. In some cases balance activities and strengthening exercises can help to reduce the occurrence of falls. For some people, wearing hip protectors (specialised undergarments with padding over the hip areas) can be useful in protecting the hip bones from fracturing as a result of a fall.
TOP

Exercise is important in helping you manage your condition. Ideally you should try to exercise daily, when your medication,( if you are on any) is peaking.
Exercise will not only help you to keep fit but will improve flexibility, co-ordination, strength and endurance.
It can have added psychological benefits including stress reduction and helping you to feel more positive about yourself, and giving a sense of achievement.

Activities you enjoyed before diagnosis should be continued for as long as is possible or practical. Modifications may be necessary as your disease progresses e.g. substitute cycling an ordinary bicycle for an exercise/stationary bicycle or simple set of pedals (also useful for exercising arms if placed on a table).

Strengthening exercises should emphasise the extensor or antigravity muscles as these become most weakened.
Flexibility exercises should focus on rotation (neck, trunk, hips and shoulders) and stretching the flexor muscles (e.g. the hip flexors - front of hip, hamstrings - back of knee and calf muscles at the back of the leg) , as these tend to become tight.
Facial exercises can also be helpful in improving facial expression.
Breathing exercises aid relaxation and also help maintain good lung function.
Balance activities can also be included in your exercise program.

Exercising in groups can be fun and ideas and tips can be shared, so try to link in with any sessions being run in your area. This can help to keep up motivation and to get feedback on your performance if you are not attending individual therapy sessions.
TOP

Finally, use common sense and don't exercise if you are unwell, are on antibiotics, or if it brings on or increases dizziness. It is best to consult your GP or physician before commencing any new exercise program. If you have any further queries on exercise or physiotherapy contact your local physiotherapy department for advice.