The first signs of Parkinson’s disease are often subtle — a slight tremble of a hand or a stagger of a foot — however, eventually the disease has more of an effect. As the disease progresses, patients typically have difficulty walking, talking or performing simple tasks, leading to challenges with daily activities and routine. Physical therapy is a vital component of the overall treatment plan for Parkinson’s disease. Beyond preventing falls, physical therapy preserves an active lifestyle.
“Physical therapy empowers Parkinson’s patients to do what they can for themselves,” said Brian Schulz, a physical therapist with Penn State Orthopaedics in State College. “The more exercise they do, the better they feel and the more active they are.”
The disease itself
Parkinson’s disease is a chronic movement disorder involving the malfunction of nerve cells in the brain causing various symptoms:
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▪ Tremors (usually in hands or feet) that are worse when the muscles are at rest
▪ Rigidity or stiffness in muscles, leading to a smaller range of motion
▪ Bradykinesia or “slow movement,” which also can affect speech
▪ Postural instability, making it difficult to maintain balance when standing
Individuals most often diagnosed are typically at least 60 years old and show symptoms during traditional physical exams. Tests help to rule out other causes for symptoms, such as medication side effects.
A progressive disease, Parkinson’s slowly worsens over time. No cure exists, although medications and lifestyle changes can lessen or slow the progression of symptoms for some patients.
“Eating well, getting enough rest and exercising — those are three aspects patients can control to make a difference in living with Parkinson’s disease,” Schulz said.
Physical therapy for a stronger lifestyle
As Parkinson’s progresses, the patient’s stride typically evolves into a shuffle, with the upper body bent forward.
“The body stiffens, so the individual moves less, which leads to even more stiffness,” Schulz said. “It becomes a vicious cycle.”
Physical therapy helps patients extend their stride, increasing shoulder range of motion and improving spinal flexibility using specific exercises shown to be helpful:
▪ Trekking poles — one in each hand — to gain a greater range of motion while walking
▪ Building or maintaining speed on a stationary bike
▪ Use of dumbbells to build strength and torso mobility
▪ Yoga or tai chi for flexibility and strength
▪ General stretching exercises as part of a daily routine
In addition to preserving an active lifestyle, physical therapy also helps Parkinson’s patients stay safe as their mobility lessens.
“A big concern is the risk of falling, which can cause serious injuries,” Schulz said.
When Parkinson’s disease progresses to the point where walking becomes difficult, many primary care physicians and neurologists refer patients to physical therapists for advice on ambulatory assistance devices, such as canes or walkers. With a therapist’s help, a patient can test different devices and determine which one is most appropriate before making a purchase.
“They often fight against it, saying, ‘I don’t need this; I can walk without it,’ ” Schulz said. “But if a device keeps a patient safe so they never fall again, that is a huge positive.”
Physical therapists also advise family members about how they can assist their loved one who has Parkinson’s disease.
“Often, the best help they can give is a simple reminder, such as to swing your arms or pick up your feet while walking, or to stand up straight while brushing your teeth, rather than bending over the sink,” Schulz said.
By accompanying Parkinson’s patients on walks or during other forms of exercise, family members help to ensure that the physical therapy plan continues at home as prescribed.
“Once you get patients moving and active, that gets carried over for a long time,” Schulz said. “They can get around better in their home activities, and they might maintain function longer than they would have without exercise and physical therapy. Many Parkinson’s patients function very well for many years and stay involved with their family activities.”
Tracey Dooms is a freelance writer for Penn State Health.