Parkinson's disease
It is a common neurodegenerative disorder of later stages of life with generalized slowing of movements called as Bradykinesia, Tremors, rigidity, gait abnormalities, sleep disorders and speech dysfunctions.
The cause of this disease is not really known. However, the disease has been linked to low levels of dopamine and norepinephrine in the body.
People with certain risk factors, such as age and past traumatic brain injury, are more likely to develop the condition.
Additionally, researchers believe exposure to certain toxins, such as pesticides and air pollution can increase the risk.
It does not have a cure, but symptoms may be kept under check by medications and therapies.
Did you know?
Now researchers from the University of Rochester are adding additional evidence by finding a link between Parkinson’s disease and a commonly-used chemical called trichloroethylene (TCE). It is a colorless liquid chemical that does not occur in nature. It is known to have a chloroform-like odor. And is found in: commercial dry cleaning, metal degreasing, cleaning wipes, stain removers for clothing and carpeting, lubricants and spray adhesives.
How can Physical Therapy help?
Aims of Physical Therapy
Improve functional independence and Quality of life
Improve mobility
Correct and improve abnormal movement patterns and posture
Maximize muscle strength and flexibility
Promote good breathing pattern
Address gait abnormalities
The Review version of the European Physiotherapy Guideline divides physiotherapy intervention for Parkinson’s into:
1) Exercise and
2) Movement strategy training.
During the earlier stages of diagnosis, greater emphasis must be placed on education and self-management. The individual should be encouraged to continue being active and participate in physical exercise for as long as possible.
Attention must be given to monitor and manage respiratory muscle weakness and thoracic cage rigidity.
Exercise
Maintains health and well-being in Parkinson’s,
Focuses on strength, endurance, flexibility, functional practice and balance
Exercises for neuroprotection is the choice.
It focuses on endurance and uses motor learning principles approaches
Aerobic exercises can slow down motor skill degeneration and depression and thus improve the quality of life..
Resisted exercises like cycle ergometer, weight machines, therapeutic putty, elastic and, weight cuffs. Strength training can also improve physical parameters such as balance, gait, and physical performance.
Training with motor-cognitive dual-task training improves dual-task ability and might improve gait, balance and cognition.
Progressive Resistance Training (PRT) to be effective in decreasing bradykinesia and improving functional performance in patients with mild-to-moderate Parkinson's Disease.
Dancing and Pilates are also other effective methods just like exercise programme to help PD patients improves balance and mobility.
Movement strategy training:
Music -based therapy combined with cognitive movement strategies, cueing techniques, balance exercises and physical activity helps the patient in focusing on enjoying the movement and not the limitations and has been helping patients that regular standard exercises.
External cueing and attention helps in improving step length, freezing and turning during walking tasks, and in activities of daily living.
Motor learning with cued functional and dual task training, compensatory strategy training uses external cues, self-instruction and attention are strategies will benefit. Eg, visual, auditory and proprioceptive cueing and attention.
As per studies, passive therapies like transcranial stimulation, active therapies like cognitive or physical and transient effect therapies like auditory, visual or proprioceptive cueing helps in addressing the freezing of gait.
Complimentary Technology
Uses virtual reality in rehabilitation to bring about improvement in balance, co-ordination and gait speed in Parkinson's patients
Eg. Visual cues by using virtual reality to improve gait, or blue tints and glasses to improve dyskinesia and Use of gait aids to improve freezing
Voice exercises
The Lee Silverman Voice Training or LSVT LOUD technique focuses on simple tasks that are designed to maximize vocal and respiratory functioning.
The benefits area improved voice quality, loudness, articulation of speech, inflection or modulation of tone and improved intelligibility of speech.
Voice warm ups, voice stretches, voice aerobics and Voice Choral Singing Therapy or VCST are other forms of voice exercises that can benefit those patients with Parkinson’s disease who have significant problem with their speech.
Patient education:
Therapist must provide the patients with information and education and allow time for patients to discuss their options and ask questions
Research
A systematic review of research on the application of Respiratory Muscle Strength Training to Parkinson's Disease rehabilitation found that respiratory muscle training is a useful therapy for managing decreased respiratory muscles, dysphagia, ineffective coughing, speech disorders, and cardiorespiratory dysfunction in people with Parkinson's, with prolonged positive impact on respiratory muscle strength, swallowing function, and cardiovascular autonomic function(1)
A 2021 study found that dual task training can improve gait performance, most notably increasing gait velocity, step length, and decreased freezing of gait in elderly patients. This study also found dual task training improved the physical well-being of the study participants.(2)
A 2022 meta-analysis found that progressive resistance training in persons with Parkinson's improved freezing of gait, increased muscle strength and improved reported quality of life during rehabilitation(3)
Literature suggests that robot-assisted gait technology has better results in addressing the freezing of gait for Parkinson's patients. Detailed research is required in this field.(4)
According to Lee’s meta analysis, non-pharmacological interventions are effective in increasing the Health-Related quality of life (HRQOL)(5)
Research studies have found that people with PD who are treated using LSVT are likely to maintain improvement in their vocal function for up to two years following therapy.(6)
At Valley Healing Hands, Brownsville, Texas, We provide the best Physical therapy treatment for Parkinson’s Disease. We have highly qualified Physical Therapists, Occupational Therapists and Speech Therapists who are highly qualified and will be more than willing to help you . They will address your complaints by planning a customized exercise regimen and will walk you through every step with complete dedication. Our patients are totally satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!!!
References:
1. Zhuang, J. and Jia, J. (2022) “Effects of respiratory muscle strength training on respiratory-related impairments of parkinson's disease,” Frontiers in Aging Neuroscience, 14. Available at: https://doi.org/10.3389/fnagi.2022.929923.
2. Wollesen B, Rudnik S, Gulberti A, Cordes T, Gerloff C, Poetter-Nerger M. A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson’s disease. Scientific Reports. 2021 Jun 14;11(1):1-0
3. Yang X, Wang Z. Effectiveness of Progressive Resistance Training in Parkinson’s Disease: A Systematic Review and Meta-Analysis. European Neurology. 2022 Oct 20:1-9.
4. Alwardat M, Etoom M. Effectiveness of robot-assisted gait training on freezing of gait in people with Parkinson disease: evidence from a literature review. Journal of exercise rehabilitation. 2019 Apr;15(2):187.
5. Lee, J., Choi, M., & Yoo, Y. A Meta-analysis of nonpharmacological Interventions for People With Parkinson's. Clinical nursing research, 2017;26(5), 608-631.
6. Ramig L, Sapir S, Countryman S, et al. Intensive voice treatment (LSVT®) for patients with Parkinson’s disease: a 2 year follow up. Journal of Neurology, Neurosurgery, and Psychiatry. 2001;71(4):493-498. doi:10.1136/jnnp.71.4.493.