Parkinson’s disease, the most common Movement Disorder seen in the elderly and the second most common neurodegenerative disorder, was first described as “the shaking palsy” by James Parkinson in 1817.

Depending on the key observable feature, Parkinson’s disease has two sub-groups:

(1)    People who exhibit Postural Instability: have difficulty in keeping their body in a stable or balanced position
(2) People who exhibit Tremors: have progressively lost their muscle control leading to trembling of the limbs and head while at rest.
Other signs and symptoms of Parkinson’s disease:

•  walking with short, uncertain steps, with minimal flexion
•  heaviness and stiffness in the limbs
•  sudden break or block in movements
•  impairment of balance and co-ordination
• difficulty with speech and swallowing

As a result of these impairments most patients develop a forward or a backward lean. Some have the tendency to step backwards when they start to walk (retropulsion). Because of such movements they can fall easily and suffer major injuries: fractured ankles, hips, shoulders. Falls may also occur due to loss of “righting reflexes”, an inability to take corrective measures to prevent a fall. More falls take place as the disease progresses. Waking steps may become shorter and shorter as if s/he is hurrying forward to keep balance (festination).

Patients may halt in mid-stride and “freeze” in place, possibly even topple over. It may become difficult to walk, talk or even to complete simple tasks. Some secondary symptoms include anxiety, depression and dementia. Although adult onset Parkinson’s disease is the most common form, there is early-onset Parkinson’s disease (onset between 21-40 years), and juvenile-onset Parkinson’s disease (onset before age 21) as well.

Physiotherapy treatment for Parkinson’s

Physiotherapy for people with Parkinson’s disease concentrates on increasing and maintaining mobility whilst reducing the risk of falls. Hence Parkinsonism is better treated as early as possible to avoid consequent events followed by physical disability.

The goal of physiotherapy is to increase mobility and advise on relevant environmental changes to increase the patient’s independence and safety. Independence is increased with balance, co-ordination, stretching and strengthening exercises and with walking aids and such equipment. The Physiotherapist will assess how an individual performs certain activities such as walking, climbing stairs, getting out of a chair and getting in and out of bed and guide the patients, their family and caregivers about special strategies on managing the symptoms.

Importance of exercise for Parkinson’s patients

Parkinsonism is all about movement hence exercise plays a major role. Exercises will help the person maintain muscle tone and function. The maintenance of normal muscle tone and function is an important aspect of the treatment of Parkinsonism.

Remember there is no cure for Parkinson’s disease. Medication is merely to relieve the symptoms. But with medication and physiotherapy exercises Parkinsonism can be controlled and managed. With proper treatment, most individuals with Parkinson’s disease lead long, productive lives for many years after diagnosis. (The writer is a physiotherapist)

Exercise tips

n    Move your ankle up and down, clockwise and anti-clockwise.
n    Exercise your facial muscles; make funny faces in front of the mirror, read louder, smile often, sing along.
n    Practise your walking with small steps in front of a mirror
n    Swing arms freely when you walk
n    Check your posture often, keep your back straight and avoid forward bending of your back.
n    Get out of the house as much as possible (do not walk alone if you have a high risk of falling)
n    Do day to day activities as much as you can, as little movements will help you.
n    If any activity is giving you trouble (eg:if  unable to put your shirt buttons on) repeat the activity a few times, practice makes it perfect.
n    Use a crutch or a walking stick for assistance if necessary
n    Try to move all the joints in the body one at a time; start with your toes and go up till the neck.
Precautions
n    Do not overdo the exercises, start with 10 minutes and make your way up to 30-45min depending on your stamina
n    Remember to work out in a safe environment (eg: non-slippery hard surface, no sharp objects nearby)
n    If you have difficulty in balancing, exercise within reach of a grab bar or rail.
n    If you have trouble standing or getting up, try exercising on a bed rather than on the floor or an exercise mat
n    If you feel pain or difficulty during any exercise, stop. Seek professional help soon. Each individual is different and exercises have to be tailored accordingly. Meet a physiotherapist for an accurate exercise plan for your stage of Parkinsonism.

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