Parkinson’s disease comprise a group of disorders characterised by tremor & disturbance of movement, posture & balance. It stems from a disturbance of function of that part of the brain which is responsible for the production of dopamine. Dopamine carries electrical messages from one nerve cell to another, & when dopamine is reduced, the messages are not transferred properly. This leads to difficulty with voluntary & involuntary movements. Common symptoms are slowness of movement, generally walking & disturbance of balance with occasional falls or difficulty with fine manipulative movements. Pain is quite common in the form of cervical spondylosis, frozen shoulder, backache & osteoarthritis of hip, & are generally relieved by appropriate treatment for Parkinson’s. It may occur secondary to other neurological disease (eg. Alzheimer’s) but patients retain intellect & are co-operative to treat.

      Symptoms:

• Difficulty with specific movements such as writing
• Difficulty in turning over in bed or rising from a low chair
• Excessive greasiness of skin
• Inability to raise voice or even cough effectively
• Chewing & swallowing problems
• Bowel/Bladder control problems
• Thinking difficulties (later stages)
• Sleep disorders
• Depression & emotional changes

Signs:

• Posture – There is slight flexion (bending) at all joints while standing, shoulders rounded & head held forward with arms bent across the trunk. Patients may sump while sitting, sliding sideways to lean on the armrest & head may fall forward on the chest.
• Balance – There is a tendency to topple forwards & are unable to make quick compensatory movements to regain balance & are easily knocked over. Their pace is short & shuffling & may feel like they are ‘chasing’ their center of gravity while walking in order to avoid falling forward while walking.
• Voluntary movements – All movements are reduced in range & speed. Speech becomes slower & softer. Handwriting becomes smaller & after a point, slows down & becomes untidy.
• Involuntary movements – They are reduced or lost, such as swinging the arms while walking, automatic swallowing of saliva is impaired, & coughing is defective.
• Rigidity – Muscle tone is increased & there is resistance to passive movements. Rigidity is often the cause of muscle pain & relieving rigidity is a part of the treatment.
• Tremors – This occurs due to involuntary alternating contraction of opposite muscle groups & is present at rest.

      Rehabilitation for Parkinson’s at Curezone Physiotherapy

Treatment of Parkinson’s patients must be multi-disciplinary & must cater to the individual cases depending on their disability or symptoms. Drug therapy & Physiotherapy are the most important forms of treatment for this condition. None of the drug therapy is effective unless the patient takes advantage of his improvement & returns to normal activity. They may be dependant on other due to their slowness & difficulties while walking & must be encouraged to be independent, get regular exercise & maintain an interest in hobbies & social activities.

      Physiotherapy Treatment program should include the following:

1. Analysis of functional difficulties – Treatment should be goal-oriented to help the patient to overcome their functional difficulties. The faulty patterns should be identified & corrected when possible, or alternative measures should be provided & practiced. Auditory & visual cues to be given to reinforce the correct movement patter. For example, the instruction ‘heels down’ helps in case of patients who have difficulty walking & freeze. This helps their center of gravity to return to a more normal position & thus maintain balance & prevent falls.
2. Posture – Postural awareness must be encouraged & practiced so that they can correct their posture & return to correct posture while sitting or standing or lying down.
3. Joint range of motion exercises – As the disease progresses, they become more rigid & hence, ROM exercises should be a part of their treatment to maintain proper range & length of joints & muscles respectively.
4. Stretching – Both active & passive stretching should be done mainly to counter the rigidity due to increased muscle tone.
5. Relaxation – Physiological relaxation is helpful to calm them down, treat anxiety & also bring more awareness to their posture & joint position.
6. Memory exercises – Simple memory games are encouraged for patients so that they do not regress if not progress.
7. Balance & co-ordination exercises – They help them to train themselves when they feel that they are being knocked over & can train them to correct their own posture when they loose balance.
8. Breathing & speech exercises – They help to train the respiratory muscles to an extent & must be taught because patients have difficulty coughing & sometimes breathing (later stages). Some of the exercises that can be done are deep breathing, pitch glides, practicing pronouncing vowels, volume control (saying a word out loud at 5 different volume levels), reading aloud with proper intonation & clear pronunciation, exaggerating mouth movements, singing etc.

     It is often helpful to conduct group exercise classes for patients with the disease so that they all feel familiar & normal. Patients with Parkinson’s often tend to isolate themselves from society & avoid going out due to the embarrassment of clumsy & slow movements. Group sessions can therefore help them to ease out the anxiety, be more active & something that they look forward to.

Make sure you book your appointment today and get assessed by our physiotherapist for the Treatment of Parkinson’s Disease.