Physiotherapy for Parkinson’s Patients

Parkinson’s disease is one of the most common neurological diseases. As in all degenerative conditions, the onset is insidious and once the patient seeks medical advice, it is often possible to report a history of a few months or even years. This disease can be characterized as a disease of wear and tear. That is, it occurs when certain brain cells can no longer produce dopamine. Because of this, the chances of developing Parkinson’s increase with age.

Possible causes of the disease are atherosclerosis, alcoholism, drug use, metabolic disorders, toxic substances (such as manganese and MPTP toxin), medication (mainly neuroleptics), brain tumors, and and premature aging of the neurons of the substantia nigra. Finally, the existence of an inherited predisposition to the disease has not been proven and does not seem possible.

So far there is no cure for the disease or a way to prevent the disease from progressing. But there are several drugs that significantly improve the symptoms for many years, thus improving the quality of life. Drug therapy is based on replenishing dopamine levels in the brain. There is also surgery, when the drugs work but do not constantly control the symptoms. Patients must meet specific criteria to be eligible for surgery. Exercise has also been shown to help a lot in controlling symptoms and well-being.

Symptoms

The disease first appears with the combination of two symptoms, bradykinesia and stiffness or tremor and stiffness, and as it progresses, all the characteristic manifestations of the disease appear slowly. It most often occurs in the sixth and seventh decade of life and affects both sexes equally. It can, however, occur at almost any age although it is very rare under thirty. As age increases, so does the frequency.

Essentially, the onset of the disease is slow and the course progressive. The initial symptoms are not typical. Diffuse pains are observed, mainly in the shoulders, due to the stimulation of the joints, feeling of fatigue and reduction of daily activities. The patient complains that he has become sluggish and cumbersome, but often attributes the discomfort to old age. When the disease is established, then the characteristic four symptoms are observed: bradykinesia, tremor at rest, stiffness, as well as loss of corrective reactions.

Non-motor symptoms, such as constipation, urinary disorders (frequent urination, nocturia, urination), olfactory disorders and depression, are also common, which may precede motor manifestations. Over time, and especially when the disease begins in old age, dementia (about half of patients after 15 years of follow-up) is very common, often accompanied by visual hallucinations.

Diagnostic Approach

The diagnosis of the disease is made only by clinical examination. An experienced neurologist is able to diagnose the disease through the patient’s symptoms and clinical examination. There is no laboratory test to confirm the disease.

There are only tests recommended by a neurologist to rule out other conditions similar to Parkinson’s disease.

Parkinson’s disease is divided into idiopathic and secondary.

Parkinson’s idiopathic disease is a progressively developing disease with the main manifestations being restlessness, stiffness, sluggishness and loss of reflex postures (corrective postures). There must be at least two of the above main symptoms in practice to diagnose the disease.

Secondary Parkinsonism presents a similar clinical picture to the idiopathic and is caused by factors such as infections (viral encephalitis), toxic substances, brain tumors, etc.

Every patient has a different development. Still, the evolution can stop for some other time. It can be slow and mild, or for no apparent reason lead to significant deterioration.

Prevention

To date, no reliable method of preventing the disease has been found. Therefore, early or even early diagnosis does not help anything. There is no way to reverse or even delay the progression of the disease. Neither early medication nor any exercise or special diet has been shown to slow the progression of long-term disability caused by the disease.

On the contrary, there is evidence that early administration of dopamine or similar dopamine-mediated drugs, called dopamine agonists, may damage specific cells. For this reason there is no need to rush into the treatment of the disease.

Self-restraint and the most conservative medication possible are the best strategy in Parkinson’s disease.

Physiotherapy Treatment

The current model of physiotherapy intervention in patients with Parkinson’s is based on the assumption that normal movement can be acquired through teaching. Knowledge of the features of motor disorders in Parkinson’s patients is the starting point for designing a rehabilitation program. Most patients with Parkinson’s have difficulty walking at some stage of the disease. The use of external stimuli and cognitive strategies are the main therapeutic options of the physiotherapist for the gait disorder. Consequently, the elimination of falls is an important goal of physiotherapy, especially in patients in the later stages of the disease. Also, the prevention of muscle weakness and atrophy, limited range of motion and reduced ability to exercise, is a major goal of physical therapy in the Parkinson’s patient. Continuous physiotherapy is not necessary, but frequent meetings and advice are valuable.

Aging, any concomitant pathological conditions and secondary adaptive changes in the musculoskeletal and cardiovascular systems are also very important issues in the design of the physiotherapy program. Because Parkinson’s generally progresses slowly, patients and their families need to be supported in developing programs that should be implemented during long-term treatment. This support can help them take on more responsibility for their health and well-being in general.

Sources
by Goede G.J.T., Keus S., Kwakkel G., & Wagenaar R., (2001). The effects of physical therapy in Parkinson’s Disease: A research synthesis, Archives of Physical Medicine and Rehabilitation, 82 (4): 509 – 515.
Kwakkel G., de Goede G.J.T., & van Wegen E., (2007). Impact of physical therapy for Parkinson’s disease: A critical review of the literature, Parkinsonism & Related Disorders, 13 (3): 478 – 487.