PARKINSON'S DISEASE - PHYSIOTHERAPY REHABILITATION

What is  Parkinsonism?

Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson's disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells 

Difference between Parkinsonism and Parkinson's Disease:

Parkinsonism is a generic term for a group of symptoms that can be seen in someone with Parkinson's disease such as tremor, stiffness, and slowness of movement. There are several conditions other than Parkinson's disease which can cause these symptoms.

Drugs might be a cause?

Sodium valproate, used to treat epilepsy, and lithium, used in depression, both commonly cause tremor which may be mistaken for Parkinson's. 

Secondary parkinsonism is similar to Parkinson disease, but the symptoms are caused by certain medicines, a different nervous system disorder, or another illness. Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease.

Causes:

Medications:those used to treat psychosis, major psychiatric disorders and nausea

Repeated head trauma: injuries sustained in boxing

Certain neurodegenerative disorders: multiple system atrophy, Lewy body dementia and progressive supra nuclear palsy

Exposure to toxins: carbon monoxide, cyanide and organic solvents

Certain brain lesions: tumors, or fluid buildup

Metabolic and other disorders:chronic liver failure or Wilson's disease 

Parkinson's signs and symptoms may include:

Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson's disease is a tremor of your hand when it is relaxed (at rest). This is the positive sign for the Parkinsonism

Slowed movement (bradykinesia).  Parkinson's disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move.

Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain. This may lead to mild contractures

Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease. 

Loss of automatic movements. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.

Speech changes. You may have speech problems as a result of Parkinson's disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone.

Writing changes. It may become hard to write, and your writing may appear small.

Exercise and Physical Therapy

Research has shown that regular exercise benefits people with Parkinson’s disease. Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based memory exercises can also help keep our memory sharp. Postural awareness exercises to improve the posture. Balance and co- ordination exercises help to improve balance and co-ordination.

Exercise:

• reduces stiffness
• improves mobility, posture, balance and gait

BALANCE EXERCISES FOR PARKINSON'S DISEASE

Best exercises for Parkinson’s disease

There is increasing evidence that aerobic and learning-based exercises could be neuroprotective in aging individuals and those with neurodegenerative disease.  Facilitating exercise programs that challenge our heart and lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best.  Dancing to music may be particularly good for decreasing stiffness.

Exercises that require balance and preparatory adjustment of the body are also important along with rhythmic activities such as dancing, skipping and cycling can maintain the ability to perform reciprocal movements.   Finally, exercises that promote attention and learning are beneficial. 

Types of exercises that do this:

• Walking outside or in a mall
• Dancing
• Yoga classes
• Stepping over obstacles
• Marching to music with big arm swings
• Sports (ping pong, golf, tennis, volleyball)
• Aerobic classes  

Types of exercises that promote cardiopulmonary fitness:

• Paced walking (treadmill walking at different speeds and different inclines)
• Hiking using walking sticks
• Swimming with different strokes to increase heart rate and provide good cardiopulmonary conditioning.
• New body weight-supported treadmills can also be helpful to protect from falling, and to facilitate easier coordinated movements for fast walking with a long stride or jogging.

These exercises for cardiovascular, endurance and strengthening could be enriched by performing simultaneous activities such as reading, writing, problem solving, singing, watching the news or a movie or throwing and catching balls. Exercises that demand attention, repetition, progression of difficulty with spaced practice over time are the best exercise routines to promote learning.

Strengthenind exercises:

Individuals need to be careful how they perform strengthening exercises to minimize increasing stiffness and rigidity. When performed properly, strengthening exercises do have some value.

As one ages, more exercise must be performed to maintain muscle mass.  Muscle mass and strength allow an individual to complete daily chores and to maintain balance. Additionally, strengthening postural muscles may help to maintain a more upright posture. Infact, functional exercises other than weight-training may strengthen muscles in ways that are more beneficial to individuals with Parkinson’s disease.  

Walking with ankle and wrist weights can help strengthen while encouraging increased awareness of arm swinging and high stepping. Moderation is the best word for strength training without other forms of exercise.  However, integrating strengthening and flexibility exercises into aerobic, rhythmic and learning-based exercise routines that are fun, engaging, progressing in difficulty and rewarding are the best.

Swimming can help?

Swimming provides good cardiopulmonary training and maintains muscle strength.   The arms, legs and head may be doing different things, it may increase coordination.  The resistance of the water increases stiffness in some people and decreases it in others.  

Activities to try:

• Adding resistance with paddles and trunk support – provides more opportunity for reciprocal movements and circling movements of the arms and the legs
• Rolling and somersaults – in the pool are good for those who are particularly comfortable in the water

Will exercise make my muscles less stiff?

Exercises that require large, rhythmical movements through a full range of motion have been shown to decrease rigidity.  For example, in a program of aerobic exercise using music, there was a reduction in rigidity in 9 out of 10 participants immediately after the exercise program.

Exercises to reduce stiffness:

• Large, rhythmical movements
• Rotating the trunk
• Vibration, rocking and swinging

How often should I exercise?

The guidelines for people with Parkinson’s disease are no different from those without the disease (i.e. 4-5 times a week for at least 30-40 minutes).  This assumes that your heart is beating at 70 to 80% of maximum (220 – your age times 70 or 80%).  

Make the exercise time fun:

Engage in group exercise, movement or dancing classes.  For many, participating in activities with other people, can be more stimulating and increase compliance. 

Stay active :

• Walk whenever possible instead of driving
• Climb the stairs instead of taking the elevator
• Take regular 5 minute breaks every 30 minutes (lifting the arms up over your head, performing wall glides, breathing diaphragmatically, getting up to get a glass of water, or putting theraband on chairs to work on some strengthening)
• Avoid long periods of time watching TV and or using a computer

 Is there anything else I should know?

A “cool-down period” is important.  After exercise, allow yourself a longer time for a cool-down than others would need (Individuals who exercised before developing Parkinson’s disease typically double their cool-down time).  

A cool-down period accomplishes 2 goals:

1)      Promotes a slow decrease in heart rate

2)      Allows the muscles time to cool down gradually so they do not become stiff.  

Learn something new every day:    

If you listen to the news, talk to someone about it.  Listen to educational programs and discuss what you learned.  Do crossword puzzles or participate in memory training programs on the web or from a CD.

Challenge yourself to go out each day:       

Practice writing:        

Exercise your voice: 

To help decrease freezing movements:

• Reciprocal arm swinging
• High long steps
• Scanning the environment and using visual fixation on an object in the distance or auditory cues (listening to music, singing to yourself, counting)
• Thinking about making big steps to clear obstacles on the floor or marching (high steps)
• Walking hand-in-hand, swinging the arms with a friend or family member
• Having someone place their foot in front of you as a cue to step high and over
• One person found that throwing pennies and stepping over them was helpful (“But,” he added, “don’t bend down to pick them up.”). 
• Loud rhythmical clapping
• Paced walking with high stepping. 
• Using walking sticks (using them for sensory feedback and sense of stability may be more important than using a cane. Of course, using a cane or a walker can be helpful if there is a lot of weakness and stiffness.) 

Pushing one’s self to stay active should be the goal. To get improvement from the Parkinson's disease.