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Parkinson's Disease & Physical Therapy

Parkinson's Disease & Physical Therapy

-Sutherland Wyatt, DPT; CPR Physical Therapist

What is Parkinson’s Disease

            Parkinson’s Disease is a progressive neurologic disorder that affects over 12 million people worldwide with 1 million living in the US. It is the second most prevalent neurological disease (Alzhiemers is first) and can drastically change the quality of life for individuals. Parkinson’s Disease (PD) has been more popularized and known after the diagnosis of Michael J Fox and the creation of the Michael J Fox Foundation. Most people diagnosed are over the age of 50 however their symptoms usually begin much earlier than when they are diagnosed.

PD causes a decrease in the production of dopamine in the brain (Substantia Nigra), a neurotransmitter, which enhances the action potentials sent for voluntary and involuntary muscle contractions to create a normal movement pattern. This decrease in dopamine production can suppress the amplitude of muscle contractions which relates to symptoms of tremors, stumbling, swallowing, difficulty rolling over in bed, performing fine motor tasks with hands, and voice projection, and others. These symptoms can be exacerbated with both internal mental stress and environmental stress i.e. business, sounds, thresholds (curbs), and dual tasking (walking on uneven ground while talking at a family member’s soccer game).

Big and Loud Parkinson's Class at CPR Physical Therapy + Performance Treating Parkinson’s Disease

Parkinson’s Disease is diagnosed by ruling out other neurological diseases, MRI’s, showing symptoms of Parkinsonism, and having a positive Levodopa test. Levodopa is a medication used to upregulate dopamine in the brain to improve motor control and muscle contractions. Usually someone with Parkinson’s Disease is prescribed medication from their neurologist (typically Levodopa/Carbidopa), however sometimes more severe cases of PD are treated with a deep brain stimulator. With the medications, individuals can experience on and off cycles where their function seems to be better or worse depending on the medication’s half life. These side effects can also fluctuate based on heat/cold, sleep, or hydration levels. It is important to communicate with the neurologist and physical therapist about symptoms to modify treatments as appropriate.

Physical Therapy and Parkinson’s Disease

            Physical therapy can play an important role in the quality of life for someone diagnosed with PD. Because it is a progressive nature of the disease, patients typically decline in function over time in their ability to walk, balance, stand, move and perform tasks at home. Physical therapy can aid in slowing down how rapidly the disease progresses, keeping in mind that there is a spectrum of functional deficits and each individual presents uniquely. Within physical therapy, there is extensive research regarding LSVT BIG (Lee Silverman Voice Treatment) which improves an individual's ability to combat the symptoms of Parkinson’s Disease of smaller and slower movement patterns. LSVT BIG incorporates a series of specific daily exercises to enhance the quality of movement with moving larger and faster. It is suggested to start working through LSVT BIG exercises as early as possible from the time of diagnosis to help individuals recalibrate the amplitude at which they move for the best prognosis. The role of the physical therapist is to educate, correct, and promote normal movements to ensure that each patient understands the effort required to perform each exercise. Along with performing these ‘Maximal Daily Exercises’ it is important to create a care plan that is personalized to specific goals that each patient has to improve their daily life to better integrate into their community activities. After the initial bout of therapy, it is important to discuss what future treatments look like for each individual with Parkinson’s Disease. This should be a team decision between the neurologist, PT, and patient. Typically, patients are discharged from formal therapy when they demonstrate appropriate quality of movement and demonstrate improved balance and safety with household and community integration and their individuals are met. It then becomes the individual’s responsibility to continue to exercise on their own at home or with a family member to maintain appropriate levels of function. If the patient, family member, or neurologist notices a decline in function with future visits, likely a referral for follow up therapy will begin to address any new mobility deficits.

Boxing and Parkinson’s Disease   Boxing in Parkinson's Class at CPR Physical Therapy + Performance

Other considerations to improve someone’s function is to meet standard ACSM guidelines of 150 min of cardiovascular exercise and 2-3 days of moderate strengthening each week to ensure appropriate cardiovascular health and maintenance of strength. This can be achieved by joining a local gym or community exercise group and working with a physical therapist to ensure safety. One specific avenue of exercise is boxing specifically for PD. Boxing has been researched extensively for the improvement in function for someone with Parkinson’s Disease. It is a great workout involving high intensity effort paired with large, quick movements to sparring mitts. Boxing can be tailored by changing the surface at which someone is standing on or by adding footwork into the punching sequence to improve static/dynamic balance. Boxing has been popularized with “Rock Steady Boxing” which is a non-profit organization spread across the nation to give access to individuals with PD to fight back against Parkinson’s Disease.

Suggestions:

  • Reach out to your local PT clinic or neurologist to work through a specific Parkinson’s Disease related therapy program.
  • Look up local Rock Steady Boxing or other PD specific boxing classes to continue with high intensity exercise and fight back.
  • Communicate with PT and neurologist about maintenance therapy if there is a decline in function because of the progressive nature of the disease.

 

Resources

  • Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018;8(s1):S3-S8. doi: 10.3233/JPD-181474. PMID: 30584159; PMID: PMC6311367.
  • Duncan et al 2014, Mov Disord 29:195
  • Hely et al 2008, Mov Disord 23:837
  • Greenland JC, Barker RA. The Differential Diagnosis of Parkinson’s Disease. In: Stoker TB, Greenland JC, editors. Parkinson’s Disease: Pathogenesis and Clinical Aspects [Internet]. Brisbane (AU): Codon Publications; 2018 Dec 21. Chapter 6. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536715/ doi: 10.15586/codonpublications.parkinsonsdisease.2018.ch6
  • Petzinger et al 2013 Fisher et al 2013
  • Tomlinson et al 2012, Allen et al 2010, Lima et al 2013, Brienesse & Emerson 2013
  • Duncan & Earhart 2012, Corcos et al 2013, Frazzitta et al 2014 & 2015
  • Chen et al 2005
  • https://rocksteadyboxing.org/
  • https://www.lsvtglobal.com/LSVTBig
 
Posted on 2023-07-28