Parkinson’s disease (PD) is a complex condition that affects millions of people worldwide. Physical therapists can play a big role in helping those affected regain independence, improve their quality of life, and manage symptoms. This article will cover the pathology of Parkinson’s disease and discuss strategies for physical therapy for Parkinson’s clients.
Recommended course: Examination and Management of the Client With Parkinson’s Disease, Updated
Understanding Parkinson’s Disease
Parkinson’s disease refers to a group of disorders that are difficult to differentiate from one another. They share similar characteristics but vary in specific symptoms and causes. Parkinsonian syndromes are diagnosed by determining if there is a cause for the disorder and if they align with the standard definition of PD. This helps identify the type of parkinsonian syndrome a patient might have.
For example, idiopathic PD (AKA primary PD) is diagnosed when there is no identified cause or etiology, but there are still tell-tale signs of PD like:
- Bradykinesia
- Tremors
- Postural instability
- Rigidity
There are cases where a patient shows the typical symptoms of PD, but also has additional uncharacteristic symptoms. This is referred to as “parkinsonism” or “parkinsonian features.”
Etiology and risk factors
Idiopathic Parkinson’s disease is characterized by the degeneration of dopaminergic neurons in the substantia nigra. This is a very important region within the basal ganglia. This leads to a large reduction of dopamine and affects the autonomic motor pathway. Lewy bodies are shown to be a key puzzle piece in understanding PD.
While their exact role in causing dysfunction isn’t clear, their presence is strongly associated with the damage seen in PD. This damage disrupts motor circuits, resulting in the cardinal motor signs of PD. Individuals may also experience challenges with the autonomic system, attention, and learning.
Causes of Parkinson’s Disease
Science has not yet figured out the exact cause of PD. Despite their strong influence, Lewy bodies are still a mystery. Research is working to understand their role and formation, not just in PD, but in other diseases as well.
However, several mechanisms contributing to neuronal cell loss in PD have been identified:
- Mitochondrial dysfunction
- Oxidative stress
- Altered protein handling
- Inflammatory changes
Genetics account for 5 to 10% of PD cases, while environmental factors are also indicated. Some studies suggest a link between pesticide exposure and increased PD risk, whereas tobacco and caffeine use appear to lower the risk.
Age is the most significant risk factor for PD onset, with the average age of onset being between 58-62 years. 5 to 10% of cases occur before age 40, and most cases are diagnosed between ages 50-79.
Symptoms and progression
The symptoms of Parkinson’s disease can vary significantly between people. The cardinal motor signs of PD include:
- Resting tremor: Involuntary shaking, often starting in the hands or fingers.
- Bradykinesia: Slowness of movement, making simple tasks time-consuming and challenging.
- Rigidity: Muscle stiffness that can limit the range of motion and cause discomfort.
- Postural instability: Difficulty with balance and coordination, leading to an increased risk of falls.
There are also a variety of non-motor symptoms, including:
- Autonomic dysfunction: Issues with blood pressure regulation, digestion, and bladder control.
- Cognitive impairment: Difficulties with attention, memory, and executive functions.
- Mood disorders: Depression, anxiety, and apathy.
- Sleep disturbances: Insomnia, restless legs syndrome, and REM sleep behavior disorder.
- Sensory changes: Loss of the sense of smell and changes in vision.
The progression of idiopathic PD is typically gradual, with symptoms worsening over time. However, the rate of progression can vary widely. Early-stage PD generally shows mild symptoms that don’t impact daily activities significantly.
As Parkinson’s advances, symptoms become more pronounced, and can severely affect mobility, independence, and overall quality of life.
Physical therapy assessment of Parkinson’s Disease
Physical therapists should look at many different aspects when assessing individuals with PD. It’s important to get a baseline for things like:
- Muscle strength: Assessing muscle strength helps identify areas of weakness that may need targeted interventions. Manual muscle testing (MMT) or handheld dynamometry can be used to quantify muscle strength.
- Range of motion: Limited ROM can contribute to rigidity and postural abnormalities.
- Gait: Gait disturbances are a hallmark of PD, often leading to increased fall risk.
- Balance: This can include static and dynamic balance, as well as postural stability.
Having a baseline of different measurements can help determine what treatments are most appropriate, track progress, and personalize treatment plans.
A subjective examination is also important, helping physical therapists get deeper understandings of the patient’s lifestyle, struggles, goals with physical therapy, and medical history.
Physical therapy treatment of Parkinson’s Disease
A physical therapist’s main goal is to improve the patient’s overall function, provide lifestyle modifications, and educate on fall prevention and symptom management.
Range of motion and stretching
Muscle stiffness and rigidity can limit joint movement, making daily activities challenging. Physical therapists can help patients with:
- Passive stretching: Assisting patients in stretching their muscles to maintain flexibility and avoid contractures.
- Active stretching: Encouraging patients to perform their own stretches to improve muscle length and joint mobility.
- Joint mobilization: Techniques to enhance joint movement and reduce stiffness.
Motor control
Various techniques can be used to improve motor control, including:
- Task-specific training: Practicing specific tasks that patients find challenging, such as buttoning a shirt or writing.
- Cueing strategies: Using visual, auditory, or tactile cues to facilitate movement. For example, a metronome can help patients maintain a steady walking pace.
- Repetitive practice: Repeatedly practicing movements to reinforce neural pathways and improve motor control.
Building strength
Strength training programs include:
- Resistance Training: Using weights, resistance bands, or body weight to strengthen muscles.
- Functional Strengthening: Exercises that mimic daily activities, such as sit-to-stand exercises or carrying groceries.
- Progressive Overload: Gradually increasing the intensity of exercises to continue building muscle strength.
It’s important for therapists to tailor strength training programs to each patient’s needs and abilities.
Balance
Balance issues are a classic sign of Parkinson’s disease, increasing the risk of falls and injuries. Physical therapists can help improve balance through:
- Balance exercises: Activities that challenge the patient’s balance, such as standing on one leg or walking on uneven surfaces.
- Postural training: Exercises to improve posture and alignment.
- Vestibular training: Techniques to enhance the vestibular system’s function.
Mobility
Maintaining proper mobility helps remain independent and active. Physical therapists can help their PD patients through:
- Gait training: Techniques to improve walking patterns, such as increasing step length and reducing shuffling.
- Assistive devices: Recommending and training patients to use devices like canes or walkers to enhance mobility.
- Flexibility exercises: Stretching exercises to improve muscle flexibility and joint range of motion.
Fall prevention
Falls are a significant concern for individuals with Parkinson’s Disease, often leading to injuries. Physical therapy for Parkinson’s patients can help through:
- Risk assessment: Identifying factors that increase the risk of falls, like muscle weakness or balance impairments.
- Environmental modifications: Recommending changes to the patient’s home environment to reduce fall hazards, such as removing loose rugs or installing grab bars.
- Education: Teaching patients and caregivers about fall prevention strategies and safe movement techniques.
Conclusion
Physical therapy plays a key role in improving mobility, balance, strength, and overall quality of life for individuals with PD.
By understanding the complexities of Parkinson’s disease and staying current with continuing education, physical therapists can provide the highest level of care and support to their patients.
