A Physical Therapy Guide to Parkinson's Disease
Parkinson's Disease primarily affects people in the later stages of their life. 60,000 Americans are diagnosed with Parkinson's Disease every year.1 Major symptoms of Parkinson's Disease (PD) affect a person's movement and balance. However, they can also affect cognition, mental health, and speech.
Physical therapy is often prescribed to address these symptoms and slow the progression of the disease. Aerobic exercise, resistance training, external cueing, and balance training are all shown to help people with PD improve their functional mobility.2
Continue reading to learn more about Parkinson's Disease and how a physical therapist can help address symptoms.
- Understanding Parkinson's Disease
- Symptoms of Parkinson's Disease
- How is Parkinson's Disease Diagnosed?
- Treatment for Parkinson's Disease
- Can Physical Therapy Help?
- Is It Time to Seek Treatment?
Parkinson's Disease occurs when brain cells in a specific part of the brain (the basal ganglia) become weak and start to die. The basal ganglia is the area of the brain which controls movement, as well as emotional behaviors.
Typically, the brain cells in the basal ganglia create dopamine, which is an important chemical for various areas of the body. When the cells become weak and die, the amount of dopamine in the body decreases, which makes controlling movement harder.
PD is a neurodegenerative disease, which means symptoms and movement get worse with time. That said, every person's disease progresses differently. A person with PD may go from being extremely active to having difficulty walking over a short or longer period of time.
As the nerve cells in the brain begin to degenerate, symptoms in both motor and non-motor areas of the body begin occurring. Although PD is typically called a "movement disorder" because it mostly affects the control people have on their body movements, PD also affects other areas of the body such as mood, cognition, pain, and blood pressure.
Non-motor symptoms often start before motor symptoms. Additionally, motor symptoms often start on one side of the body and progress to both sides.
The most common motor symptoms include:3
- Tremors: Most common in the hands
- Bradykinesia: Slowed movement, typically when walking
- Rigidity: Throughout the body
- Impaired balance and reactions: Putting a person at a higher risk of falling
- Pain: Due to stiffness and decreased mobility
- Changes in walking patterns:
- Shortened steps
- Shuffling feet
- Freezing (getting stuck)
- Decreased arm swing
- Forward neck and shoulders posture (hunched over)
The most common non-motor symptoms include:4
- Depression: Often also includes anxiety
- Fatigue: Difficulty being able to take part in activities of daily living
- Speech and swallow impairments: Might affect a person's nutrition and increase risk of fluid into lungs
- Sleep impairments: Including difficulty sleeping through the night and increased fatigue
- Cognitive decline: Changes in memory and initiating tasks as well as other difficulties
- Orthostatic hypotension: Decreased blood pressure with position changes, which often leads to preventable falls
Often times, a physical therapist is the first person to notice symptoms as a result of someone seeking treatment for a fall or changes with their coordination and walking. The earlier a person is diagnosed with Parkinson's Disease, the better their chances are to slow the progression of the disease.5
Parkinson's Disease is usually diagnosed by a neurologist, who notes the typical clinical signs and symptoms during a thorough examination. Neurologists are able to provide a patient with the stage of PD they are in (learn more about the stages of PD below). If you suspect that you or someone you know is showing signs of PD, or have other neurological concerns, you should schedule an assessment.
Stages of Parkinson's Disease
The stages of Parkinson's Disease are measured using the Hoehn and Yahr scale, which breaks down the general functional mobility of people with PD,6 as shown below:
- Stage 1: One side of the body is affected
- Stage 1.5: One side & the trunk is affected
- Stage 2: Both sides of the body are involved, balance is intact
- Stage 2.5: More involvement of both sides of the body
- Stage 3: Some balance impairments, still independent
- Stage 4: Significantly affected, however able to walk or stand up without assistance
- Stage 5: Wheelchair or bed bound, unless assisted
Treatment for PD includes taking medications, physical and cognitive exercises, and in extreme circumstances — surgery.
Changes and difficulty with movement is generally the most prevalent symptom for someone who has PD. Physical therapists play a key role in helping people return to their daily and recreational activity, as well as help to slow the progression of a person's motor symptoms.
Consistent exercise has shown to have significant positive outcomes to address both motor and non-motor symptoms (such as depression and cognitive decline) for people with PD.7
It is important to remember that the disease affects each individual in a different and unique way. No two people with Parkinson's Disease will present exactly the same. If you or someone you know has been diagnosed with PD, a CityPT clinician, specialized in neurological conditions, can help!
CityPT physical therapists can guide you with:
- Education and knowledge sharing about the disease and it's progression
- Habit forming — making exercise part of your daily routine
- Helping find activities you enjoy despite your mobility status
- Creating an exercise program which focuses on aerobic training, strengthening, flexibility, and balance
- Goal setting and focusing on activity-specific goals, and assisting in addressing impairments in gait and balance8
- Decreasing your risk of falls[^falls-pd]
It is never too early to seek a PT consultation if you are diagnosed with PD. In fact, studies show that the sooner you begin exercise, the better your prognosis could be.9
Consulting with a CityPT physical therapist, online or in-person, will help you develop and establish an exercise program in the earlier stages of PD, and help to maintain functional mobility and balance in the later stages.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Statistics. Parkinson's Foundation. https://www.parkinson.org/understanding-parkinsons/statistics. Accessed September 6, 2022. ↩
Osborne JA, Botkin R, Colon-Semenza C, et al. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association [published correction appears in Phys Ther. 2022 Aug 1;102(8):]. Phys Ther. 2022;102(4):pzab302. doi:10.1093/ptj/pzab302 ↩
Movement symptoms. Parkinson's Foundation. https://www.parkinson.org/understanding-parkinsons/symptoms/movement-symptoms. Accessed September 13, 2022. ↩
Non-movement symptoms. Parkinson's Foundation. https://www.parkinson.org/understanding-parkinsons/symptoms/non-movement-symptoms. Accessed September 13, 2022. ↩
Chen JJ. Parkinson's disease: health-related quality of life, economic cost, and implications of early treatment. Am J Manag Care. 2010;16 Suppl Implications:S87-S93. ↩
Goetz CG, Poewe W, Rascol O, et al. movementdisorder society task force report on the Hoehn and Yahr Staging Scale: Status and recommendations themovementdisorder society task force on rating scales for parkinson's disease. Movement Disorders. 2004;19(9):1020-1028. doi:10.1002/mds.20213 ↩
Wu PL, Lee M, Huang TT. Effectiveness of physical activity on patients with depression and Parkinson's disease: A systematic review. PLoS One. 2017;12(7):e0181515. Published 2017 Jul 27. doi:10.1371/journal.pone.0181515 ↩
Morris ME, Martin CL, Schenkman ML. Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther. 2010;90(2):280-288. doi:10.2522/ptj.20090091 ↩
Crizzle AM, Newhouse IJ. Is physical exercise beneficial for persons with Parkinson's disease?. Clin J Sport Med. 2006;16(5):422-425. doi:10.1097/01.jsm.0000244612.55550.7d ↩