Parkinson’s Disease

Written by Titus Selvaraj

Role of physiotherapy in Parkinson’s disease

 Parkinson’s disease (paralysis agitans / shaking palsy) is a slowly progressive neurologic disease that is characterized by a fixed inexpressive face, tremor at rest, slowing of voluntary movements, gait with short accelerating steps, peculiar posture and muscle weakness (caused by degeneration of an area of the brain called the basal ganglia), and low production of the neurotransmitter dopamine.

Approximately 9,000 people are with Parkinson’s in the Republic of Ireland. The WHO estimate that in the next thirty years the incidence of Parkinson’s will double. It is commonly seen in population over 50, but at least 10 percent are under 40.

Main symptoms of Parkinson’s disease are:

  • tremor, shaking, or trembling
  • slowed movement
  • stiff or rigid arms, legs, and trunk
  • balance trouble that can lead to falls

Other symptoms that are common in Parkinson’s (not everybody will have all of them) include:

  • abnormal walking
  • decreased arm swing
  • excessive salivation
  • feelings of depression or anxiety
  • increase in dandruff or oily skin
  • lack of facial expression (hypomimia)
  • less frequent blinking and swallowing
  • lowered voice volume (hypophonia)
  • slight foot drag
  • small cramped handwriting (micrographia)
  • stooped posture
  • trouble sleeping
  • constipation
  • generalised body pain
  • decreased sense of smell
  • tiredness

Depression is common in people with Parkinson’s. Psychotic symptoms, such as visual or auditory hallucinations, may occur in up to 50% of cases.


Physiotherapy Goals

  • Maintain and improve levels of function and independence, that helps to improve a person’s quality of life
  • Use exercise and movement strategies to improve mobility
  • Correct and improve abnormal movement patterns where possible
  • Maximise muscle strength and joint flexibility
  • Correct and improve posture and balance to minimise risk of falls
  • Maintain good breathing pattern and effective cough
  • Educate the person with Parkinson’s and their carer or family members
  • Enhance the effects of drug therapy

Our physiotherapists play a vital role in supporting people with Parkinson’s to choose management strategies, prioritise and address the challenges they face over the course of the condition.

During the earlier stages of diagnosis, greater emphasis is placed on education and self-management. The individual should be encouraged to continue being active and participate in physical exercise for as long as possible. Significant respiratory complications develop in many people as Parkinson’s progresses, so attention is paid to monitor and manage encroaching weakness of respiratory muscles and rigidity of the thoracic cage.

Physiotherapy Management includes:

 Visual cueing

  • Auditory cueing
  • Proprioceptive cueing
  • Dual task training
  • Intensive sports training
  • Treadmill training with body weight support
  • Resistance training
  • Aerobic exercise

Benefits of exercise in PD?

Exercise can benefit in two ways:

Symptom management.  Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination.  Exercise such as treadmill training and biking have all been shown to be beneficial.

Possibly slowing disease progression.  Improved mobility decreases the risk of falls and other motor complications of Parkinson’s.

How can you benefit from exercise?

The best way to achieve these benefits is to exercise on a consistent basis. People with Parkinson’s enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, have shown significant gains in functional balance and mobility as compared to programs of only two-week or ten-week durations. Furthermore, when it comes to exercise and PD, greater intensity equals greater benefits. Intense exercise is exercise that raises your heart rate and makes you breathe heavily.

 Should exercise be done well before major motor symptoms of PD occur?

In PD, a special kind of neuron—brain cells—that produces the chemical transmitter dopamine gets damaged and lost. There is a lag between the time when the loss of neurons begins and the time when Parkinson’s motor symptoms start to show. By the time most people are diagnosed, as much as 40-60 percent of their dopamine neurons are already gone.

The reason that people with Parkinson’s don’t experience symptoms until they reach this point is that the brain can compensate for the loss of dopamine neurons by gradually changing to adapt to the situation.

In fact, the brain reshapes itself throughout life in response to experience. Scientists call this ability to change and compensate experience-dependent neuroplasticity.

 How does exercise change the brain?

Researcher found that the ones that had exercised, the brain cells were using dopamine more efficiently. They also found that exercise improves that efficiency by modifying the areas of the brain where dopamine signals are received — the substantia nigra and basal ganglia.

group doing stretches to warm up and cool down