Physical Therapy Guide to Parkinson Disease
Parkinson disease is the second most common degenerative brain disorder affecting adults. (Alzheimer's disease is the most common.) People of all ethnic groups can develop PD. However, it occurs less among African American and Asian American populations. People with PD are at risk of falling and injuries due to movement and balance challenges. Treatment involves a combination of medicines and physical therapy as part of a team approach to care that also includes other therapies and community-based exercise coaching. In some cases surgery may be needed. Physical therapists partner with people with PD and their families. They help them manage symptoms, maintain fitness levels, and stay as active as possible.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Parkinson Disease?
Parkinson disease is related to a loss of nerve cells in the brain that produce dopamine. Dopamine and other brain chemicals are normally in balance. They control body movements, thought processes, decision making, moods, and other behaviors.
The exact cause of PD is not yet known. Family history, aging, or exposure to certain toxins may contribute to the onset of the disease. PD is a chronic degenerative disease. This means that it gets worse over time. However, people usually do not die from PD.
The severity and symptoms of PD can vary widely. Some people have the disease for 20 to 30 years. They tend to experience a slow decline in mobility and thinking over a long period of time. Others, for whom the disease progresses more quickly, experience problems with movements and thought processes much earlier (within five to 10 years).
Signs and Symptoms
PD was first defined as only a "motor" (movement) disease. Research has shown, however, that it also causes "nonmotor" symptoms in other systems of the body. Nonmotor symptoms of PD can begin many years before motor symptoms develop. Nonmotor symptoms can include:
- Decreased sense of smell.
- Sleep problems.
- Feeling lightheaded when first standing up.
Motor symptoms of PD most often begin at or around age 60. However, early-onset PD can affect people at a younger age. Motor symptoms typically include:
- Muscle and joint stiffness (rigidity).
- Shaking (tremors) in the hands and limbs.
- Slowed movement.
- Balance problems.
The motor symptoms can be very mild at first. A common early symptom is a tremor in one hand. Tremors occur or are apparent most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Tremors usually go away when moving. They typically don't interfere greatly with daily functions.
As the condition progresses, a person with PD may notice other motor symptoms, such as:
- Movements that become smaller. This may result in:
- Shuffling when walking.
- The arms swinging less when walking.
- The voice becoming quieter.
- Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders.
- Pain due to muscle stiffness.
- An unstable posture, resulting in poor balance and a greater risk of falling.
- Movements that become slower during daily activities such as dressing, showering, or moving in bed.
- A feeling of the feet being "frozen" to the floor. This makes it hard to take a first step or to turn around when walking.
- Stooped posture.
- Difficulty speaking at a normal voice level.
- Trouble swallowing.
- Problems doing tasks that were once easy, such as gardening or swinging a tennis racquet or golf club.
- Difficulty making facial expressions.
- Difficulty holding and releasing urine (bladder urgency and incontinence).
Nonmotor symptoms might include:
- Having trouble paying attention to a task for a long time or dividing attention between two or more tasks.
- Lack of motivation.
- Disturbed sleep.
How Is It Diagnosed?
Because there is not one definitive test for PD, it can be hard to diagnose. Your medical history and a neurological examination will help to determine if you have PD. If your physical therapist suspects PD, they may refer you to a neurologist for further examination.
A Parkinson diagnosis may be made if a person has:
- Slowness of movement.
- Shaking or tremor of the hand or foot when resting.
- Muscle rigidity (stiffness) in the arms, legs, or trunk.
- Trouble with balance and possible falls.
- A major improvement in symptoms when taking medicine to treat PD.
- Initial symptoms on one side of the body only.
How Can a Physical Therapist Help?
Because PD affects each person differently, your physical therapist will partner with you and your family. They also will team with your other health care providers to manage your specific case as your condition changes. You are not alone!
After a diagnosis of PD, your physical therapist will conduct a full evaluation. This will include tests to examine your:
- Attention with movement.
Your physical therapist will tailor a treatment plan to your specific needs and goals to help you stay as active and independent as possible. They will work with you to help you keep the strength and ability to:
- Move in and around your home or community.
- Perform everyday activities.
- Take part in sports or other physical activity.
They also will design a well-rounded exercise program specific to your stage of disease and your goals. They will teach you exercises and techniques to help you battle symptoms and slow the decline in physical condition that can result from PD. Working with a physical therapist can help you:
- Improve function (such as walking, balance, and reducing your falls risk).
- Recover lost function due to the disease or after a fall or injury.
- Maintain function over the long term.
Depending on the nature and severity of your condition, your physical therapist may focus on activities and education to help you:
- Improve your fitness level, strength, and flexibility.
- Develop more effective strategies to get in and out of bed, chairs, and cars.
- Turn over in bed more easily.
- Stand and turn to change directions more efficiently.
- Improve the smoothness and coordination of your walking.
- Improve your ability to perform hand movements.
- Decrease your risk of falling.
- Improve your ability to climb and go down stairs and curbs.
- Perform more than one task at a time more efficiently.
Your physical therapy program may include some or all of the following:
Aerobic exercise. This often includes cardiovascular exercises done at moderate to high intensity. Aerobic exercise is important to slow the decline in physical condition that can come with Parkinson disease. It should be initiated early in the disease process.
Resistance training. Building strength in each muscle group with progressive exercises can reduce the severity of motor disease in people with Parkinson disease. It also can improve strength and power.
Balance training. Standing exercises, complex walking activities, and agility training can help improve balance, gait, and mobility.
Flexibility training. To help improve your range of motion.
Gait training. Physical therapists use specialized cueing strategies to address freezing of gait. This improves walking speed, walking endurance, stride length, mobility, and balance.
Task-specific training. Your physical therapist will design a program to help you improve how you do activities such as turning, standing from a chair, daily tasks, or rising from the floor.
Movement cueing. Physical therapists can help provide visual, auditory, or technology-assisted feedback and guidance with walking or specific movements to make better improvements in gait and balance outcomes.
Integrated care. If additional motor and nonmotor problems are present, a physical therapist can recommend additional team members that help address the various areas of your life.
Behavior changes. Physical therapists can help with advice on specific behavior changes to help improve physical activity, improve safety with daily tasks, and improve quality of life.
Community-based exercise. Exercise classes and opportunities in the community setting can be helpful to improve motor, nonmotor, functional mobility, and quality of life in people with PD. Your physical therapist can offer advice on the types of exercise classes that can be helpful for PD.
Other benefits of exercise-based physical therapy include:
- Improved cognition and mood (mental health).
- Learning more about the disease and the techniques to use to adapt your activities.
- Improved quality of life.
Parkinson disease can make daily activities seem frustrating and time-consuming. Your physical therapist will partner with you and your family to help you manage your symptoms. As your condition changes, your physical therapist will adjust your treatment program to help you stay as independent and active as possible.
Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if one of these devices is right for you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can work with you and your family to develop strategies to make moving easier and help prevent injury. They also can suggest changes to your home environment to help enable safe and efficient daily function.
Some of the medicines used to manage PD symptoms may have a rapid positive effect. For example, movement is typically much easier shortly after people begin taking certain PD medicines. Your physical therapist will know how to time treatments, exercise, and activity based on the schedule and effects of your medicines to get the best results.
Can This Injury or Condition Be Prevented?
To date, there is no known way to prevent PD. Studies have shown that people with PD who take part in a regular exercise program can improve their:
- Mental well-being.
However, studies also show that people with PD can lose the gains they make when supervised exercise programs end. Therefore, it is very important to work with your physical therapist to develop good long-term exercise habits. Consider participating in community-based exercise classes. Your physical therapist can help you determine the best classes for your needs based on your interests.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat patients with PD. You may want to consider:
- A physical therapist who is experienced in treating people with neurological disorders. Some physical therapists have a practice with a neurological focus.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can search for physical therapists in your area with these credentials and clinical expertise through Find a PT, a tool built by the American Physical Therapy Association.
General tips when you are looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with PD.
- Be prepared to describe your concerns in as much detail as possible, and let the physical therapist know what you would like to accomplish by going to physical therapy.
The American Physical Therapy Association believes that consumers should have access to information to:
- Inform their health care decisions.
- Prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for incontinence. They report recent research and provide information on the standards of practice in the United States and internationally. They link to a PubMed* abstract (which may offer free access to the full text) or other resources. You can read them to learn more or bring a copy to your health care provider.
American Physical Therapy Association. Clinical practice guideline for the physical therapist management of Parkinson disease. https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs/parkinson-disease. Published December 28, 2021. Accessed May 11, 2022.
Radder DL, Nonnekes J, van Nimwegen M, et al. Recommendations for the organization of multidisciplinary clinical care teams in Parkinson’s disease. J Parkinson Dis. 2020;10(3):1087–1098. Article Summary in PubMed.
Rajan R, Brennan L, Bloem BR, et al. Integrated care in Parkinson's disease: a systematic review and meta‐analysis. Mov Disord. 2020;35(9):1509–1531. Article Summary in PubMed .
Palamara G, Gotti F, Maestri R, et al. Land plus aquatic therapy versus land-based rehabilitation alone for the treatment of balance dysfunction in Parkinson disease: a randomized controlled study with 6-month follow-up. Arch Phys Med Rehabil. 2017;98(6):1077–1085. Article Summary in PubMed.
States RA, Sweeny TL, Rossi A, et al. Physical functioning after 1, 3, and 5 years of exercise among people with Parkinson's disease: a longitudinal observational study. J Geriatr Phys Ther. 2017;40(3):127–134. Article Summary in PubMed.
Rafferty MR, Prodoehl J, Robichaud JA, et al. Effects of 2 years of exercise on gait impairment in people with Parkinson disease: The PRET-PD randomized trial. J Neurol Phys Ther. 2017;41(1):21–30. Article Summary in PubMed.
Ekker MS, Janssen S, Nonnekes J, et al. Neurorehabilitation for Parkinson's disease: future perspectives for behavioural adaptation. Parkinsonism Relat Disord. 2016;22 Suppl 1:S73–S77. Article Summary in PubMed.
Strouwen C, Molenaar EA, Münks L, et al. Dual tasking in Parkinson's disease: should we train hazardous behavior? Expert Rev Neurother. 2015;15(9):1031–1039. Article Summary in PubMed.
Duchesne C, Lungu O, Nadeau A, et al. Enhancing both motor and cognitive functioning in Parkinson's disease: aerobic exercise as a rehabilitative intervention. Brain Cogn. 2015;99:68–77. Article Summary on PubMed.
King LA, Wilhelm J, Chen Y, et al. Effects of group, individual, and home exercise in persons with Parkinson disease: a randomized clinical trial. J Neurol Phys Ther. 2015;39(4):204–212. Article Summary in PubMed.
Conradsson D, Lofgren N, Nero H, et al. The effects of highly challenging balance training in elderly with Parkinson's disease: a randomized controlled trial. Neurorehabil Neural Repair. 2015;29(9):827–836. Article Summary in PubMed .
Petzinger GM, Holschneider DP, Fisher BE, et al. The effects of exercise on dopamine neurotransmission in Parkinson's disease: targeting neuroplasticity to modulate basal ganglia circuitry. Brain Plast. 2015;1(1):29–39. Article Summary in PubMed.
ParkinsonNet. European Physiotherapy Guideline for Parkinson's Disease. Nijmegen, the Netherlands: KNGF/ParkinsonNet; 2014. https://www.parkinsonnet.com. Accessed May 11, 2022.
Ellis T, Boudreau JK, DeAngelis TR, et al. Barriers to exercise in people with Parkinson disease. Phys Ther. 2013;93(5):628–636. Article Summary in PubMed .
Parkinson’s Foundation. Parkinson’s Foundation website. Accessed May 11, 2022.
Parkinson’s Foundation. Parkinson's Exercise Recommendations. Accessed August 15, 2022.
Davis Phinney Foundation for Parkinson’s. Davis Phinney Foundation website. Accessed May 11, 2022.
Brian Grant Foundation. Brian Grant Foundation website .
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
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