Rehabilitation

Parkinson’s Disease & Rehab Explained | Neurological Conditions

Parkinson's disease affects the hands and can be managed with regular exercise with Fish & Field biokineticists

What is Parkinson’s Disease?

Parkinson’s disease is a progressive neurological disorder and forms part of the hypokinetic movement disorders (lack of movement). It is an Idiopathic (unknown cause), slowly progressive, degenerative Central Nervous System disorder. It most commonly occurs in individuals over the age of 50. The disease is associated with a reduction in dopamine levels (dopamine being a neuro-transmitter) in the brain. The reduction in dopamine levels results in these 4 characteristic features of Parkinsons: slowness of movement (bradykinesia), muscular rigidity, resting tremor as well as gait and postural abnormalities.

Signs and Symptoms

Unfortunately, there is no specific test to diagnose Parkinson’s disease. Usually a neurologist will diagnose a patient based on their history, signs and symptoms as well as a physical and neurological examination. Due to the nature of the condition, as well as there being no specific test for Parkinson’s, it can take some time before a patient is officially diagnosed with Parkinson’s disease. Quite often the symptoms of Parkinson’s occur on one side of the body first. And that side remains the worse affected side even as both sides become affected.

Some of the Symptoms may include:

  • Tremor – You may notice a mild tremor in a hand or limb, most often when a person is at rest
  • Impaired balance and co-ordination, sometime resulting in falls
  • Stooped posture due to loss of postural reflexes
  • Slowness of movement
  • Shuffle gait
  • Stiff or rigid muscles – which can become quite painful as well as very limiting
  • Loss of facial expressions
  • Changes in hand writing – quite often a person’s handwriting will become smaller or more cramped
  • Voice changes – softer voice and slower speech patterns

Treatment

It is important that the Parkinson’s patients’ treatment is overseen by a multidisciplinary team. This is because there are many components to take into consideration when deciding on a treatment plan. This team should provide information, education and advice to both the patient and their families about what to expect going forward with the disease. There is currently no cure for the disease. However, there are medications which can significantly improve many of the symptoms one experiences. Lifestyle modifications also play a vital role in the treatment and maintenance of quality of life of the individual.

Exercise to improve quality of life

One of the most important modifications a Parkinson’s patient can make is to make exercise a regular part of their daily routine. Studies have shown that doing 2½ hours of exercise per week has significantly slowed the decline in quality of life of a Parkinson’s patient.

With the increased difficulties and postural changes that occur in Parkinson’s patients, they are prone to developing hypokinetic diseases eg, high blood pressure and cardiac arrhythmia amongst others. We know that muscles that are not used will atrophy and weaken. Joints become frozen and the surrounding tissue becomes stiff and fibrotic, resulting in contracture of the joints. Gait is often characterized by slow small steps and turn-around time is slow, mostly done by taking multiple small steps. Patients may experience freezing of steps mid-stride. However, it more commonly occurs when initiating the walking action, when turning or when walking through a narrow passage-way. Often there is festination, which is the fast succession of steps, with patients not always being able to stop at an obstacle. Which, in turn may in a fall or injury. Daily tasks like rising from a chair or turning in bed can become quite difficult.

Developing a structured exercise program

Starting a regular, structured exercise program, will help to slow the motor changes that occur. In general, your program should include stretching, aerobic activity, proprioception exercises as well as strengthening exercises. Stretching and range of motion exercises are used to keep range in the joint and slow or prevent contracture of the joint occurring. While aerobic activities are important to help control blood pressure and improve your cardiovascular function. Specific balance and co-ordination exercises will help to reduce the risk of falls as well as improve reflexive response time. Strength exercises are important to improve ADL’s (activities of daily living), which will make getting up out of a chair, or turning in bed, easier as one gets stronger.

Aqua-Therapy for Parkinson’s patients

San Sereno Aqua Therapy Pool, Bryanston

Aqua-therapy is especially beneficial to Parkinson’s patients. It is a safe environment to retrain gait patterns as the water allows for longer reaction times. This also allows for easier practice of balance and proprioception exercises. The natural viscosity of water helps to build strength. And the warmth of the water assists in relaxing stiff muscles, enabling one to move through the full range of the joint.

Try to do your exercises when you are well rested and when you move most freely. Wear loose comfortable clothing and ensure you have the correct footwear with good support if you are doing land exercises.

There is no “one fits all” exercise program. It is best to have an assessment with an exercise specialist (like a Biokineticist) and get a personalised exercise program that will meet your individual needs.

References:

ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, (1997) American College of Sports Medicine, Human Kinetics, USA

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment.

https://institute.progress.im/en/content/history-definitions-and-diagnosis

https://sites.google.com/site/pathologicalgaitpatterns/pathological-gait-parkinsons-disease

https://www.nia.nih.gov/health/parkinsons-disease

https://www.healthline.com/health/parkinsons-warning-signs#1

https://www.parkinson.org/Understanding-Parkinsons/Treatment/Exercise

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