Parkinson’s disease is the second most common neurodegenerative disorder in Australia. It is a disease in which the dopamine-producing cells of the basal ganglia fail, resulting in distinct changes in movement quality. The average age at diagnosis is 65 years, but adults of any age can be affected. In Australia there are approximately 80,000 people living with Parkinson’s disease and about 20% are people of working age. The causes of Parkinson’s disease are still unknown and there are currently no disease-modifying therapies. Medication is the standard treatment, supervised where possible by a neurologist skilled in movement disorders. Physiotherapists can prescribe exercise and give advice to assist with problems with everyday function.
--What is Parkinson's disease?
It is not clear what causes Parkinson’s disease, but genetic and environmental factors may play a part in a person developing the disease. The symptoms of Parkinson’s disease are associated with the deterioration and death of neurons (nerve cells) in a region of the brain called the basal ganglia. Healthy neurons produce a chemical messenger called dopamine which helps to control movements. As a result of Parkinson’s disease, neurons become damaged or die and there is not enough dopamine in the system to maintain good movement control.
The core motor symptoms of Parkinson’s disease are:
- Slowness of movements, called bradykinesia
- Tremor at rest
- Rigidity or stiffness in muscles
- Problems with walking and balance.
However, Parkinson’s disease is different for each person and not everyone will have all of these symptoms. For instance, around 30% of people with Parkinson’s disease do not have a tremor. People with Parkinson’s disease may also have problems with daily activities like walking, standing up from a chair, moving around in bed, and everyday tasks needing fine hand coordination.
Parkinson’s disease also affects other body systems and produces non-motor symptoms such as:
- Depression
- Anxiety
- Constipation
- Changes in memory and thinking
- Sleep disorders
- Hyposmia (poor sense of smell)
These symptoms are experienced to varying degrees by individuals with Parkinson’s disease and can be as difficult to live with as the motor symptoms.
--How do I know if I have Parkinson's disease?
There is currently no test available to confirm whether or not you have Parkinson’s disease. Your GP may make a preliminary diagnosis based on your symptoms and refer you to a neurologist for further investigation. Some neurologists, called movement disorders specialists, have a particular interest and expertise in treating people with Parkinson’s disease and other similar conditions.
Some of the early signs of Parkinson’s disease include:
- Slowness
- Loss of balance or falls
- Difficulty multi-tasking
- Handwriting smaller
- Tremor at rest
- Sleep disorders
- Hyposmia (reduced sense smell)
- Anxiety
--How can physiotherapy help with the management of Parkinson's disease?
Physiotherapists are trained to provide treatment plans for people at all stages of Parkinson’s disease. Treatments will vary according to your stage of Parkinson’s disease and individual problems.
Because research evidence suggests that regular, vigorous exercise may delay the onset and progression of disability, exercise and physical activity are very important. Even if you have been recently diagnosed, a physiotherapist can help you devise an activity and exercise program which is appropriate and enjoyable.
Maintaining or increasing physical activity and exercise has many benefits including strengthening muscles, improving balance and reducing stiffness, and maintaining heart health and fitness. A physiotherapist will assess your individual needs and tailor an appropriate program which could include some of the following:
Resistance training: Training to improve muscle strength.
Balance training: It is important to train balance skills because people with Parkinson’s disease have a higher risk of falls than the general population.
Training of everyday activities: Includes practising specific aspects of walking or common actions like rolling and getting out of a chair. If you find it difficult to initiate or maintain actions such as walking, your physiotherapist can give you advice on strategies and cues you can use to help you overcome these problems.
Cardio-vascular training: Your program may include activities such as treadmill training to improve your fitness level.
Hand training: An exercise program of dexterity exercises may improve your ability to manipulate small objects.
--How effective is physiotherapy for managing Parkinson’s disease?
- Morris, ME, Menz, HB, McGinley, JL, et al. 2015a, ‘A randomized controlled trial to reduce falls in people with Parkinson’s disease’, Neurorehabilitation Neural Repair, vol 29, no 8, pp. 777-785. https://www.ncbi.nlm.nih.gov/pubmed/25567121
- Canning, CG, Sherrington, C, Lord, SR, et al. 2015, ‘Exercise for falls prevention in Parkinson disease: a randomized controlled trial’. Neurology, vol 84, no 3, pp. 304-312. https://www.ncbi.nlm.nih.gov/pubmed/25552576
- Keus, S, Munneke, M, Graziano, M, et al. 2014, ‘European Physiotherapy. Guideline for Parkinson's disease’, KNGF/ ParkinsonNet (updated 2017). https://www.parkinsonnet.nl/media/15336569/addendum_evidence__engelstalig___kngf_richtlijn_ziekte_van_parkinson.pdf
- Morris ME, Martin CL & Schenkman, ML 2010, ‘Striding out with Parkinson disease: Evidence-based physical therapy for gait disorders’, Physical Therapy, vol 90, no 2, pp. 280-288. https://www.ncbi.nlm.nih.gov/pubmed/20022998
--Can I fully recover from Parkinson's disease?
There is no cure for Parkinson’s disease and symptoms gradually worsen over time. The main medical treatment is antiparkinsonian medications which increase the amount of dopamine available to the neurons in the affected area of your brain. These medications reduce the symptoms of Parkinson’s disease but become less effective after several years. It is important that medications are taken on time as prescribed by your doctor.
Deep Brain Stimulation (DBS) is a less common surgical treatment which may also be effective in controlling some of the symptoms of Parkinson’s disease. Small electrodes are placed in the affected part of the brain and are connected to a small stimulator device which is placed under the skin in the chest.
--What can I do at home to help manage Parkinson's disease?
If you have Parkinson’s disease, it is important for you to maintain or increase your level of exercise and physical activity. It is not necessary to stop sporting activities as long as you are safe to continue.
There are many ways to increase your levels of exercise and activity. Select activities that you enjoy and are more likely to continue in the longer term. Some options are gym sessions, community exercise groups, boxing exercise, and special programs specifically developed for people with Parkinson’s disease. Tai Chi and different types of dance have also been found to be effective for improving balance.
As each person with Parkinson’s disease is different, your physiotherapist can help you to develop an exercise and activity regime to suit your needs. Home exercise programs may include walking and balance training, practising daily activities and strengthening exercises.
Many people with Parkinson’s disease experience falls. You may be able to reduce your risk of falls at home by making simple changes such as clearing cluttered areas and removing dangerous obstacles such as loose carpets. If you have more advanced Parkinson’s disease, your physiotherapist may help you to learn movement strategies to make it easier to move around your home.
--FAQs
Can I keep working?
Depending on your type of work, you should be able to continue working. You may find you need to make changes to your work. Sometimes problems with fine coordination, fatigue and concentration can impact on your capacity to work.
When should I see a physiotherapist for my Parkinson’s disease?
A physiotherapist can assist you at any time following your diagnosis. We recommend early contact with a physiotherapist to prescribe an appropriate program of exercise and activity.
I am having some problems with my walking. Do I need a gait aid?
Every person with Parkinson’s disease has individual needs. If you are having walking difficulties a physiotherapist can advise whether you need a gait aid or which aid is the best one for you.
--Where can my family go for support?
Support is available for people with Parkinson’s disease and their families. These websites contain helpful information about Parkinson’s disease and links to local support groups.
Parkinson’s Australia: https://www.parkinsons.org.au/
Parkinson’s Victoria: https://www.parkinsonsvic.org.au/
Parkinson’s NSW: https://www.parkinsonsnsw.org.au/
Parkinson’s SA/NT: https://www.parkinsonssa.org.au/
Parkinson’s QLD: http://www.parkinsons-qld.org.au/
Parkinson’s WA: https://www.parkinsonswa.org.au/
Parkinson’s TAS: http://www.parkinsonstasmania.org.au/
Parkinson’s ACT: https://www.parkinsonsact.org.au/
