If you have been diagnosed with Parkinson's disease (PD) your doctor may refer you to many specialists to help you move and function better. A physical therapist is a movement specialist who can assess and treat the motor control and planning changes that occur with the disease.
While every physical therapist may provide slightly different services for PD, some of the basic impairments that he or she may focus on are:
- Postural assessment. If you have PD, you may notice that your posture has changed. Most often, PD causes posture to become more flexed forward. This can alter your center of gravity and cause balance difficulty. A physical therapist can evaluate your posture and help provide strategies to maintain or improve your posture.
- Endurance assessment. Changes in endurance can often occur with PD. You may notice difficulty walking up hills or stairs. Your physical therapist can assess your current aerobic endurance and provide exercises to improve overall endurance.
- Gait evaluation. Since PD affects the area of the brain that is responsible for motor planning, your gait may become impaired. You may be walking and then suddenly stop. This is often called the freezing phenomenon. Or, you may be walking and then start to take small, rapid steps. This is called a festinating gait pattern. You may also have difficulty initiating walking.
- Strength measurements. Parkinson's disease often affects the muscular system, thus your strength may be impaired. Therefore, your physical therapist may measure the strength of specific muscle groups.
- Measurements of flexibility and range of motion (ROM). Rigidity and stiffness are common symptoms of PD. Therefore, your physical therapist may measure your range of motion around specific joints. Flexibility may also be assessed to provide strategies and exercises to improve ROM and flexibility.
- Breathing function. As your posture becomes more flexed forward, it becomes more difficult for your diaphragm to function properly. You may notice that breathing may be difficult, especially with tasks that require more endurance.
- Balance. Motor function and postural changes in PD may cause your center of gravity to change and this may alter your balance. Your physical therapist can assess your balance and provide exercises to improve balance. He or she can also recommend changes in your home to ensure safe mobility.
After collecting information about your current functional abilities and impairments, your physical therapist can start to formulate a treatment plan. Your plan of care will likely involve other healthcare professionals since PD affects so many different body systems. It is also important to include family members or friends in your treatment so that they can provide assistance if needed.
The main focus of your physical therapy should be on maintaining functional mobility and control. Specific strategies to help improve smoothness of movement may also be necessary to maintain optimal functional mobility.
Since PD can cause many motor planning changes and mobility problems, exercise should be a primary component of treatment. Focus of exercise for PD should be to improve walking and balance, improve strength and range of motion, increase postural awareness and improve breathing and endurance. Be sure to speak with your doctor and physical therapist before starting an exercise program to be sure that it is safe for your specific condition. Your doctor and physical therapist can also work together to help you decide which exercises would be best suited for you.
Parkinson's disease can have a profound effect on your functional ability and movement. While there is currently no cure for PD, a well-planned and executed physical therapy evaluation can help guide you to the proper treatment to help manage symptoms and to help improve safe, functional mobility.
Carr, J. H. (2000). Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
Umphred, D. A. (1995). Neurological rehabilitation. (3 ed.). St. Louis: Mosby.