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Physiotherapy, delivered as part of a multidisciplinary approach, provides physical and psycho-social benefits for people with Parkinson’s disease.
What is Parkinson's disease?
Parkinson’s disease is a progressive neurological condition characterized by motor and non-motor problems. The main changes arise from brain dysfunction through reduced production of chemical messengers particularly the neurotransmitter dopamine.1
The three main motor (movement) symptoms are bradykinesia (slowness), rigidity (stiffness) and tremor.1 Diagnosis is usually based on clinical examination. People with Parkinson’s might present with falling, loss of confidence and independence, and reduced quality of life.1,2
Drug therapy and deep brain stimulation can provide partial relief of symptoms. The 2012 Canadian Guidelines on Parkinson’s disease also recommend additional support from allied health interventions including physiotherapy.3
Physiotherapy involvement is supported by a growing evidence base of high-quality research, which is informing best practice guidelines.2 Short-term patient benefits in a range of physical and quality of life measures have been identified through systematic reviews.3, 4, 5, 6
The 2012 Canadian Guidelines on Parkinson’s disease recommend physiotherapy for:
- Gait re-education
- Improvement of balance and flexibility
- Enhancement of aerobic capacity
- Improvement of movement initiation
- Improvement of functional independence, including mobility and activities of daily living and provision of advice regarding safety in the home environment.2
Other issues such as pain, well-being, respiratory function and support networks, may also need attention.2
During the earlier stages, physiotherapists emphasize education and self-management encouraging use of leisure activities and programs that promote general fitness and inclusion in community activity. Physiotherapy-specific exercise can offset the effects of Parkinson’s to minimize deterioration in strength, endurance, flexibility, and balance. Exercise may help improve non-physical symptoms such as mood, cognition, and sleep disorders as well.3
As the condition progresses, physiotherapists teach and apply movement strategies to overcome difficulty in generating automatic movement and thought, including developing strategies to compensate for loss of function, using external (auditory, tactile, visual and sensory) or internal (mental rehearsal and visualization) cues, dual task training, self-instruction and improving attention span.
The exercise component of a rehabilitation program is essential, and demonstrates better outcomes than traditional care.6,7 Physiotherapists are integral members of a multi-disciplinary team, prescribing individually tailored exercise programs to their patients as they learn to be physically active and to include activity as part of lifestyle improvement measures. The team approach is cost-effective and leads to a better prognosis.4
Cost of Parkinson’s disease
- Direct annual health-care costs for Parkinson’s disease in Canada is $120,358,000.9
- People living with Parkinson’s disease have the highest rate of prescription drug use recorded in the National Population Health Study of Neurological Conditions.9
- Annual out-of-pocket expenses for individuals with Parkinson’s disease averages $1,100.9
- Direct costs are reduced when community-based physiotherapists deliver evidence-based care.12
- Targeted falls prevention programs for individuals with Parkinson’s are cost effective when compared to usual care.13
Physiotherapy is essential in the multidisciplinary management of people with Parkinson’s. Advice and education offered in the early stages maintains general fitness, minimizes deterioration, and promotes self-management. In the later stages, physiotherapy can improve gait, balance, transfers, manual activities, and reduce the risk of falls.
Physiotherapist in the community
There is evidence that using rhythm and music in Parkinson’s disease treatments can improve gait (speed, frequency, and step length), limbs coordination, postural control, and balance.14 In 2015, an exercise program for Parkinson’s that includes movement to music was introduced at the Faculty of Rehabilitation Medicine’s satellite campus in Camrose, Alberta. Led by physiotherapist Connie Harrison, the program is designed to increase overall function, such as ease in rising from a chair or turning in bed. The patients enjoy the class and have made such comments as “by end of class I am walking with longer strides and a faster pace” or “my tremor calms down by end of class.” Harrison says that since the program began, she has observed gains in gait speed, balance, and strength in the majority of participants.
Size of the problem
- More than 25 people are diagnosed with Parkinson’s every day. Between 2011-2031, the number of Canadians diagnosed with Parkinson’s is expected to double to more than 163,700.9
- Diagnosis is higher in men than women in Canada by a 3:2 ratio.9
- Parkinson’s disease is not a normal part of aging but the incidence does increase with age.14 85% of those diagnosed with Parkinson’s are over the age of 65.14 In Canada, Parkinson’s affects one in 100 people over 60.9
- Of the remaining population, 20% of those diagnosed with Parkinson’s disease are under 50.10
- Iansek R, Morris M, editors. Rehabilitation in movement disorders. Cambridge: Cambridge University Press; 2013.
- Canadian Guidelines on Parkinson’s Disease Canadian Neurological Sciences Federation 2013 http://www.parkinsonclinicalguidelines.ca/sites/default/files/PD_Guidelines_2012.pdf
- Reynolds GO, Otto MW, Ellis TD, Cronin-Golomb A. The Therapeutic Potential of Exercise to Improve Mood, Cognition, and Sleep in Parkinson’s disease. Movement disorders : official journal of the Movement Disorder Society. 2016;31(1):23-38. doi:10.1002/mds.26484.
- Corcos DM, Robichaud JA, David FJ, et al. A Two Year Randomized Controlled Trial of Progressive Resistance Exercise for Parkinson’s disease, Movement disorders : official journal of the Movement Disorder Society. 2013;28(9):1230-1240. doi:10.1002/mds.25380.
- Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, Shah L, Sackley CM, Deane KHO, Wheatley K, Ives N. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD002817. DOI: 10.1002/14651858.CD002817.pub4
- Allen NE, Sherrington C, Paul SS, et al. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord. 2011 Aug 1;26(9):1605-15. doi: 10.1002/mds.23790. Epub 2011 Jun 14.
- Pearson MJT, Lindop FA, Mockett SP, et al. Validity and inter-rater reliability of the Lindop Parkinson’s Disease Mobility Assessment: a preliminary study. Physiotherapy. 2009 Jun;95(2):126-33. doi: 10.1016/j.physio.2009.02.003. Epub 2009 Apr 23.
- Skelly R, Brown L, Fakis A, et al. Does a specialist unit improve outcomes for hospitalised patients with Parkinson’s disease? A prospective study. 3rd World Parkinson Congress; Montreal: Journal of Parkinson’s Disease; 2013:3;Suppl 1: p 196. https://doi.org/10.1016/j.parkreldis.2014.09.015
- Neurological Health Charities Canada (NHCC), Health Canada, Public Health Agency of Canada (PHAC), Canadian Institute of Health Research (CIHR). MAPPING CONNECTIONS: An Understanding of Neurological Conditions in Canada. Sept. 2014. pg.66. http://www.phac-aspc.gc.ca/publicat/cd-mc/mc-ec/assets/pdf/mc-ec-eng.pdf
- Parkinson Canada. Young Onset Parkinson’s Disease. Available at: http://www.parkinson.ca/about-parkinsons/young-onset-parkinsons-disease/ Accessed January 25, 2018.
- Munneke M, Nijkrake MJ, Keus SH, et al. Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a cluster-randomised trial. Lancet Neurol. 2010 Jan;9(1):46 doi: 10.1016/S1474-4422(09)70327-8. Epub 2009 Dec 1.
- Farag I, Sherrington C, Hates A, Canning CG, Loord SR, Close JC, Fung VS, & Howard K 2016. Economic evaluation of a falls prevention exercise program among people with Parkinson’s disease, Mov Disord. 2016 Jan;31(1):53-61. doi: 10.1002/mds.26420
- Raglio, A. (2015). Music Therapy Interventions in Parkinson’s Disease: The State-of-the-Art. Frontiers in Neurology, 6, 185. http://doi.org/10.3389/fneur.2015.00185
- Parkinson Canada. Statistics on Parkinson’s Disease. Parkinson Canada. Available at http://www.parkinson.ca/wp-content/uploads/Statistics_On_Parkinsons.docx. Accessed on January 25, 2017.
Adapted and used with permission of the Chartered Society of Physiotherapy