Author: Dr. Oscar Paredes Ottalengo, G.Guido Rodriguez PT, RT about this authors..⟩⟩
In this article, I would like to refer to Parkinson’s Disease Rehabilitation.
Parkinson’s Disease (PD) is a disease of the brain, a progressive condition that is difficult to treat, It is not acutely fatal. However, it leads to years of compromised quality of life or disability.
In PD both physical movements and other brain functions suffer, it affects men more than women and normally develops between 40and 60 years of age.
Various treatments aim to slow down disease progression and improve quality of life.
Parkinson’s occur due to the death of dopamine-producing cells in an area of the brain called basal ganglia, It results in resting tremor and slowdown of the movements as well as autonomic dysfunction resulting in poor bladder and bowel control.
PD also affects mental abilities, reducing attentiveness, causing sensory disorders, sleep disorders, and mood disorders being a more global disease of the brain than most people think.
There are some typical clinical patterns in the progression of PD that are classified in stages.
This stage is associated with mild symptoms that in general terms do not affect activities of daily living, with some tremor and other dyskinesias (abnormal, involuntary movements) affecting one side of the body. Changes in facials expression, as well as posture, occur.
Symptoms start evolving to worse, both sides of the body now get affected by tremors, rigidity, and dyskinesias. Patients develop walking and posture problems. The person can still live independently, but activities of daily living start to become more difficult.
This is the mid-stage where postural instability, (Bradykinesia) slow movements and falls are common. Sensory deficits are more notorious. The person remains independent, although symptoms are more severe, impairing some activity of daily living such as dressing and eating.
At this stage, symptoms have become severe and limiting. The person is still able to stand unassisted, although a walker may be necessary for safety. Help is now needed with most activities of daily living and living alone is no longer feasible.
This is the most debilitating and advanced stage. The patient is no longer ambulatory due to severe stiffness in the legs. The person is either wheelchair-bound or bedridden, 24 hs nursing care is needed. The person may experience delusions or hallucinations.
Treatment for PD is generally based on the patient ’s symptoms.
There are many medications available, and the leading families of drugs used for treating motor symptoms are Levodopa, dopamine agonists, and MAO-B inhibitors, drugs that improve the amount of dopamine in the brain, although none yet that can reverse the progressive effects of the disease.
People with this disease take a variety of these medications to manage symptoms.
With time, treatment stops helping sufficiently, increasing dose of drugs or levodopa results in numerous side effects needing emphasis on non-pharmacological therapies.
Medication is the treatment of preference, although surgery is restricted to only a few cases.
Surgery for PD have been perfected through the years, yet they are being used in specific patients with advanced debilitating PD for whom drug therapy is no longer working.
Less than 10% of PD patients qualify as suitable candidates for a surgical approach. There are three different kinds of surgeries for PD: ablative surgery (the irreversible freezing/burning of brain tissue), deep brain stimulation (DBS), and transplantation or restorative surgery.
DBS is currently the most used surgical treatment because it does not destroy brain tissue, it is reversible, and it can be adapted to individuals at their particular stage of disease
In recent years, rehabilitation therapy has emerged as an effective therapy, complementary to the drug therapy. It is proven to improve the quality of life.
Most of the systemic reviews (analysis of clinical researches) support the use of intensive rehabilitation therapy in Parkinson’s. These methods are proven to work.
One of the most widely practiced rehabilitation programs for people with PD is the Lee Silverman Voice Treatment-LOUD (LSVT-LOUD) initially developed as a speech therapy program to improve speech sound production disorder in PD, increasing vocal loudness, delivered by a speech therapist.
LSVT® BIG was then developed for motor deficits of PD; it is based on the neuroplasticity principle where the brain can reorganize neural synaptic connections to compensate for a brain injury.
It is designed to promote quick, high-amplitude movements to reverse slow movements typical of PD. It can be delivered by a physical or occupational therapist
It is recommended that rehabilitation therapy in Parkinson’s should be multidisciplinary and intensive, due to it improves/maintains movement ability to do complex physical tasks.
Occupational therapy can teach a person to compensate for physical and mental disability, and live independently for as long as possible and to participate in as much of their daily routine as possible
Here is a video about how physical therapy helps with Parkinson’s disease.
Physical Therapy in PD
As every individual with Parkinson’s has a different set of problems, a qualified physical therapist would need to individualize the treatment focused mostly on:
- Improve posture, gait, and rigidity, through stretching and neuromuscular re-education, to walk better, work effectively.
- Muscle strengthening exercises to improve movements.
- Teach strategies to manage the day to day tasks.
- Provide mobility aids to keep a person active and independent.
- Prescribe special exercises to improve balance and stability.
- Reduce the risk of trauma or fall by teaching specific techniques
- Helping manage fatigue
Occupational Therapy in PD
Occupational therapy differs from physical therapy, it provides various practical skills for living independently. It starts by accessing the abilities of the person and prepares accordingly. It is about understanding the limited abilities (disabilities) and showing new ways of doing old things.
- A person is taught how to perform various tasks while living with a disability; lessons may be in groups or given individually.
- Assessment of memory and other cognitive skill, and then teaching how to live with them. Like explaining to use dairy, alarms, notes, to manage the day to day life.
- Assessing the quality of life and abilities to carry on various tasks.
- Providing non-pharmacological treatment for improving mental abilities.
- Teaching handwriting techniques, using other equipment like computers or gadgets.
- Re-educating about eating, swallowing, and so on.
Speech Therapy in PD
People in PD do not lose the ability to speak, but speech becomes slurred and slow. A person may present difficulty in swallowing excess of saliva, which creates other problems.
Almost 90% of individuals living with PD have speech and voice disorders with dysarthria which is characterized by reduced speech intelligibility that negatively impacts communication, more specific treatments like swallowing training and breathing exercises may all help to overcome specific issues caused by PD.
Quite often those living with Parkinson’s stop talking to avoid embarrassment.
- Speech therapy involves training a person to speak clearly, and family members or caregivers are taught to communicate effectively.
- Advice equipment and aids for improving communication.
- Facial exercises to improve looks and expression.
- Breathing exercises to help cope with the pressure of speech
- Assess the neuropsychological status, detailed assessment of memory, emotional health, cognition.
- Advice and provide treatment for various disorders, like sleep issue, anxiety or depression.
It involves providing splints, braces, other fittings to improve posture, movement, and so on.
- Providing orthotics to improve walking abilities.
- Insoles to improve balance and gait.
- Providing unique footwear to improve balance and walking
Above are only examples of various strategies used to enhance the physical and mental abilities of those living with Parkinson’s. In most cases, rehabilitation would involve neuromuscular re-education, stretching, muscle strengthening, treadmill training.
Researchers are also exploring the use of numerous innovative technologies like using virtual reality, electronic games, imagery and use of robots.
There is a need to consider the usefulness of other well-known methods in Parkinson’s like dancing, practicing martial arts.
Rehabilitation programs work when goals are well defined, both from the perspective of therapist and patient.
Once the target is established, the rehabilitation program should determine specificity, complexity, and intensity of the plan to achieve those goals.
Finally, we must say that there is still a need for research on the subject of rehabilitation. There is some discrepancy between the specialists about what kind of therapy should be provided at what stage.
In conclusion, it can be said that rehabilitation programs work in most cases. In some instances, it may help well, in other cases less. Considering that all the methods used are entirely safe, there is no logic in waiting. The Parkinson’s disease rehabilitation program should be started as early as possible.
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