Parkinson’s disease is a progressive neurological disorder that affects the smooth control of muscle movement. It can lead to difficulties in initiating, controlling and coordinating movement. There are both physical and non-physical symptoms.
Physiotherapy plays an essential role alongside the wider health care team to maintain function and quality of life for people living with Parkinson’s. Working in conjunction with the Neurologist, Movement Disorder Clinical Nurse Specialist, Speech Pathologist, Dietitian, Occupational Therapist and when needed a Psychologist, Physiotherapists aim to educate and teach self-management strategies for living with Parkinson’s disease, both for patients and their carer’s.
There are five stages of the disease clinically identified by the Hoehn and Yahr scale. Stages one and two represent the initial stages. Symptoms may include a resting tremor, loss of sense of smell, and difficulty writing or using hands in a fine and delicate way. At this point usually only one side of the body is affected.
Stages three and four are middle to late stages where symptoms can be noticed on both sides. Posture becomes more stooped and shuffling. Turning over in bed and general rotational movements of the body (like swinging your arms when walking) stop happening. Balance and falling can start to become a problem, and people may need assistance from their partner or other supports to help them around the house. Toward stage four people usually find they feel safer walking with a stick or walker.
Stage five is considered the later stage of the disease. Full care is often required at this point either from family members and community support, or in a residential facility.
Not every person living with Parkinson’s disease progresses through all five stages. Some never get past the early stage, while others move quickly to stage five. At this time nobody can tell which person will follow which path, and so it continues to be the subject of much research.
What we do know is that with a good health care team, early diagnosis, good understanding of the disease and keeping as active as possible, progression through the stages and the potential side effects can be slowed.
The role of the Physiotherapist in stages one and two involves education, both to the person with Parkinson’s and their carers. It involves undertaking assessments of strength, balance and function, and introducing large amplitude exercises into their every day. Walking is the best thing that can be done! Parkinson’s Warriors is also an evidence-based exercise program with large amplitude movements that aims to improve strength, flexibility, coordination, confidence and control. Programs run at the Physiotas Ulverstone clinic on Wednesday mornings and at the Physiotas Shearwater clinic on Thursday mornings. These classes are taken by Kathryn, one of our experienced Exercise Physiologists.
In stages three and four the role of the Physiotherapist is to continue monitoring symptoms. It is to also begin trouble shooting potential issues such as ‘freezing’. This is the term used when a person is trying to do something, but the movement just won’t happen. This normally occurs when trying to initiate a movement such as getting up from a chair and walking, or moving between rooms. A physiotherapist will work through strategies to help when someone finds themselves ‘getting stuck’. More specific exercise may also be warranted to target postural changes such as leaning forward, and walking strategies to make you walk faster and longer in stride. This helps reduce the risk of falling.
In stage five the physiotherapist’s role changes towards supporting family members and carers. At this point carers are usually taking a more hands on roll which can be physically demanding. Physiotherapists teach ways to get out of bed safely, so neither the person with Parkinson’s or their carer gets injured. Teaching correct transfer techniques, if walking is no longer possible, is useful as well. Physiotherapists will also work alongside the occupational therapy team to provide equipment that will allow people to live in their own accommodation for as long and safely as possible.
If you have Parkinson’s disease and have never had contact with a physiotherapist, then book in to see Lisa at our Shearwater or Ulverstone Practices. Appointments with Lisa, or with Kathryn to attend PD Warriors can be made by phoning 6428 7500.
About the Author:
Lisa qualified as a physiotherapist from the University of East London in 1999. She spent the first 7 years of her career in the NHS before emigrating to Tasmania in 2006. Prior to working at Physiotas Lisa worked in the acute hospital sector in clinical and managerial roles, where she developed her special interest in lung conditions and Parkinson’s disease.
Lisa began working at Physiotas in 2012, providing general musculoskeletal physiotherapy and lung and Parkinson’s disease management. Lisa has appointments available in our Shearwater and Ulverstone clinics.