Parkinson's

Home Physio specializes in diagnosing and carefully treating Parkinson's while making sure each patient is fully informed throughout the process. Serving the Central, West & North London , Home Physio is known for delivering outstanding results while helping you minimize your personal investment and creating a suitable treatment plan for your needs.

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How can physiotherapy help Parkinson's

Physiotherapy aims to keep you moving safely and independently, with your body in as good a working condition as possible. A physiotherapist (also known as a physical therapist) is often a member of the multidisciplinary team, that is, a group of professionals with different areas of expertise, who together will help you manage your symptoms and maximise your quality of life.

Physiotherapists use exercise and other forms of physical therapy to help you keep your functional independence. Physiotherapists work in hospital and community settings as well as in people’s homes.

The key aims of physiotherapy in Parkinson's are:

to maintain and improve functional ability and independence
to correct and improve posture and balance
to minimise the risk of falls
to allow strength and flexibility to be maintained
to enhance daily activities (getting in and out of bed, rising from a chair)
to maintain a safe walking pattern (with or without mobility aids)
if freezing is evident, coping strategies such as auditory or visual cues may be taught
to improve manual activities (reaching and grasping)
to maintain respiratory function through breathing exercises
to teach relaxation techniques
to educate carers.

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Stages of Parkinson's treatment

Early stage:

The key aim in the early stage of the condition is to prevent inactivity and to improve physical ability in terms of aerobic capacity, muscle strength and joint mobility. Your physiotherapist may provide an exercise programme that you can follow on your own or in a group, with suggestions and advice on maintaining your fitness levels.

Mid stage:

In this stage physiotherapy will aim to improve upper limb function, in particular reaching and grasping, as well as improving posture, balance, gait and transfers. Your physiotherapist may suggest a range of exercises to help with these activities, including hand exercises to help with manual dexterity so you can more easily button a shirt, for example. He or she may also collaborate with an occupational therapist to ensure that your home is safe and to reduce the risk of you falling.

Cueing strategies may also be suggested to improve gait and overcome freezing – for more information on cueing see Freezing and Gait. In addition, cognitive movement strategies may be taught which allow you to break down complex movements into a sequence of individual movement that you can focus on following step by step, for example when transferring from a bed or a chair and you need to move to the edge, bend knees, place hands by your side to push up, lift your bottom etc.

Late stage:

In this stage, physiotherapy aims to prevent complications that may arise as a result of using a wheelchair or being bedridden. This includes maintaining your breathing, preventing pressure sores and working with carers to ensure that they position you correctly and avoid injuring themselves when lifting.

Physiotherapy and Carers

Physiotherapists can also advise your carer and family how to help you stay as independent as possible. In addition, they can advise carers and family on ways to look after their own health, for example their back, if they help you with getting out of bed, chair or car.

Exercising regularly and safely

It is thought that people with Parkinson’s are around a third less active than the general population of the same age. Not exercising can harm your health and you are more likely to develop other conditions such as heart disease, type 2 diabetes and osteoporosis. You should therefore try to make exercise part of your regular routine, choosing types of exercise to suit your individual abilities and needs. It is a good idea to ask your physiotherapist or doctor for advice before starting any new exercise regime.

The following tips should help you to exercise effectively and safely:

Try to exercise for at least 150 minutes each week. During each session you should aim to get warm, sweat lightly and be out of breath to the point that it is hard to keep up a conversation. How you make up the total time is up to you; you could try 5 sessions of 30 minutes but if that is too long at once, then repetitions of say two 15-minute periods or 3 bursts of 10 minutes each is also fine. It is better to exercise two or three times a week for shorter periods than just a long session at weekends.
Reduce the amount of time you sit each day, for example by walking rather than driving short distances, getting off the bus one stop early or making a walk part of your daily routine. Where possible, take the stairs rather than a lift or escalator.
Make sure you include different styles of exercise that will extend your endurance, build and maintain muscle strength, and maintain joint flexibility and your ability to stretch.
Improve your functional mobility, for example try making large movements when you are sitting, lying down, standing or walking. These will help with daily activities such as walking and balance.
Enjoy. Develop an exercise programme that includes exercise you enjoy and which suits your daily routine and physical capabilities. You are far more likely to maintain your regime if you enjoy what you are doing and feel able to cope!
Use the buddy system. An exercise ‘buddy’ or group sessions can add a welcome social dimension and motivation. Consider joining organised or group classes at your local gym or other public venues, particularly if they are Parkinson’s specific or provide recognised benefits for people with Parkinson’s such as dance or Tai Chi.
Choose your time. Exercise when medication is working well and you are feeling rested as movement will then be easier for you.
Know when to stop. It is normal to feel tired and sweat when exercising but stop if anything hurts or feels uncomfortable. You should talk to your doctor if you experience any of the following when exercising: pain, nausea, light-headedness, dizziness, a tight chest for more than a few minutes, or if you feel your heart missing or adding beats. Listen to your body and learn to recognise when to stop.
Consult your doctor. If you have recently had a heart attack, have any other heart problems or have been told that you are a risk of heart disease then you should consult with your doctor before you embark on an exercise programme. You should also talk with your doctor before exercising if you have been inactive for a long time.

Getting the most out of Physiotherapy

Your physiotherapist will assess your mobility, and specifically if you have difficulties with walking, transfers, balance and falls, your manual dexterity and your physical capacity, and why these problems occur. He or she may assess your ability to perform activities of daily living. This may take one or two appointments and your physiotherapist may want to assess you at home if problems mainly occur there.

Your physiotherapist, with your input, will set goals according to your specific needs and jointly you will agree a treatment plan. Generally this will be a combination of advice and education, plus an exercise programme and strategies to better manage your daily activities. When and how often you see your physiotherapist will depend on your individual goals and treatment plan.

Before your appointment

Write a list of any problems you experience and questions you want to ask, leaving space to write notes when you talk with your physiotherapist. The Pre-assessment Information Form (PIF) within the European Physiotherapy Guideline for Parkinson’s Disease will help you to prepare.

During your appointment

Be honest. Your physiotherapist can only act on the information you provide, so let them know how you really feel.
If you don’t fully understand something, ask the physiotherapist to explain again.
Consider taking a friend or carer with you who can help take notes or prompt you on questions to raise if you find it difficult. Make sure they understand what you want to say so that they can help to explain things if necessary.
Be prepared to explain your key problems and how they affect your daily life. It’s useful to think in advance how to describe difficulties as it’s easy to get tongue-tied when under pressure during an appointment.
Be clear what you hope to gain from your appointment and treatment plan.
Let your physiotherapist know if you have had any treatment before or tried different methods to overcome these problems, and explain how effective these were.
If your physiotherapist is unable to help with a particular problem, he or she will be able to suggest other healthcare professionals who may be able to help.

You and your physiotherapist are partners in managing your Parkinson’s. Here are some aspects of your care you might both want to focus on:

Jointly agree on your goals of treatment, in particular what you should achieve and when.
Agree on a treatment plan that is tailored to your daily routine and abilities.
Agree how to liaise on an ongoing basis, including follow-up appointments which enable you to ask for feedback, for example if you want to check that you have been doing exercises properly. Always get in touch between scheduled follow-up appointments though if you have any queries.
Discuss any problems you have with adhering to your agreed programme so that it can be adjusted to enable you to continue properly.
Plan in advance how you will maintain an exercise regime independently once your treatment has finished.
Agree on what information your physiotherapist will share with your doctor.