Managing life with Parkinsonism: A Physiotherapist’s Insight ( Part 2 )

Dealing Life with Parkinsonism : A Physiotherapist’s Insight ( Part 1)
January 21, 2018
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February 4, 2018
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All about Parkinson’s Disease

Let’s see the Management of the Parkinson’s. Though this condition makes patients life worst than anything, it still can be managed with Medical and Physiotherapy interventions.

I believe,nothing in this world is impossible if we constituently move towards the goal.

So, medically the strategy is to improve level of Dopamine in the brain.

Medical Management for Parkinsons


Neurologist may start with any of the Medications to alleviate the symptoms such as

Carbidopa-levodopa : Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine.

MAO-B inhibitors : These medications include selegiline (Eldepryl, Zelapar) and Rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolises brain dopamine.

Medical Management Plays an Important Role in Initial Stages

Catechol-O-methyltransferase (COMT) inhibitors : Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Anti – cholinergics These medications were used for many years to help control the tremor associated with Parkinson’s disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.

AmantadineIt provides short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.


Functional Neurosurgery has a lesser success rate

Functional neurosurgeryThere are two main neurosurgical options for Parkinson’s disease. The first is lesional surgery, which permanently ablates a target region to achieve either tremor control or lessen dyskinesia. The second is deep brain stimulation surgery.

This is reversible and provides continuous electrical stimulation to a target from an implanted pulse generator (battery) which is adjustable via an externally applied programmer. Deep Brain Stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall. This is connected to one or two fine wires placed under the skin, and is inserted precisely into specific areas in your brain.

A tiny electric current is produced by the pulse generator,( Neuro Stimulator ) which runs through the wire and stimulates the part of your brain affected by Parkinson’s disease.

Although surgery doesn’t cure Parkinson’s disease, it can ease the symptoms for some people.


Physiotherapy Management is not very easy in Parkinson’s but its the only one which works consistently.

1) Physiotherapy Management: Now comes the interesting part, Physiotherapy management. Personally, being a physiotherapist I have seen patients improve with this significantly. But the biggest agony is lack of awareness which leads the patient fall into advanced stages in a short duration. If Physiotherapy rehabilitation started in early stages of the disease it helps to maintain patients mobility . Physiotherapy is an ocean of techniques which can change life of many people. Physiotherapy rehabilitation helps to deal with all the major symptoms of Parkinson’s disease.Regular physical exercise and/or therapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life.

Looking at the symptoms in details

2) Tremors : One of Parkinson’s cardinal symptoms are a tremor. These tremors are known as a resting tremor. Typically, these tremors initially occur only when the arms or legs are at rest. Use of a small rubber ball or stress ball to strengthen the hand affected by tremors. Therapeutic clay , egg exercisers ,pinch grippers can be used to strengthen the hand muscles. Strengthening hand and wrist by using a lightweight dumbbell and resistance bands. Performing body-weight exercises. Complete planks and push ups can also help to strengthen hands and wrists.


3) Bradykinesia : Slowing of movements called Bradykinesia is also typical of PD and will affect an individual’s ability to carry out daily activities, such as walking or dressing, at a normal speed. Exercises to improve balance and gait training helps. Functional training exercises such turning on bed, getting up from chair, walking on footsteps; weight bearing exercises improve the condition. The secondary effects of bradykinesia include a shuffly or festinating walking pattern with intermittent episodes of “freezing. Frenkels exercises, visual and verbal cuing are effective to combat episodes of freezing.

4) Rigidity : The physiotherapist measures specific ROM deficits. Both active and passive Rom exercises are used to improve flexibility. ROM exercises emphasise active motions that are performed 2-3 times in a day. PNF ( Proprioceptive Neuromuscular Facilitations) techniques are used to emphasise ROM. Stretching exercises and Yoga also have been proven to aid with improving flexibility in Parkinson’s Disease.


Instability And Balance Exercises help a lot.

Postural instability and balance

Balance dysfunction and postural instability in Parkinson’s disease are among the most relevant determinants of an impaired quality of life. Physiotherapy interventions are essential to reduce the level of disability by treating balance dysfunction and postural instability.

Physiotherapist does the thorough assessment of your balance.  Retropulsion test, Berg Balance Scale etc. are used that assess static and dynamic controls under conditions of varying base of support. Balancing boards, therapy balls , mirror etc tools can be used to improve the balance.  Reach outs with medicine ball in standing and sitting can help in improving static and dynamic balance.

LSVT : One of the latest and more effective methods used for management of Parkinsons.

There are many researches going on with the effectiveness of exercises in Parkinson’s. One of the most accredited programs called Lee Silverman Voice Treatment ( LSVT ) and loud has found to be effective with Parkinson’s patients.



Contributed By :

Dr. Swati Songolkar

Swati Songolkar

Physiotherapist (Mumbai)


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