The period of time after receiving the diagnosis of Parkinson's disease may make one feel uncertain, particularly when the symptoms still seem not to be much. The patient may observe slight tightness, reduced swinging of the arm, slower turning of the body, reduced confidence in balance, or a slightly changed rhythm of walking. These changes in the first stage may not seem urgent, but they can affect the safety and the confidence in movement in daily life
Physiotherapy for Parkinson's disease from the first stage is not merely "exercising more", but is a clinical approach that has structure, beginning from the assessment, identifying how Parkinson's disease affects the movement, and laying out a plan of restoration according to the current ability, the needs in respect of safety, and the goals of movement in the long term
Physiotherapy should support the medical treatment. The emphasis is not on a technique or an instrument in isolation, but is on coming to understand the movement of the patient, choosing the treatment that is suitable, and adjusting the plan when the symptoms, the goals, the response to medicine, and the needs in daily life change
Why physiotherapy in the beginning stage for Parkinson's disease is important
Parkinson's disease affects movement gradually. In the first stage there may already be stiffness, slow movement, tremor, and changed posture and pattern of walking, even though the patient can still live life by themselves
These symptoms may affect walking, turning the body, the reactions of balance, changing position, and the daily routine. Assessment from the first stage gives the team of restoration the opportunity to understand the change before the problem of movement becomes clearer
The NICE guideline (opens in a new tab) recommends considering referring patients in the first stage to a physiotherapist who has experience in the field of Parkinson's, for assessment, the giving of knowledge, and recommendations on the matter of physical activity, and recommends physiotherapy specific to Parkinson's disease for those who have a problem in the field of balance or of the working of movement
For patients and families, this means that it is not necessary to wait until walking is not safe or the ability to depend on oneself has reduced greatly before beginning physiotherapy. A specialist can help identify the change of the movement at present, explain its meaning for real use, and create a plan that supports daily life so that it is safer and more active
The changes of movement in the first stage that should not be overlooked
The symptoms of Parkinson's in the first stage usually appear as slight changes of the quality of movement. The patient may begin to take shorter steps, walk more slowly, turn the body with several small steps, or feel less stable in crowded or narrow spaces
Other signals may include reduced swinging of the arm, a posture bent forward, tightness at the trunk or the limbs, changing from sitting to standing more slowly, or reduced confidence during movement
These changes may easily be overlooked because they are not painful or always prominent. However, as time passes they may affect the effectiveness and the confidence in movement. Shorter steps may make the walking unstable, slower turning of the body may increase instability, stiffness may make posture and movement require more effort, and reduced confidence may make the patient avoid activity, which may affect the strength, the endurance, and the ability to depend on oneself
An assessment by a physiotherapist helps translate these symptoms so that their meaning for use is seen. Instead of considering only whether there is tremor, tightness, or slow movement or not, the therapist assesses how these characteristics affect walking, changing position, going up and down stairs, reaching, turning the body, and the daily routine
What an assessment of Parkinson's disease by a specialist considers
A plan of restoration for Parkinson's disease should begin from clear information on the ability in functioning, which may include the assessment of the pattern of walking, the length of the step, the speed of walking, the control while turning the body, the reactions of balance, the posture, the flexibility, the strength, the risk of freezing of gait, the risk of falling, the fatigue, and the doing of the daily routine
The assessment also takes into account the stage of Parkinson's disease, the periods of time of using the medicine, the confidence, the environment at home, the history of exercise, and the personal goals of the patient. For example, one patient may want to walk outdoors safely, while another may need to increase the confidence in going up and down stairs, reduce the risk of freezing of gait, or maintain the ability to travel and work independently
An assessment at this level helps prevent the use of a general plan of exercise, and helps the team of restoration judge which treatment is clinically suitable, how intensive the programme should be, and how the progress should be followed
The important techniques of physiotherapy for Parkinson's disease in the beginning stage
Gait training for safety and effectiveness
Gait training is an important part of physiotherapy for Parkinson's disease. It may emphasise the length of the step, the rhythm of the walking, the lifting of the foot, the turning of the body, walking while doing two tasks, the control of posture, and the confidence in various environments
The goal is to develop the quality of the walking and reduce the risk in use, not merely to increase the distance that can be walked. The guidelines of clinical practice support gait training for those who have Parkinson's disease, including the role in increasing the length of the step, the speed of walking, the ability in movement, and the balance
In some selected cases, gait training with technology may help in the matter of repeated practice, feedback, or the quality of movement, but it should be a supporting part, not a replacement for training specific to the activity, clinical reasoning, and the taking of the skills for use in daily life
The strategy of giving cues in order to begin and control movement
A large number of those who have Parkinson's disease get benefit from cues from outside. The cue may be a visual mark, a rhythmic sound, counting, a recommendation from the therapist, or a strategy of movement that helps the patient begin, control, or carry out the movement more effectively
Giving cues may be of benefit when the patient has difficulty beginning to walk, maintaining the rhythm, turning the body, or moving through a narrow space. The guidelines of clinical practice of the American Physical Therapy Association (opens in a new tab) support giving cues from outside for results in the field of walking and for problems of movement connected with freezing of gait
Task-specific training for the living of daily life
Task-specific training connects the restoration with daily life directly. Instead of training movement in isolation, the patient practises meaningful tasks, such as getting up from a chair, turning the body safely, walking through a doorway, stepping over an obstacle, using stairs, carrying objects, or changing direction
This is important because Parkinson's disease may affect automatic movement. Movement that was once done without thinking may require more attention and structure. Task-specific training helps the patient learn strategies that can really be used and build confidence in real situations
The same guidelines support task-specific training in order to develop deficiencies specific to the task and results in the field of use in Parkinson's disease
Training of strength, balance, and movement
Physiotherapy in the first stage may include resistance training, exercises of balance, training of flexibility, training of posture, and exercises of movement. These components are selected from the result of the assessment, and the level increased according to the safety, the response, the fatigue, and the goals in respect of use
Resistance training may help put right the problem of reduced strength and power. Training of balance may develop the control of posture and the confidence in movement. Training of flexibility and of movement may help manage the tightness and support a better range of movement
The heart of it is accuracy. A patient who has stiffness in the first stage and turns the body slowly may need a plan different from a patient who has reduced confidence in balance or is beginning to have symptoms of freezing of gait. Those guidelines support resistance training and training of balance in care by a physiotherapist
The role of technology in the restoration of the nervous system for Parkinson's disease
Technology has value in the restoration of Parkinson's disease when it is used with suitable reasoning. Gait training with a robot, feedback from sensors, technology of balance, or other advanced instruments of restoring the nervous system may help increase the repeated practice, guide the quality of movement, or give feedback during the training more clearly
However, technology should not replace clinical reasoning. In Parkinson's disease, the most suitable treatment depends on the stage of the disease, the symptoms, the risk of falling, the state in respect of cognition, the endurance, the goals, and the response to the therapy of the patient. An instrument cannot set these factors by itself
The team treating should set the goals of the restoration before choosing the instrument. Some patients may suit gait training with technology, while others may need to emphasise the giving of cues, training of balance, training of strength, training of the routine, or the giving of knowledge in order to plan activity in the long term
Why multidisciplinary care is important
Parkinson's disease may affect more than walking; it may affect speaking, swallowing, cognition, mood, sleep, fatigue, the doing of the routine, and the ability to depend on oneself. For this reason, physiotherapy therefore usually gives the best result when it is connected with a strategy of restoration that is more comprehensive
A multidisciplinary approach may have physicians, physiotherapists, occupational therapists, speech and language therapists, and other specialists caring for them together according to the needs of the patient. NICE also points to considering referral in the first stage to occupational therapy and to speech and language therapy when it is suitable in Parkinson's disease
This does not mean that every patient must receive every service, but it means that the plan of restoration should respond to the state, the goals, and the needs in respect of the living of daily life of the patient
When patients should consider physiotherapy for Parkinson's disease
Those who have Parkinson's disease may consider physiotherapy by a specialist not long after receiving the diagnosis, even though the symptoms are not yet much, and it may be suitable when there are changes of the speed of walking, the length of the step, the balance, the turning of the body, the posture, the tightness, the confidence, or the movement in daily life
Physiotherapy does not guarantee that the symptoms will stop the progress of the disease. Parkinson's disease is a state of the nervous system that progresses continuously. However, restoration that begins early and has structure may help the patient understand their own pattern of movement, use strategies that can be carried out, maintain having activity, and reduce the decline of use that can be avoided
Frequently asked questions about physiotherapy in the beginning stage for Parkinson's disease
Is physiotherapy of benefit in the first stage of Parkinson's disease
Yes. Physiotherapy may be of benefit from the first stage, because it helps assess the change of movement, give knowledge, support physical activity, and lay out a plan for walking, balance, posture, strength, and the living of daily life. The plan should be under the care of a specialist who has experience in the restoration of Parkinson's disease
What does physiotherapy for Parkinson's disease usually consist of
Physiotherapy for Parkinson's disease may consist of gait training, the giving of cues from outside, task-specific training, training of balance, resistance training, training of movement, training of posture, and the planning of exercise at home, depending on the state of the patient. The most suitable combination should hold to the result of the assessment
Can physiotherapy help slow the progress of Parkinson's disease
Physiotherapy should not be presented as a complete cure or as a method that guarantees that the progress of the disease will be stopped. The role of physiotherapy is to support the quality of movement, the movement, the balance, the confidence, the living of daily life, and the planning of activity in the long term
When should those who have Parkinson's disease begin physiotherapy
The patient may get benefit from an assessment not long after receiving the diagnosis, particularly when changes of walking, tightness, balance, posture, turning of the body, or confidence begin. Assessment from the first stage helps the team of restoration understand the baseline information and design an active plan
Creating a plan of physiotherapy for the long term
Physiotherapy for Parkinson's disease in the first stage should be specific, have structure, and be under clinical guidance. The goal is not merely exercise, but is understanding how Parkinson's disease affects movement and creating a plan of restoration that supports safe use as time passes
An assessment by a specialist helps set the baseline values and the priorities that can really be used. After that the plan should be reviewed when the symptoms, the medicine, falls, the routine, or the goals change, and the training at home and the following adjusted to suit each person