What is Parkinson's Disease and How Can Physical Therapy Help?

Parkinson’s Disease (PD) is the second most common neurodegenerative disorder in adults, second only to Alzheimer’s Disease. Approximately 60,000 people in the U.S. are diagnosed with PD yearly. 1 million people in the U.S. and 10 million people worldwide are living with PD each and every day. In this article, we provide you with a detailed understanding of PD and the important role physical therapy plays in the lives of those diagnosed with PD.

What is Parkinson’s Disease (PD)?

PD is a neurodegenerative disorder that affects the cells in the brain that produce a chemical called dopamine –  a vital brain chemical not only for bodily movement, but many other actions including regulating thoughts, mood, and the ability to make decisions. In those with PD, there are multiple areas of the central nervous system that can be impacted, but the disease is mainly characterized by an overall loss of the dopamine-producing cells and thus a decrease in the amount of dopamine available for use within the brain.

Causes of PD

The exact cause of PD is not completely understood, but scientists do believe that it is a combination of genetics and environment that play a role in the development of the disease. There is research to suggest that several gene mutations may result in PD, as these mutations have been found within the DNA of those who have a PD diagnosis. Likewise, researchers believe the environment has a strong interaction on gene expression. Some environmental factors include head trauma, exposure to metals and pesticides, geographic-specific risk factors, and occupation-specific risk factors. There is a need for further research in this area to help identify more clear causation.

Common Symptoms

Those with PD can experience both motor (pertaining to movement of the body) and nonmotor symptoms.

Motor Symptoms

The three hallmark motor symptoms of PD are bradykinesia, tremors, and rigidity. Bradykinesia means individuals perform abnormally slow movements, have difficulty initiating movements (such as changing positions), or appear to remain still overall. Bradykinesia is a symptom that must be present for an official PD diagnosis. Tremors are often at rest, and may resemble what is called a “pill-rolling” movement at the hands in which a person is unable to prevent their thumb and fingers from rubbing over top of one another – as if rolling a pill between them. Tremors can be present throughout the rest of the body as well but are often only present in the later stages. Rigidity can be described as an excessive stiffness of the muscles that limits movement.

Two other important symptoms are the presence of postural instability or balance deficits and abnormal gait or walking pattern. When walking, people with PD may shuffle their feet, swing their arms less, and have particular difficulty with turns. Freezing, or trouble initiating the next step, is common especially around turns, and can put the individual at an increased risk for falls. For more information about changes in gait, check out our article How Does Parkinson’s Disease Impact How You Walk? Other symptoms include facial masking or a lack of expressing emotions, drooling, stooped posture, and other problems with increased muscle tone and cramping.

Because PD is both a motor and a sensory disorder, the disease impacts a person’s ability to not only control and start movement, but also sense and make necessary corrections throughout a task. Those with PD have difficulty controlling and adapting the speed and size of their movements – performing actions that are slower and smaller than typical and necessary for certain activities, like walking and standing from a chair.

Nonmotor Symptoms

Nonmotor symptoms include cognitive changes (difficulty with attention, memory, and language), constipation, feeling full with small amounts, loss of smell or taste, mood changes (depression, anxiety, irritability), decreased vision, and sleep disorders.

Not everyone diagnosed with PD will experience the same symptoms or severity. Some people live for many years with a very slow progression of symptoms, while others experience a more rapid progression of the disease.

How is a diagnosis made?

Diagnosing PD can take time, as patients may not present with symptoms until later stages. Physicians will take a thorough patient history and perform a neurological exam. While imaging of the brain is not always indicative of disease, physicians may order a dopamine transporter scan that will demonstrate if there is a loss of those specific dopamine-producing cells in the brain, though this is not always necessary. In order for an official diagnosis, a person must present with bradykinesia and either tremors or rigidity. In later stages, the presence of postural instability can also be used to make a diagnosis. Based on the presence of symptoms and a neurological assessment, physicans are able to make a PD diagnosis.

Treatment and Management

While there is no cure at present time, there are various treatments available to help manage symptoms, preserve function, and reduce the risk of complications. There are a wide variety of medications that can be prescribed, most of which work to increase dopamine levels in the brain in some capacity. Other medications are also used to treat the symptoms of PD, such as rigidity and tremors.

Those with advanced PD may also be candidates for surgical intervention, called deep brain stimulation (DBS). DBS is not a cure but can be helpful at decreasing tremors, minimizing rigidity, and improving the speed of movement in some patients.

How Physical Therapy Can Help

Studies have shown that physical therapy and exercise can drastically improve PD symptoms and quality of life. Those with PD will typically show a decline over time in walking, balance, posture, strength, and endurance. Physical therapists work with patients to maximize their functional status and preserve their mobility throughout life.

Therapists can even attain special certification, called LSVT, that emphasizes making larger movements and louder sounds since these are areas with which those with PD struggle. A PT certified in LSVT BIG is highly qualified to assist patients in not only a specific exercise program to facilitate muscle strengthening, but also therapeutic activities that help the patient to relearn how typical, larger movements should feel. This is particularly important as patients who are able to gauge and attain appropriate movements decrease their risk for falls, a major safety concern for those with PD. Therapists work closely with patients to improve their posture and balance, optimize their walking pattern, and promote muscle strength and endurance.

In order to minimize functional decline, patients must be consistent and intentional with their exercise programs. As with any chronic condition, there are many obstacles that arise with transportation, fatigue, and health status that can prevent patients with PD from making it to physical therapy on a weekly basis. It’s particularly important for these patients to have a solid home exercise program that they are comfortable with and able to perform on their own time or with the help of caregivers. New studies suggest that many patients with PD can benefit from telehealth and remote patient monitoring platforms that encourage patients to be engaged in daily physical activity and motivated to perform their exercises while having access and guidance from a therapist.

Interested in learning more about whether you or a loved one with PD is a good fit for digital physical therapy? Download the OneStep Digital Physical Therapy app to consult with a licensed physical therapist today!

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References

Understanding Parkinson's. Parkinson’s Foundation. Updated 2022. Accessed April 4, 2022. 

Physical Therapy Guide to Parkinson’s Disease. ChoosePT by the APTA. Updated July 3, 2017. Accessed April 4, 2022.

Bhalsing KS, Abbas MM, Tan LCS. Role of Physical Activity in Parkinson's Disease. Ann Indian Acad Neurol. 2018;21(4):242-249.

Langer A, Gassner L, Flotz A, et al. How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review. NPJ Parkinsons Dis. 2021;7(1):25.

Quinn L, Macpherson C, Long K, Shah H. Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic? Phys Ther. 2020 Sep 28;100(10):1730-1736.

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