Parkinson's disease (PD) is the second most common neurodegenerative disorder behind Alzheimer's disease. It affects the parts of the brain responsible for motor control and presents unique challenges that require a comprehensive multidisciplinary approach. In addition to neurologists, mental health providers, social workers, nurses, speech and occupational therapists, physical therapists are a vital part of the care team for a patient with Parkinson's disease.

Understanding Parkinson's disease

Parkinson's disease is primarily associated with the progressive degeneration of dopamine-producing neurons in the brain. Dopamine is a neurotransmitter responsible for regulating movement, so as the production of dopamine declines, the movement issues and loss of automatic motion associated with Parkinson's disease become prominent. These movement issues may include tremors, rigidity, bradykinesia or slowed movement, and instability. 

Along with these motor symptoms, Parkinson's disease can also manifest with common non-motor symptoms, including cognitive impairment, depression, anxiety, sleep disturbances, and autonomic dysfunction. Many of these symptoms occur years before formal diagnosis. The combination of motor and non-motor symptoms can significantly impact an individual's quality of life and functional independence. 

Addressing both the motor and non-motor symptoms of Parkinson's disease means looking for ways to improve a patient's functional capacity and enhancing overall quality of life. Physical therapy for Parkinson's disease can and should be an integral part of a patient's management plan. 

How physical therapy helps Parkinson's disease patients

Physical therapy plays a crucial role in managing motor symptoms and promoting mobility and independence, both in Parkinson's disease as well as for any older person experiencing a decline. The American Physical Therapy Association has developed a Clinical Practice Guideline to provide evidence-based principles for physical therapists to follow when working with Parkinson's disease patients. These guidelines include:

  • Aerobic training
  • Resistance training
  • Balance training and fall reduction
  • Gait (walking) training
  • Task specific training
  • Multidisciplinary care
  • Community exercise groups

Aerobic and resistance exercise

Regular exercise has been shown to have possible neuroprotective effects and can help alleviate symptoms of Parkinson's disease. Aerobic exercise and strength training exercises are recommended to improve cardiovascular health and muscle strength. There is evidence that these types of exercise may help to slow the progression of symptoms of PD. Exercise programs should be individualized and supervised by qualified healthcare professionals to ensure safety and effectiveness. 

Balance training and fall reduction

Individuals with PD can develop balance problems as the disease progresses. Thankfully, there are specific therapies that can target balance and further reduce the risk of falls. Intensive balance training has been shown to improve balance and reduce falls for individuals early in the disease course. Later in the disease, training is more focused on addressing fall prevention strategies, such as using appropriate assistive devices, reducing multi-tasking, and making adjustments to home environments.

Gait training

Gait training is a specific type of therapy aimed at improving someone's walking quality. Parkinson's disease can cause patients to shuffle their steps, limit their arm swing and trunk rotation, and slow their walking speed significantly. Gait training may focus on having someone call attention to how they are walking to focus on "big" movements. New evidence also suggests that walking to the beat of a metronome or to music can improve walking quality. 

Task specific training

Since PD affects automatic movements, task specific training can help to make functional, everyday movements more automatic by optimizing how the brain learns. This type of training can include a variety of different training techniques, such as dual (multi) tasking, mental imagery, turning training, and upper extremity functional training. Depending on the specific effects of the disease, one or more of these techniques can be used to manage symptoms. 

Multidisciplinary care

Collaboration among healthcare professionals is crucial to comprehensive PD care. A multidisciplinary approach allows for holistic assessment and management of both motor and non-motor symptoms, addressing the diverse needs of individuals living with the disease. In addition to physical therapists, patients with PD may meet with other rehabilitation experts, such as occupational therapists and speech and language pathologists

Community exercise and behavior change approaches

Parkinson's disease is a lifelong, progressive disease. It is vital that patients living with PD are optimizing how they manage their symptoms. We know that the earlier a patient begins treatment and their specific, personalized exercise programs, the better their long-term prognosis. Many community exercise programs are available to help patients maintain their exercise programs as well as engage in interacting with other people living with the disease, which helps to address some of the mental health symptoms. The American Parkinson Disease Association has information on community groups on their website.

Parkinson's disease presents complex challenges that require a multifaceted approach to management. Following the evidence-based recommendations outlined in the APTA Clinical Practice Guidelines, individuals with Parkinson's disease can optimize their physical function, enhance their quality of life, and maintain independence for as long as possible. With ongoing research and advancements in treatment approaches, there is hope for improved outcomes and better quality of life for individuals living with PD. 

For more information about how Lifespan Outpatient Rehabilitation Services can help patients with Parkinson's disease and other neuromuscular disorders, visit our website.

 Kenneth Vinacco, PT

Kenneth Vinacco, DPT, NCS

Kenneth Vinacco, DPT, NCS, is a board-certified clinical specialist in neurologic physical therapy with Lifespan Outpatient Rehabilitation Services.