Physical Therapists for Parkinson's

People with PD who have orthostatic hypotension are not always diagnosed which can limit there abilities if left untreated. Here is an individual with PD who is coming to physical therapy for the 1st time to address her PD and is scheduled to undergo DBS(deep brain stimulation) surgery in the near future. It was the patient who requested physical therapy. She was feeling down because over the course of a year she was trying to increase her walking endurance however because of extreme fatigue and legs feeling like they were going to buckle, her walking endurance worsened. She was unable to stand for more than a minute before needing to sit. When asked if she had blood pressure problems, she denied any problems. When asked if she ever had her blood pressure taken while standing or after standing for a few minutes the answer was no. She reportedly drinks a lot – about a gallon of water a day. Her sitting blood pressure was 98/54 Heart rate 60. Initial standing 78/52 heart rate 64. After 3 minutes her blood pressure did rebound somewhat but the systolic was still below the initial sitting blood pressure. She was advised to see a nutritionist since I thought her fluid intake seemed excessive and could potentially act as a diuretic – but wasn’t sure. She contacted her neurologist and communicated the blood pressure readings. She took her blood pressure at home everytime she was symptomatic with systolic readings typically in the 70’s. The neurologist started her on florinef. The nutritionist calculated her recommended fluid intake which was less than the gallon she had been drinking. With these adjustments she is now walking on average 8,000 steps a day. her systolic is in the 120’s

I am currently sharing a physical therapy student with another clinical instructor. The student told me today that she had been reading about PD and exercise. Apparently she read many articles on this topic. She looked at me and said, “it looks like any kind of exercise will help people with PD.” Well I couldn’t disagree although exercise frequency and intensity do play a role in gains.

Recently I met a women with Young Onset PD (YOPD). We were sitting next to each other in a class. She introduced herself and casually mentioned she has PD. She mentioned it so casually that I thought I misunderstood her because she didn’t exhibit any symptoms. Later she informed me that she had symptoms since 2003 (7 years ago). Was treated for a “frozen shoulder” initially. Five years later was diagnosed with YOPD and clinically presented with right sided bradykinesia, rigidity and tremor at that time. She started to exercise very regularly and is asymptomatic! She admits to getting stiff after sitting for more than 45 minutes and therefore attempts to limit her sitting within this time interval. With more research demonstrating how higher intensity exercise can reduce bradykinesia and rigidity, I asked what she did for her exercise regimen. I was amazed at how much work she put into her exercise program and wondered how many people could maintain this level of motivation. I was equally impressed by the variety of activities she incorporated which most likely helped keep her motivated. Here is the exercise regimen she outlined:

• 20 minutes of ping pong in the early morning to get started
• she converted a room in her house to an exercise room with mirrors and treadmill – spends an hour daily primarily practicing various dance moves Zumba, latin dance, hip hop, jive and swing. She may substitute her dancing with Yoga stretches or floor exercises.
• Zumba classes 3 times a week
• Tennis 3 times a week (not official games)
• She has enrolled at a university for a PD pilot study on exercise which consists of floor and balance exercises, weight training, treadmill
• Instead of watching TV in the evening she has become a “Wii addict” playing: tennis, golf, bowling and Wii balance/fit

For many of you this schedule may seem or would be overwhelming. Simply having the time for this routine is a separate problem. For this individual it is doable. Looking at her program critically may help others make choices to improve their activity. I think a key component for these activities is that she has chosen ways to exercise which are fun for her. She has a back up system in place that if she doesn’t want to go out of her home to exercise – she has a room dedicated to exercise. The mirrors in her room are a great idea since people with PD may think they are moving well but when they actually see themselves move they are often surprised how underscaled their movements are.  The mirrors offer additional feedback to optimize amplitude of movement and form. The Wii games are great because you can compete against yourself and monitor your progress for added incentive. Dancing challanges balance and strength and is typically an aerobic activity. Any activity performed with music improves drive and motivation to keep going when otherwise you may have stopped much sooner.  So adding music to any kind of exercise may help keep you going as long as it doesn’t distract or interfere with the activity.  Enrolling in an exercise research study is another great idea not only to exercise but meet different people and learn other things to do to help yourself after the study has finished. Yoga stretching typically stretches more than one area at a time AND can help strengthen your muscles by attempting to hold the position (bonus).

Current research is indicating that exercise may be neuroprotective. Exercise offers hope to control the progression of PD. The opposite also seems to hold true. Being sedentary may actually accelerate the progression of PD. Research is indicating that higher intensity exercise is needed to improve or reverse symptoms of PD. To read abstracts addressing this topic, go to the research page.

Recently I received an email requesting information on the Oxford Collar for the drop head posture. This type of posture is more commonly seen in people with Multiple Systems Atrophy disorders (MSA) but is also present (although uncommon) in people with PD. The Oxford Collar is also known as the Motor Neuron Disease (MND) Collar which was originally intended for people who have disorders such as ALS and unable to support their head due to muscle weakness. It allows for cervical rotation and some flexion. See website: http://www.saltstechstep.co.uk/mnd-collar.aspx

The grey boxes to the right of this text contains links. Each grey box addresses a particular category of information. For example, if you are looking for a PD exercise class, scroll down to the box titled “Support Groups and Exercise Classes”. If you are looking for exercise classes in Illinois, click on “APDA Illinois”. Fill in the check box for exercise classes and click ’search’ to show locations of exercise classes.

Last week I was seeing a person with PD with a camptocormic posture (this is a more extreme forward bent posture) who was experiencing back fatigue and pain when walking with a cane. (I’ll call him ‘Sam’) This back problem limited Sam’s ability to walk. The cane offered some support and more relief than not using any assistive device. In therapy ambulation was limited to 100 feet when using the cane. I had informed him that a walker could offer greater back support and allow him to walk more. Sam wasn’t very receptive to this suggestion and shunned the use of a walker but was willing to try it out in therapy. When walking with the walker Sam was able to walk 900′ without a rest, his back pain was under good control and he was able to walk at a more natural walking speed. He was a bit winded because he hadn’t walked such a distance or speed for some time. He admitted he could walk better with the walker but was still reluctant to rely on such a device. I asked Sam what he didn’t like about the walker. He said it made him feel more disabled. Sam and I discussed the meaning of being disabled and explained to him that he was actually more disabled walking with a cane and in the long run using a cane would actually be detrimental. The walker in Sam’s case will offer back protection, improve his walking abilities and ultimately be a healthier choice.

Recently I received emails asking for balance exercises. This seems like a simple question but the answer is not always straight forward. Exercises which would enhance the balance of a person with young onset PD will look quite different from exercises to enhance the balance of an elderly person with PD who also has arthritis. Generally speaking the muscles in our legs are the main guide wires for balance. Fortunately there are many avenues to strengthen these guide wires. Performing exercises in a standing position offers the greatest return on your investment. These types of exercises or activities would be: Tai Chi, Dance (becoming more popular and definitely more fun), playing Wii games/balance activities, LSVT BIG program or simply performing conditioning exercises. Yoga, another form of strengthening which isn’t necessarily performed in the standing position, offers both strength and flexibility benefits. The level of difficulty can be adjusted with all of these activities. Balance exercises should be performed in a safe environment so that proper support is available to prevent a fall and at an intensity to achieve strength gains.

This blog now has the capability of listing PTs nationwide. Simply click on the “Locate a PT” page and select the state you are located or select “all states” if you are curious. The goal is to enable PWP find PTs in their area more easily. There have been 7 PTs added to the listing who have experience treating PWP. The current tally is 7 from Illinois and one from Ohio. The 7 from Illinois are located in Chicago or surrounding suburbs. If you know of a therapist who specializes in treating people with PD, tell them about this blog so they can be added to the list. This listing is very new and does not reflect the number of PTs who are knowledgeable in PD.

I am certain there are highly qualified physical therapists who frequently see people with Parkinson’s (PWP), have reviewed the literature, adjusted their approaches based on responses and have not been targeted as a valuable resource for this population by various Parkinson’s Disease (PD) organizations or by the local communities where you live or work. I am just as certain of the lack of knowledge many therapists have regarding PD. Since I am a physical therapist, I know we can’t be specialists in everything – life is too short. My specialty is treating people with PD and similar disorders. This is all I do all day. If I was asked to treat a total shoulder I would definitely have some reading to do and would be able to help someone at the more basic level.