“This is part of our on-going series of exploring neurological and degenerative conditions that can affect a number of individuals and specifically how Physical Therapy can help”
Today’s Topic: Parkinson’s Disease
Many of us have heard about Parkinson’s because of Michael J. Fox and his very early diagnosis and subsequent public life with this condition. Parkinson’s disease was first introduced into the medical field in 1807 and is described as condition with a few distinct characteristics. It is estimated that one out of 100 people are diagnosed with Parkinson’s and over 800,000 people are living with PD in the United States. Typically, Parkinson’s is diagnosed in the age span of 60 to 80 years of age and more prevalent in men. However, people as young as the age of 40 years old have been diagnosed with Parkinson’s.
Parkinson’s disease is described as a loss of different cells specifically dopamine that is produced by a part of the brain called the substantia nigara. These cells are the chemical messengers that transmit signals within the central nervous system that allow for coordination of movement. At this point in time there is no specific cause but there is some research leaning toward a genetic component, an environmental component and/or a combination of both.
Parkinson’s is diagnosed by a neurologist and can be a arduous process since there are no definitive tests present that clearly indicate PD such as using blood markers, brain scans or EEG’s. There are 3 cardinal signs of Parkinson’s and two of these must be present and a responsiveness to certain medication that can help increase dopamine supplies. The cardinal signs of Parkinon’s are Bradykinesia or the sloweness of movement, rigidity within the musculoskeletal system and a tremor is observed and usually decreased with movement. Other signs are postural instability that can lead to episodes of falling and gait deviations such as decreased velocity and stride length as well as cognitive/emotional changes can be evident. Often times, a person’s cognitive status and personality can change before motor symptoms are present. Parkinson’s is controlled through medications and
So what can PT do to help? Most of the time as physical therapists we see patients with this condition they are either hospitalized, had a number of falls and their physical function has deteriorated to a great degree. In this case we will work extensively with a patient to improve their balance, strength, coordination, safety with functional mobility like walking, sitting to standing, getting in/out of bed, etc… This is a very reactive form of PT, if its broken then we fix it and it works to get the person back to a safe level of function.
However, there is more and more evidence coming out on prevention or slowing down of disease progression which has largely been researched medicinally but now there is a growing body of evidence that certain types of exercise can be very beneficial for individuals with Parkinson’s. Darn it, but there is that dreaded work exercise again!
Research in animals models shows that exercise can help the body’s own internal repair mechanisms and in cases interfere with the body’s own mechanisms related to cell death. It also has been demonstrated that exercise has the ability to stimulate growth of new neurons as well as change metabolic and immune system responses. My big take home is that exercise is very beneficial and it is important to speak with a physical therapist regarding a good program for individual based on their current functional status and disease stage.
Again, looking at the evidence research tells us that regular exercise at least three times a week and for longer duration’s such as 50 minutes of activity seems to have a greater affect on this condition. Some activities that people participate in are specific exercise regimens for Parkinson’s that are sometimes offered through county health/wellness programs, boxing, dance classes, walking on treadmill and cycling. Another theory is incorporating big movements into certain functional activities such as squatting, lunging, sitting to standing into a exercise program that can be easily performed in the comfort of one’s home. It is important to note, that Parkinson’s is a progressive, degenerative disease but like many things the more we move the better we feel…. Before starting any program it is a smart decision to consult a physical therapist with experience working with these type of patients in order to come up with a safe and effective routine.