PARKINSON’S DISEASE  PHYSICAL THERAPY

INCIDENCE
According to the Parkinson’s Disease Foundation, at least 1 million Americans suffer from Parkinson’s disease, which is more than people who suffer from Muscular Dystrophy, Multiple Sclerosis, and Lou Gehrig’s disease combined.  At least 40,000 Americans are diagnosed each year with Parkinson’s Disease (PD), noting 15% of these individuals are diagnosed before the age of 50

How is PD Diagnosed?
Although there is still no standard test to show if a patient has Parkinson’s disease, a skilled Neurologist is able to accurately diagnose PD. 

What does the research say about treatment of PD?
Increasingly, the research is showing how Physical Therapy, when combined with medications prescribed by Physicians, can improve a patient’s quality of life, including transfers, ability to walk better.  In a recent September 2006 symposium, Dr. John Nutt, one of our country’s lead researchers for Parkinson’s disease (Director, Parkinson’s Center of Oregon, OHSU), states they are becoming increasing involved in researching the long term effects of exercise.  Evidence of physical therapy helping improve many with Parkinson’s Disease has been published for over 10 years.

Hear what this patient has to say about Physical Therapy and Parkinson’s: 
“When I was diagnosed with Parkinson’s 4 years ago, I was told I had to give up golf. It was devastating after playing for 55 years. I could not get on the ladder any more, rake the leaves off the roof, do heavy yard work, or use the sewing machine. I had to give up washing the dishes by hand also.  When I started at Physical Therapy in June of 2006 for an evaluation, I was using a walker. I didn’t believe the therapy would do me any good.  By July, I was able to walk on the beach with my family, hit some balls at a driving range in August, and in September I raked some leaves.  I recommend GNPs, doctors, and neurologists to refer people with Parkinson’s to Eugene Physical Therapy.”

WHAT MAKES YOU A GOOD CANDIDATE FOR PHYSICAL THERAPY?
First of all, like the above patient, a good family support system is a priority to help you practice at home.  Even more important, though, is the desire that you want to try and change yourself, recognize the deficits you truly have and work on physically improve.   If someone with PD does not really wish to change, but their family does, this unfortunately does not make this person a good candidate.

CAN PHYSICAL THERAPY HELP EVERYONE WITH PD?
No.  There are many cases of advanced PD where little to no change may be possible.  Catching it early as possible, having good education as to what activities to practice that affect breathing, walking, coordination, strength, and balance are just a few important physical attributes that PD may have a negative affect on?

OUR CLINICAL STAFF
Our Physical Therapists with expertise in Vestibular Rehabilitation emphasize current evidence based approaches to treat the patient with Parkinson’s disease.   In most cases, it is extremely beneficial to have a family member attend with the patient, to assist with the treatment program to be performed at home in an optimal fashion.

LANE COUNTY PARKINSON’S DISEASE SUPPORT GROUP
This support group was started 50+ years ago.  Meets monthly at Campbell Senior Center, High St., Eugene, OR

American Parkinson Disease Association Inc.

National Parkinson Foundation

Parkinson’s Disease Foundation

The Michael J. Fox Foundation for Parkinson’s Research

2007-2005 Literature Review: Parkinsons & Physical Therapy (listed by recent to past)

Keus SH, Bloem BR, Hendriks EJ, et al. Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov Disord. 2006 Nov 28

Horstink M, Tolosa E, Bonuccelli U, et al. European Federation of Neurological Societies; Movement Disorder Society-European Section. Review of the therapeutic management of Parkinson's disease.  Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section. Part I:early (uncomplicated) Parkinson's disease.  Eur J Neurol. 2006Nov;13(11):1170-85

Jobges M, Spittler-Schneiders H, Renner CI, et al. Clinical relevance of rehabilitation programs for Parkinson's disease. I: Non-symptom-specific therapeutic approaches. Parkinsonism Relat Disord. 2006 Oct 19

Jobges EM, Spittler-Schneiders H, Renner CI, et al.  Clinical relevance of rehabilitation programs for patients with idiopathic Parkinson syndrome. II: Symptom-specific therapeutic approaches. Parkinsonism Relat Disord. 2006 Oct 19

Sammer G, Reuter I, Hullmann K, et al.   Training of executive functions in Parkinson's disease. J Neurol Sci. 2006 Oct 25;248(1-2):115-9.

Crizzle AM, Newhouse IJ.  Is physical exercise beneficial for persons with Parkinson's disease?  Clin J Sport Med. 2006 Sep;16(5):422-5.

Dibble LE, Hale T, Marcus RL, et al. The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson's disease.   Arch Phys Med Rehabil. 2006 Sep;87(9):1280-2.

Rodrigues de Paula F, Teixeira-Salmela LF, Coelho de Morais Faria CD, et al.  Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease.  Mov Disord. 2006 Aug;21(8):1073-7

Kluding P, McGinnis PQ.  Multidimensional exercise for people with Parkinson's disease: a case report.  Physiother Theory Pract. 2006 Jun;22(3):153-62.

Perriol MP, Krystkowiak P, Defebvre L, Stimulation of the subthalamic nucleus in Parkinson's disease: cognitive and affective changes are not linked to the motor outcome.  Parkinsonism Relat Disord. 2006 May;12(4):205-10. Epub 2006 Mar 23

Gage H, Kaye J, Owen C, et al.  Evaluating rehabilitation using cost-consequences analysis: an example in Parkinson's disease. Clin Rehabil. 2006 Mar;20(3):232-8.

Stack EL, Ashburn AM, Jupp KE.  Strategies used by people with Parkinson's disease who report difficulty turning.  Parkinsonism Relat Disord. 2006 Mar;12(2):87-92.

Silverman EP, Sapienza CM, Saleem A, et al.  Tutorial on maximum inspiratory and expiratory mouth pressures in
individuals with idiopathic Parkinson’s disease (IPD) and the preliminary results of an expiratory muscle strength training program.  Neuro Rehabilitation. 2006;21(1):71-9.

Brichetto G, Pelosin E, Marchese R, et al.  Evaluation of physical therapy in Parkinsonian patients with freezing of gait: a pilot study. Clin Rehabil. 2006 Jan;20(1):31-5.

Horstink M, Tolosa E, Bonuccelli U, Deuschl; European Federation of Neurological Societies; Movement Disorder Society-European Section.Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section. Part I: early (uncomplicated) Parkinson's disease. Eur J Neurol. 2006 Nov;13(11):1170-85.

Carne W, Cifu DX, Marcinko P, et al.   Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson's disease. J Rehabil Res Dev. 2005 Nov-Dec;42(6):779-86.

Franchignoni F, Martignoni E, Ferriero G, et al.  Balance and fear of falling in Parkinson's disease.  Parkinsonism Relat Disord. 2005 Nov;11(7):427-33.

Michalowska M, Fiszer U, Krygowska-Wajs A, et al. Falls in Parkinson's disease. Causes and impact on patients' quality of life. Funct Neurol. 2005 Oct-Dec;20(4):163-8.

Heikkila VM, Kallanranta T.  Evaluation of the driving ability in disabled persons: a practitioners' view.  Disabil Rehabil. 2005 Sep 2;27(17):1029-36

Inzelberg R, Peleg N, Nisipeanu P, et al.  Inspiratory muscle training and the perception of dyspnea in Parkinson's disease.  Can J Neurol Sci. 2005 May;32(2):213-7.

Smidt N, de Vet HC, Bouter LM, et al.  Exercise Therapy Group. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews.  Aust J Physiother. 2005;51(2):71-85

Idjadi JA, Aharonoff GB, Su H, et al. Hip fracture outcomes in patients with Parkinson's disease.  Am J Orthop. 2005 Jul;34(7):341-6.

REFERENCES
1.  Guccione, AA.  Geriatric Physical Therapy 
Mosby-Year Book, Inc.  St. Louis, MO.  1993  pp:  193-197

2.  Kandel ER, Schwartz JH, Jessell TM.  Principles of neural science.  3rd ed.
                Elsevier Science Publishing Co. Inc., New York.  1991  pp:  653-656

3.  O’Sullivan SB.  Schmitz TH.  Physical Rehabilitation:  Assessment & Treatment 2nd ed.
                F.A. Davis Co., 1980  pp:   481-493

4.  Schenckman M. Butler RB.  A model for multisystem evaluation treatment of individuals with parkinson’s disease. 
Physical Therapy 69(11); Nov 1989; 932- 943

5.  Schenckman M, Donovan J, Tsubota J., et al.  Management of individuals with parkinson’s disease:  rationale and
case studies.  Physical  Therapy  69(11):  Nov 1989: 944 – 955