Rehabilitation in Parkinson's disease
Parkinson's disease (also known as Parkinson disease, Parkinson's, idiopathic parkinsonism, primary parkinsonism, PD, hypokinetic rigid syndrome/HRS, or paralysis agitans) is a degenerative disorder of the central nervous system. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown. Early in the course of the disease, the most obvious symptoms are movement-related; these include tremors or shaking, rigidity, bradykinesia (slowness of movement), loss of postural control, difficulty with walking, and gait.  Later, cognitive and behavioural problems may arise, with dementia commonly occurring in the advanced stages of the disease.
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Regular physical exercise with or without physiotherapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life. In terms of improving flexibility and range of motion for patients experiencing rigidity, generalized relaxation techniques such as gentle rocking have been found to decrease excessive muscle tension. Other effective techniques to promote relaxation include slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing, and meditation techniques. Common changes in gait associated with the disease such as hypokinesia (slowness of movement), shuffling and decreased arm swing are addressed by a variety of strategies to improve functional mobility and safety. Goals with respect to gait during rehabilitation programs include improving gait speed, base of support, stride length, trunk and arm swing movement. Strategies include utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and varying environments (surfaces, inputs, open vs. closed).
Strengthening exercises have led to improvements in strength and motor functions in patients with primary muscular weakness and weakness related to inactivity in cases of mild to moderate Parkinson’s disease. Patients perform exercises when at their best, 45 minutes to one hour after medication. An 8 week resistance training study geared towards the lower legs found that patients with Parkinson's Disease gained abdominal strength, and improved in their stride length, walking velocity and postural angles.  Also, due to the forward flexed posture and respiratory dysfunctions in advanced Parkinson’s disease, deep diaphragmatic breathing exercises are beneficial for improving chest wall mobility and vital capacity. Exercise may correct constipation.
Exercise training on a vibratory platform, also called whole body vibration (WBV) training, has been recently introduced as a training tool complementing standard physical rehabilitation programs for people with Parkinson’s disease. Compared to no intervention, single sessions of WBV have resulted in improved motor ability, as reflected by Unified Parkinson's Disease Rating Scale (UPDRS) tremor and rigidity scores. However, longer-term (3–5 weeks) WBV programs have not led to improved UPDRS motor scores compared to conventional exercises. Furthermore, multiple sessions of WBV have failed to enhance mobility measures (i.e., the Timed Up and Go Test and 10-Meter Walking Test) in people with Parkinson’s disease. A recent review deemed that the evidence of the effects of WBV training on sensorimotor and functional performance remains inconclusive.
Visual, auditory, and somatosensory cuing devices have also been used  in conjunction with walking aids to improve gait in individuals with Parkinson’s disease. These cuing strategies have been implemented in an 'app' called Parkinson Home Exercises.
Given the challenge that this clinical population may have with initiating motor movements during gait (e.g., freezing gait) , these devices provide external stimulation to cue for the next step to take place.
Gait impairment in people with Parkinson's Disease occurs when they generate an inappropriate stride length. 
Task-specific gait training may also lead to long-term gait improvement for patients with Parkinson's disease. Previous research studies have utilized body weight support systems during gait training, where individuals are suspended from an overhead harness with straps around the pelvic girdle as they walk on a treadmill. This form of gait training has been shown to improve long-term walking speed and a shuffling gait following a one-month intervention period.
Studies are also looking at the effect of tai chi on gait performance, and balance in people with Parkinson's Disease.  The first study concluded that tai chi was ineffective since there was no improvement on gait performance and no improvement on the Part III score of the Unified Parkinson's Disease Rating Scale (UPDRS).  The second study found that patients taking tai chi improved on their UPDRS score, Timed Up and Go test, six-minute walk and backwards walking.  It did not however, show any improvements on their forward walking or their one leg stance test. 
Speech and occupational therapy
One of the most widely practiced treatments for speech disorders associated with Parkinson's disease is the Lee Silverman voice treatment (LSVT). Speech therapy and specifically LSVT may improve speech.
A study was conducted to determine if LSVT was beneficial in improving sentence intelligibility of 8 speakers with Parkinson's Disease, according to normal-hearing listeners.  The study concluded that after LSVT, there was a significant improvement in the percentage of the words understood by the listeners.  Even though the LSVT was not beneficial for 2 of the speakers, the treatment did increase their vocal loudness.  Therefore LSVT has shown that it can improve speech and voice impairments in people with Parkinson's Disease. 
Occupational therapy aims to promote health and quality of life by helping people with the disease to participate in as much of their daily routine as possible. There have been few studies on the effectiveness of occupational therapy and their quality is poor, although there is some indication that it may improve motor skills and quality of life for the duration of the therapy.
Studies are considering whether music therapy can have a beneficial effect on people with Parkinson's Disease.  A 3 month study investigated whether there was any motor benefit of music therapy and physical therapy on Parkinson's Disease patients, and whether the therapies had any effect on their emotional well being and their quality of life.  The music therapy consisted of choral singing, voice exercise and rhythmic and free body movements, whereas the physical therapy consisted of stretching exercises, specific motor tasks and ways to improve balance and gait.  The study concluded that music therapy had a beneficial effect on the patient's emotions, it showed an improvement in bradykinesia, and in quality of life.  Music therapy however lacked any motor benefit, whereas physical therapy showed that it improved the rigidity of the patients. 
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