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 shaking, rigidity, slowness of movement, 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. 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.
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.
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.
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.
- The National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–46. ISBN 1-86016-283-5.
- Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL (April 2008). "The effectiveness of exercise interventions for people with Parkinson's disease: a systematic review and meta-analysis". Mov. Disord. 23 (5): 631–40. doi:10.1002/mds.21922. PMID 18181210.
- O'Sullivan & Schmitz 2007, pp. 873, 876
- O'Sullivan & Schmitz 2007, p. 879
- O'Sullivan & Schmitz 2007, p. 877
- O'Sullivan & Schmitz 2007, p. 880
- Barichella, M; Cereda, E, Pezzoli, G (2009 Oct 15). "Major nutritional issues in the management of Parkinson's disease.". Movement disorders : official journal of the Movement Disorder Society 24 (13): 1881–92. doi:10.1002/mds.22705. PMID 19691125.
- Haas, C.T., Turbanski, S., Kessler, K., & Schmidtbleicher, D. (2006). The effects of random whole-body-vibration on motor symptoms in Parkinson's disease. NeuroRehabilitation, 21: 29–36.
- King, L.K., Almeida, Q.J., & Ahonen, H. (2009). Short-term effects of vibration therapy on motor impairments in Parkinson's disease. NeuroRehabilitation, 25: 297–306.
- Arias, P., Chouza, M., Vivas, J., & Cudeiro, J. (2009). Effect of whole body vibration in Parkinson's disease: a controlled study. Movement Disorders, 24: 891–898.
- Ebersbach, G., Edler, D., Kaufhold, O., & Wissel, J. (2008). Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. Archives of Physical Medicine and Rehabilitation, 89: 399–403.
- Sitjà Rabert, M., Rigau Comas, D., Fort Vanmeerhaeghe, A., Santoyo Medina, C., Roqué, I., Figuls, M., Romero-Rodríguez, D., & Bonfill Cosp, X. (2012). Whole-body vibration training for patients with neurodegenerative disease. Cochrane Database of Systematic Reviews, 15(2): CD009097.
- van Wegen et al 2006; Nieuwboer et al. 2007
- Pongmala, C., Suputtitada, A. & Sriyuthsak, M. (2010). The study of cuing devices by using visual, auditory and somatosensory stimuli for improving gait in Parkinson’s patients. International Conference on Bioformatics and Biomedical Technology
- Miyai, I., Fujimoto, Y., Yamamoto H., et al. 2002. Long-term effect of body weight-supported treadmill training in Parkinson’s disease: a randomized controlled trial. Arch Phys Med Rehabil, 83(10):1370-1373.
- Fox CM, Ramig LO, Ciucci MR, Sapir S, McFarland DH, Farley BG (November 2006). "The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders". Semin. Speech. Lang. 27 (4): 283–99. doi:10.1055/s-2006-955118. PMID 17117354.
- Dixon L, Duncan D, Johnson P, et al. (2007). "Occupational therapy for patients with Parkinson's disease". In Deane, Katherine. Cochrane Database of Systematic Reviews (3): CD002813. doi:10.1002/14651858.CD002813.pub2. PMID 17636709.
- O'Sullivan, Susan B; Schmitz, Thomas J (2007). "Parkinson's Disease". Physical Rehabilitation (5th ed.). Philadelphia: F.A. Davis. pp. 856–7.