People with Parkinson’s disease can experience multiple symptoms at the same time; your medical history and physical assessment should elicit major questions, which can be prioritized as part of a management strategy. While physical therapy focuses on the physical manifestations of disease, It is also important to note how other symptoms affect the patient’s lifestyle.
Also remember that the best results are achieved by working with others in the team of health and social care professionals who have expertise in other areas of Parkinson’s disease, from volunteers to family and friends.
Aims of Physiotherapy
- Maintain and increase levels of function and independence, which will help improve a person’s quality of life
- Use exercises and movement strategies to improve mobility
- Correct and improve abnormal movement patterns and posture where possible
- Maximize muscle strength and joint flexibility
- Correct and improve posture and balance to minimize the risk of falls
- maintain a good breathing pattern and an effective cough
- Educating people with Parkinson’s disease and their caregivers or family members
- Enhance the effects of drug therapy
A review edition of the European Physiotherapy Guidelines divides physiotherapy interventions for Parkinson’s disease into exercise and exercise strategy training.
Exercise has been shown to maintain health and well-being in Parkinson’s and, importantly, it is shown to play an important role in addressing secondary prevention (focusing on strength endurance flexibility functional exercises and balance). The neuroprotective movement focuses on endurance and Use principles of motor learning methods such as mental imagery and dual task training. Effective neuroprotective training should be introduced at an early stage, but is helpful at all stages. It involves complex powerful and intensive exercises.
Exercise in a group setting has the added value of providing social connection for those who become increasingly isolated as the disease progresses, and those newly diagnosed are able to observe the benefits of staying active and active. The collective environment also allows A time for people to ask each other questions and discuss their symptoms and their own management strategies.
Transition care settings  increase the independence and function of patients to delay their entry into residential aged care. It also provides time-limited goal-oriented and treatment-centered packages for older adults after hospitalization, which include low-intensity Therapy – such as physiotherapy and occupational therapy – social work and nursing support or personal care. A qualitative study  showed that older patients (over 80 years old) who had family members involved to assist in physical therapy care had better outcomes in a transitional care setting.
Physical activity, especially aerobic exercise, may slow the deterioration of motor skills and depression that occurs in Parkinson’s disease. In addition, it improves the quality of life of patients with Parkinson’s disease.  A randomized controlled trial showed favorable results Exercise and gardening intervention program for older adults with depression and memory problems .
A randomized controlled clinical trial protocol evaluating the effect of inspiratory muscle training on respiratory function in patients with mild to moderate Parkinson’s disease showed that inspiratory muscle training improved respiratory muscle strength, lung function, chest mobility, and functional capacity.  Similarly, a systematic review of research on the use of respiratory muscle strength training in Parkinson’s disease rehabilitation found that respiratory muscle training was an effective treatment for controlling respiratory muscle loss, dysphagia, ineffective coughing Speech impairment and cardiorespiratory dysfunction in patients with Parkinson’s disease have long-term positive effects on respiratory muscle strength, swallowing function, and cardiovascular autonomic function. 
Strength training against external resistance may improve quality of life. Examples of such resistance exercises include: bicycle ergometer weight machines therapy putty elastics and weight cuffs. Strength training also improves physical parameters such as balanced gait and physical performance. 
People with Parkinson’s disease often have difficulty performing dual tasks (such as walking and talking at the same time). Motor-cognitive dual-task training improves dual-task ability and may improve gait balance and cognition.  A 2021 study found that dual-tasking training improved gait performance Most notable was increased gait speed step length and reduced gait freezing in elderly patients. The study also found that dual-tasking training improved the physical fitness of the study participants. 
A recent study found that progressive resistance training (PRT) was effective in reducing bradykinesia and improving functional performance in patients with mild to moderate Parkinson’s disease (PD) . A 2022 meta-analysis found that for Parkinson’s improved gait freezing increases muscle strength and improves quality of life reported during rehabilitation. 
Movement Strategy Training
Disorders of the basal ganglia lead to deficits in internal (automatic) behavior. Strategies (physical or attentional cues and combined strategies) can help overcome some of the resulting problems and have therefore become an increasingly used intervention Parkinson’s disease.
Music-based exercise therapy is a promising intervention that requires further research. It’s fun because it combines cognitive-motor strategies, cueing techniques, balance exercises, and physical activity. The focus is on enjoying mobile, not mobile restrictions, which may  A 2021 systematic review and meta-analysis found that music-based exercise therapy significantly improved gait walking speed, motor function balance freeze, and overall mental health as measured by standardized tests. review does Music-based exercise therapy has not been shown to have a measurable effect on gait frequency, stride length or quality of life in people with Parkinson’s disease. 
We could immediately see the impact of external cues and attention on improving step freezing and turning during walking tasks and activities of daily living. A systematic review and meta-analysis shows that short-term physical therapy is better for symptoms of freezing gait in patients with Parkinson’s disease. However, further randomized controlled trial studies are still needed . The literature shows that robot-assisted gait technology is effective in resolving gait freezing in patients with Parkinson’s disease. However, more research is needed in this area .
Depending on an individual’s cognitive state, they may be able to learn how to use internal cues or strategies for self-direction. If less able, the cue or strategy must come from an external source, such as the rhythmic beat of a visual metronome on the ground. depends on stage The rationale for the choice of intervention will vary:
This figure is reproduced with permission from Rochester L Nieuwboer A Lord S .
As described in the subsection Physical Therapy for Parkinson’s Disease: Referral and Assessment in the Early Stages of Diagnosis, there is a greater emphasis on education and self-management. Individuals should be encouraged to continue to be physically active as long as possible. As Parkinson’s disease progresses, many individuals develop severe respiratory complications, so attention should be paid to monitoring and controlling erosive weakness of the respiratory muscles and rigidity of the chest.
The European guidelines provide a section describing how motor learning (pp. 78 to 80) expectations should be practiced and executed as a strategy to improve movement. It takes the form of a cue function and dual-task training for compensation policy training using external cues Self-direction and attention. Examples include:
- Visual cues – focus on stepping over and initiating gait; strips of tape on the floor begin or continue across areas causing slowing or freezing
- Auditory cues – count 1-2-3 to start walking; step on a metronome or the beat of specific music at a specified rhythm to continue walking
- Watch out—think big strides; make wider arcs. This is useful when correcting bad habits, such as walking with a stiff hip or hiking.
- Proprioceptive cues – rocking side to side in preparation to take a step; taking a step back as a cue to prepare and then move forward
A systematic review of 35 studies by Delgado-Alvarado M et al. Emphasize the benefits of nonpharmacological and nonsurgical treatments for freezing gait symptoms. Study results suggest passive therapy (transcranial magnetic stimulation or transcranial direct current stimulation) Active therapy (cognitive or physical training) and transient effects therapy (using visual, auditory or proprioceptive cues to transform the patient’s habitual movements into goal-directed movements) can help overcome freezing of gait episodes .
Most people diagnosed with Parkinson’s are 50 or older, but 1 in 20 people diagnosed with Parkinson’s are younger than that. Younger Parkinson’s patients more prone to early dystonia and motor fluctuations and dyskinesias induced by long-term use of dopaminergic drugs treat.
According to Lee’s meta-analysis, these non-drug interventions are effective in improving health-related quality of life (HRQOL). But because of the large heterogeneity between interventions, more research is needed before definitive conclusions can be drawn. 
To provide patient-centered care, it is important to provide your patients with information and education, and allow time for patients to discuss their options and ask questions. Limited clinical time can be a challenge, but good communication and sharing of information Intervene.
The use of virtual reality in rehabilitation has positive effects on balance coordination and gait speed in patients with Parkinson’s disease 
Example of a man using visual cues to improve his walk.
- Transition Care Programme. Aging and aged care. Accessed from ☀https://agedcare.health.gov.au/programs-services/flexible-care/transition-care-programme on 4\12\19
- Lawler K, Taylor NF, Shields N. Family-assisted therapy empowered families of older people transitioning from hospital to the community: a qualitative study. Journal of physiotherapy. 2019 Jun 13.
- National Parkinson Foundation. Ask the Helpline: Why is Exercise Important for People with Parkinson’s?. Available from: http://www.youtube.com/watch?v=e7dmw4Wuhzs [last accessed 24/09/16] (LoE)
- Wu, P.L., Lee, M., & Huang, T.T. Effectiveness of physical activity on patients with depression and Parkinson’s: a systematic review. PloS one, 2017:12(7), eo181515.
- Makizako H, Tsutsumimoto K, Makino K, Nakakubo S, Liu-Ambrose T, Shimada H. Exercise and Horticultural Programs for Older Adults with Depressive Symptoms and Memory Problems: A Randomized Controlled Trial. Journal of Clinical Medicine. 2020 Jan;9(1):99.
- Montero Ferro A, P. Basso‐Vanelli R, Moreira Mello RL, Sanches Garcia‐Araujo A, Gonçalves Mendes R, Costa D, Gianlorenço AC. Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson’s disease: Randomized controlled clinical trial protocol. Physiotherapy Research International. 2019 May 14:e1777.
- Zhuang, J. and Jia, J. (2022) “Effects of respiratory muscle strength training on respiratory-related impairments of parkinson’s disease,” Frontiers in Aging Neuroscience, 14. Available at: https://doi.org/10.3389/fnagi.2022.929923.
- Ramazzina, I., Bernazzoli, B.,& Costantino, C. Systematic review on strength training in Parkinson’s: an unsolved question. Clinical interventions in aging, 2017;12, 619.
- Fritz, N.E., Cheek, F.M., & Nichols-Larsen, d.S. Motor-cognitive dual-task training in neurologic disorders: a systematic review. Journal of neurologic physical therapy: JNPT, 2015;39(3), 142.
- Wollesen B, Rudnik S, Gulberti A, Cordes T, Gerloff C, Poetter-Nerger M. A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson’s disease. Scientific Reports. 2021 Jun 14;11(1):1-0.
- de Moraes Filho AV, Chaves SN, Martins WR, Tolentino GP, Homem RD, de Farias GL, Fischer BL, Oliveira JA, Pereira SK, Vidal SE, Mota MR. Progressive Resistance Training Improves Bradykinesia, Motor Symptoms and Functional Performance in Patients with Parkinson’s Disease. Clinical Interventions in Aging. 2020;15:87.
- Yang X, Wang Z. Effectiveness of Progressive Resistance Training in Parkinson’s Disease: A Systematic Review and Meta-Analysis. European Neurology. 2022 Oct 20:1-9.
- de Dreu, M. J., Van Der Wilk, A. S; d;, Poppe, E., Kwakkel, G., & van Wegen, E. E. Rehabilitation, exercise therapy and music in patients with Parkinson’s: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism & related disorders,2012; 18, S114-S119.
- Zhou Z, Zhou R, Wei W, Luan R, Li K. Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: A systematic review and meta-analysis. Clinical Rehabilitation. 2021 Jul;35(7):937-51.
- Cosentino C, Baccini M, Putzolu M, Ristori D, Avanzino L, Pelosin E. Effectiveness of Physiotherapy on Freezing of Gait in Parkinson’s Disease: A Systematic Review and Meta‐Analyses. Movement Disorders. 2019 Dec 4.
- Alwardat M, Etoom M. Effectiveness of robot-assisted gait training on freezing of gait in people with Parkinson disease: evidence from a literature review. Journal of exercise rehabilitation. 2019 Apr;15(2):187.
- Rochester L, Nieuwboer A, Lord S. Physiotherapy for Parkinson’s disease: Defining evidence within a framework for intervention. Neurodegen Dis Man 2011; 1: 57 – 65
- Delgado‐Alvarado M, Marano M, Santurtún A, Urtiaga‐Gallano A, Tordesillas‐Gutierrez D, Infante J. Nonpharmacological, Nonsurgical Treatments for Freezing of Gait in Parkinson’s Disease: A Systematic Review. Movement Disorders. 2019 Nov 26.
- Lee, J., Choi, M., & Yoo, Y. A Meta-analysis of nonpharmacological Interventions for People With Parkinson’s. Clinical nursing research, 2017;26(5), 608-631.
- Triegaardt J, Han TS, Sada C, Sharma S, Sharma P. The role of virtual reality on outcomes in rehabilitation of Parkinson’s disease: meta-analysis and systematic review in 1031 participants. Neurological Sciences. 2019 Dec 6:1-8.
- Oxford Computer Consultants. Virtual Reality Glasses for people with Parkinson’s (Paper Cues). Available from: http://www.youtube.com/watch?v=yKSJQ_f9cjM [last accessed 24/09/16] (LoE:5)
- RevZonenet. Dyskinesia and Blue Lenses – RevZone. Available from: http://www.youtube.com/watch?v=h3y13erwfxw [last accessed 24/09/16] (LoE:5)
- Amir Baram. Parkinson’s Freezing improves walking with the GaitAid. Available from: http://www.youtube.com/watch?v=6XoHBqw8GnI [last accessed 24/09/16] (LoE:5)
- TouroInfirmary. LSVT Big & Loud Parkinson’s Therapy at Touro Neuro Rehab Center. Available from: http://www.youtube.com/watch?v=9fUQ6jptaBY [last accessed 29/09/16]
- Advance Rehab Centre. LSVT Big. Available from: http://www.youtube.com/watch?v=3jPEtanYmI0 [last accessed 29/09/16]
- UStepWalker. The U-Step 2 Walker, a Parkinson’s Therapy Aid. Available from: http://www.youtube.com/watch?v=mirtZhHJSB4 [last accessed 29/09/16]
- Parkinson’s Dance: People with Parkinson’s can;t do that..can they? Available from: http://www.youtube.com/watch?v=pL_LZgAEsnM [last accessed 29/09/16]
- SusieG5678. Dancing Feet Help Defeat Parkinson’s. Available from: http://www.youtube.com/watch?v=koaA1T0MynM [last accessed 29/09/16]
- Tom Anthony. Dancing helps Parkinson’s Patients. Available from: http://www.youtube.com/watch?v=UEAaWPHDRbk [last accessed 29/09/16]
- 205beers. Exercise program for Parkinson disease. Available from: http://www.youtube.com/watch?v=YEiupqJDugA [last accessed 29/09/16]
- captainpat. Parkinson’s – Vigorous Exercise. Neil Sligar June 2011. Available from: http://www.youtube.com/watch?v=R_-nRQmO8ko [last accessed 29/09/16]
- Polestar Pilates. Polestar Pilates for Parkinson’s Patients. Available from: http://www.youtube.com/watch?v=yWBn0Ozt2fU [last accessed 29/09/16]