Physiotherapy and Parkinson’s

What is a physiotherapist?
A chartered physiotherapist is a highly trained professional who...
•   Work on stiff muscles and joints to maintain a posture, keep your joints
       flexible and help relieve the effects ...
tasks, the physiotherapist or an occupational therapist can advise you on the
best place to put these.

How do I find a p...
The Association of Physiotherapists in Parkinson’s Disease Europe (APPDE)
brings physiotherapists, researchers, other prof...
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Physiotherapy and Parkinson's Word version (66KB)

  1. 1. Physiotherapy and Parkinson’s What is a physiotherapist? A chartered physiotherapist is a highly trained professional who uses physical interventions as part of a holistic regime, teaches self-management of a condition, and promotes the maintenance of as much independence by an individual as possible. Just as doctors train further and specialise in different conditions, so do physiotherapists. Some work specifically with neurological conditions, such as Parkinson’s. People with Parkinson’s and their carers, can derive significant benefits from even short-term or occasional contact with such physiotherapists. An early referral is strongly recommended. What can the physiotherapist do to help someone with Parkinson’s? Physiotherapists are trained to provide an assessment to see how Parkinson’s affects the individual. This can be done with newly diagnosed, as well as those who have been diagnosed for some time. In the earlier stages, the emphasis of treatment will be mainly focussed on understanding the condition and how a person might keep up their own general levels of fitness and maintain independence for themselves. In the later stages of the disease, the emphasis will include a support network for the individual, involving the family and carers as part of the treatment. The assessment will indicate to the physiotherapist what combination of education and intervention is required, some examples of which are listed: • Teach techniques that help make some automatic movements easier. For example, the activities of walking, sitting down and standing up are some of the tasks that may become difficult as Parkinson’s progresses, but can be improved by learning new ways of doing things. • Help you to maintain independence in your daily life if you are having difficulty with certain actions, such as getting up out of a chair or turning in bed. The physiotherapist may visit your home and be able to teach you a different way of doing the action, or could give advice on aids and adaptations that might be of use. (In many places, it is the occupational therapist that deals with this sort of problem.) The PDS recommends that advice is sought first from a physiotherapist before you buy any piece of equipment, as no two individuals with Parkinson’s are quite alike, and what might benefit one person might be unsafe for another. See the PDS information sheets, Equipment and Disability Aids (FS59) and Occupational Therapy and Parkinson’s (FS97).
  2. 2. • Work on stiff muscles and joints to maintain a posture, keep your joints flexible and help relieve the effects of rigidity that might occur. This will help to make your actions more smooth and efficient. The physiotherapist can also teach you and your carer to do this. • Improve or maintain muscle strength by the use of general or specific exercises, or by providing an exercise programme for you to follow in the hospital, or at home. A physiotherapist may help to maintain your level of fitness or advise you take up a sport, such as golf or swimming, or a class like yoga or tai chi, where the additional benefits of relaxation help to decrease stress that can worsen the symptoms of Parkinson’s. • Help prevent or manage falls. The physiotherapist may work on specific balance training and improving your confidence to decrease any fear of falling, or teach techniques to help you get off the floor or call for help. They work with an occupational therapist to look at ensuring your home environment is as free from hazards as possible. See the PDS information sheet, Falls and Parkinson’s (FS39). • Provide pain relief, if you experience it, through methods such as manual therapy, the use of heat, cold or some electrical equipment. More and more therapists are being trained in complementary techniques such as acupuncture, which can also be used to alleviate pain. • Maintain or improve effective breathing.The stiffness and weakening of the chest muscles can sometimes lead to a chest infection, for which the therapist might use positioning and other techniques to help clear the phlegm. Breathing exercises can also enhance your respiratory capacity and can help if you find your voice has become softer. • Help to prevent circulatory problems through handling and positioning, especially if your movement is severely restricted, hampering the effect of the natural pumping mechanism of the muscles. What advice can a physiotherapist give carers? If you are a carer and help to move a person with Parkinson’s, it is vitally important that you get advice from a physiotherapist. They will advise you on care of your own body (most importantly your back), as well as prevention of harm to the person for whom you are providing care. This can be whether you do something as simple as lifting their legs into bed, or as involved as standing a person who cannot walk, so that they can get to the toilet. If it becomes necessary to have equipment in the house to help you with these
  3. 3. tasks, the physiotherapist or an occupational therapist can advise you on the best place to put these. How do I find a physiotherapist? Referral to a physiotherapist is generally made through your GP, a consultant doctor, or a Parkinson’s Disease Nurse Specialist. In some areas, you can refer yourself at the local hospital or a Community Health Clinic, depending on the type of service available in your area, and your need and your preference. You might find you have to wait some time before you receive an appointment, as most NHS physiotherapy departments have a waiting list. Some PDS branches have group physiotherapy sessions. There are also a growing number of private physiotherapists who run clinics and make home visits. When you contact them, make sure that they have the skills to handle with people with Parkinson’s, as not all physiotherapists do. The Physio First website allows you to search for qualified neurological physiotherapists in your area: Does the PDS have any information resources on physiotherapy and exercise? Apart from this information sheet, the PDS publishes an exercise dvd and booklet, Keeping Moving (V011 for the dvd and B074 for the booklet). What information is available for physiotherapists? The PDS publishes The Professionals Guide (B126) aimed at 8 of the professionals who work closely with people with Parkinson’s and their families. It outlines good practice for providing care as part of the multidisciplinary team. Guidelines for Physiotherapy Practice in Parkinson’s disease have also been produced by neurological rehabilitation and information management experts with funding from the Parkinson’s Disease Society. Clinical Practice Guidelines for Physical Therapy in Patients with Parkinson’s Disease (2005) have been developed in the Netherlands and an English translation should be available from the website of the Center for Evidence Based Physiotherapy. Check this site for updates:
  4. 4. The Association of Physiotherapists in Parkinson’s Disease Europe (APPDE) brings physiotherapists, researchers, other professionals, people with Parkinson’s and their carers together to progress networking, educational and research agendas in relation to rehabilitation and Parkinson’s disease. Information on their aims and activities can be found on their website: The Rescue project was a European Commission funded project that investigated a cueing therapy programme to improve walking and walking-related activities in Parkinson’s disease. A CD Rom about cueing has been produced for physiotherapists and information sheets developed for people with Parkinson’s disease and their carers. Details can be found on the project website: Acknowledgements This information sheet contains extracts from the Parkinson’s Disease Self- Care manual/CD-rom, edited by Professor RK Griffiths CBE and EH Coene MD, published by Foundation September and is used with their permission. The manual is currently out of print. The PDS would also like to thank Bhanu Ramaswamy and Anna Jones for their help with this information sheet. **************************************************************************************** Parkinson’s Disease Society 215 Vauxhall Bridge Road, London SW1V 1EJ, UK Tel: 020 7931 8080 Fax: 020 7233 9908 Helpline: 0808 800 0303. (The Helpline is a confidential service. Calls are free from UK landlines and some mobile networks) Email: Website: © Parkinson’s Disease Society of the United Kingdom (2008) Charity registered in England and Wales No. 258197 and in Scotland No. SC037554. A company limited by guarantee. Registered No. 948776 (London) Registered office: 215 Vauxhall Bridge Road, London SW1V 1EJ Revised April 2009 To obtain any PDS resource, please go online to or contact Sharward Services Ltd, the appointed PDS Distribution House, at Westerfield Business Centre, Main Road, Westerfield, Ipswich, Suffolk IP6 9AB tel: 01473 212115, fax: 01473 212114, email: Code FS42