In this slide there is complete explanation and guide about the Physiotherapy assessment and management of the Parkinson's disease. Parkinson's disease can be managed up to a level through Physiotherapy.

1. SEDATIVE PHYSIO Instagram - @sedative_doctor
PARKINSON’S DISEASE
PT Assessment and PT Management
By- Dr. Akshay Kumar PT

2. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Observation
 Behaviour of patient
 Posture of the patient
 Patient’s facial attitude
 Skin condition (any superficial lesion)
 Tremor
 Type and variation of tremor
• Examination
 Motor examination
1. Tone
2. Muscle tightness
3. ROM

3. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Examination
 Motor examination
4. Manual Muscle Testing
5. Test for Bradykinesia
6. Tremor – Location, Persistence and Severity
 Postural control and balance
o Done by “Berg Balance Scale”
 Gait Analysis
o All the gait parameters should be examined
 Coordination
o Finger Nose Finger Test
o Finger to Finger test

4. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Examination
 Sensory examination
 Superficial
1. Pain
2. Touch
3. Temperature
 Deep
1. Pressure
2. Vibration
3. Joint Position Sense
 Cortical
1. Tactile localization
2. Stereognosis

5. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Examination
 Cognitive Function examination
o Memory, Orientation, Conceptual reasoning and judgement should be checked.
o MMSE Scale can be used
• Chest and CVS Assessment
 Breathing Pattern
 Inspiratory-Expiratory Ratio
 Respiratory & Heart Rate
 Heart Sound
 Respiratory Sound

6. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Hoehn and Yahr Staging of Parkinson’s Disease
 Stage 1
o Sign & Symptoms on only one side
o Mild Symptoms
o Symptoms inconvenient but not disabling
 Stage 2
o B/L Symptoms
o Minimal disability
o Balance normal
 Stage 3
o B/L Symptoms
o Mild postural imbalance

7. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Assessment
• Hoehn and Yahr Staging of Parkinson’s Disease
 Stage 4
o B/L involvement
o Postural instability
o Patient needs help
 Stage 5
o B/L involvement with more severity
o Severe Postural instability
o Patient restricted to bed/chair

8. SEDATIVE PHYSIO Instagram - @sedative_doctor
Aim of Physiotherapy
• Improve mobility
• Improve muscle strength
• Improve flexibility
• Improve posture and balance
• Maintain a good breathing pattern
• Maintain and improve the level of function and independence

9. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Management
• Relaxation
o Gentle rocking
o Rotational movement of limbs and trunk
o Stretching
o Positioning – Hook lying
o Diaphragmatic breathing
o Lifestyle modifications
• Flexibility
o Active assistive
o Passive movement
o PNF with resistance
o PNF Stretching – Contract relax (6 sec contraction followed by 10-30 sec assistive stretch)

10. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Management
• Flexibility
o Unilateral bridging with trunk rotation
o Bilateral bridging with trunk rotation
o High kneeling with anterior pelvis translation
o MRP
o Sit to stand
o Weight bearing exercises
o Frenkel exercise
o Backward stepping
o Patient with PD experiences a high no of falling, so he/she should be taught how to get up
after fall.

11. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Management
• Balance Training
o Weight shifting
o Reaching
o Axial rotation of head and trunk
o Axial rotation with reaching
o Sitting on inflated ball
o Kneeling
o Half kneeling
o Standing
o Overhead arm clapping
o Heel raises
o Toe Standing

12. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Management
• Balance Training
o Toe walking
o Wall squats
o Chair raises
o Single limb stance with side kick and back kick
o Whole body vibration in Physioacoustic Chair
• Gait Training
o Straight
o Zig-Zag
o Side by Side
o Backward stepping
o Verbal command
o Functional training

13. SEDATIVE PHYSIO Instagram - @sedative_doctor
PT Management
• Pulmonary rehab
o Diaphragmatic breathing
o Postural drainage
o Air shifting techniques
o Vibration and shaking
• Home Plan
o Make sure that the patient understood about the importance of self exercises
o Early morning warmups
o Self stretching and self resistive exercises
o Yoga
o Meditation
o Breathing Exercises