Parkinson's disease is a progressive neurological condition caused by a decline in the brain chemical dopamine. It is characterized by movement impairments like shaking, rigidity, slowness, and walking difficulties. There is no cure yet but medications and therapies can help control symptoms. As health professionals, we can implement rehabilitation programs to slow the progression of Parkinson's, including exercise programs like PD Warrior and LSVT BIG that use high intensity training to drive neuroplasticity and rewire the brain. Diet and medication absorption are also closely linked, so managing diet is important.

1. D A N I E L L E M E L D R U M

2. WHAT IS PARKINSON'S DISEASE?
Progressive neurological condition
Decline in the production of a brain chemical called
dopamine
Categorised by as a “movement disorder.” However it
doesn’t just affect movement.
Early in the disease, the most obvious are shaking, rigidity,
slowness of movement, and difficulty with walking.
Approximately 70,000 Australians living with Parkinson’s.
30 People diagnosed each day in Australia

3. IMPAIRMENTS
Rigidity
Bradykinesia
Tremor
 Often disappears with movement, often present at rest
 Usually starts on one side of the body and progresses to the
other side; usually remains asymmetrical.
 20% wont develop a tremor
Postural Instability
Freezing

4. IS THERE A CURE?
Not yet. Parkinson's disease is
usually slowly progressive and
is incurable. However, there
are a variety of medications
and treatments that can help
control or reduce the
symptoms of Parkinson's.

5. SO WHAT CAN WE DO?
As OTs and Physios we can
implement types of therapy
which slow down the
progression of the disease.
As a Speech Pathologist you
can implement techniques
from LSVT LOUD to
improve patients speech
As a Dietician you can advise
patients on which foods to
not eat as they interfere
with the absorption of the
medication

6. PD WARRIOR
 Neuro-active group exercise program which
drives neuroplastic change. 1 on 1 for
fallers/freezers.
 Client specific
 Intensity is important: not looking at
cardiovascular output but looking at cortical
output
 The earlier we start treating, the bigger the
change
 Best for people who are newly diagnosed,
reasonably active and fit, and motivated.
 Not for atypical presentations, fallers, freezers,
cognitive impaired or medically unstable clients.
 Delay the need for increasing drug treatment,
and thus, it might have a neuroprotective effect.
 Symptomatic treatment, not disease modifying

7. PD Warrior is a radical new treatment approach
that uses exercise to slow Parkinson’s
down. People who have completed the PD
Warrior 10 Week Challenge report feeling
more confident in their movements, are able
to move more freely and are getting back
into life.
PD Warrior uses a unique combination of
physical and cognitive activities to drive
your brain’s natural ability to re-wire itself.
PD Warrior not only re-trains your brain, it
also helps you to get:
 Stronger & fitter
 better at doing more than one thing at the same
time
 better at maintaining your balance and preventing
falls
 better at all the little things you find too fiddly to
bother with anymore
PD Warrior is a game changer because there
has never been a program that has been so
encompassing, and with the capacity to give
you such great results.

8. Medication in isolation is not enough. Medication and DBS do not slow PD down

9. A randomised pilot study with a 2 year follow up: Frazzitta et
al, 2015

10. Intensive Rehabilitation Treatment in Early Parkinson's Disease:
T0: 4 week treatment
T1: 6 month follow up
T2: 4 week treatment at 12 months
T3: 6 month follow up
T4: 12 month follow up
Leva-Dopa increased signficantly in control only

11. Intensive Rehabilitation Treatment in Early Parkinson's Disease:
Increased time on monotherapy

12. PD Warrior Core
Principles
Neuroprotection Neurorestoration Neuroplasticity

13. Power= amplitude, speed and accuracy
Complexity- Drives neuroplasticity
Client specific- adapt exercises
accordingly
High Effort- working at a 8/10
Frequency- daily exercises
Fun- challenges, dual tasking, group
class->high energy levels and
motivating
Power
Specific
Frequency
Complexity
High effort

16. PROTEIN CONSUMPTION AND PARKINSON’S DISEASE
Levodopa is an amino acid, it competes for absorption with
other proteins: Eating a very protein meal would reduce
the likelihood of efficiently absorbing levodopa. That’s
why it is better to eat carbohydrates and vegetables at
lunch and leave meat, cheese and fish for night-time.
Food is absolutely critical to symptoms, good and bad. Food
interacts strongly with the medications too. It simply is
not enough to rely on drugs, and if you have periods
where the "drugs aren't working" it is vital to look to your
diet.

17. LSVT LOUD
Treatment is administered in 16 sessions over a single
month (four individual 60 minute sessions per week).
This intensive mode of administration is consistent with
theories of motor learning and skill acquisition, as well as
with principles of neural plasticity, and is critical to
attaining optimal results.
The treatment helps individuals with PD recognize that their
voice is too soft, convincing them that the louder voice is
within normal limits, and making them comfortable with
their new louder voice.

19. LSVT BIG
Exercise program, 1:1, 4 consecutive days a week for 4
weeks.
High effort
Daily homework practice
Target amplitude: largest ROM, performed with the highest
effort, with maximally efficient biomechanics
PUSH the patient, High Effort! Reinforce! Motivate!

21. Movements that are within normal limits are perceived by the
individual as too BIG.
Teaching the patient to accept that what feels too big is within
normal limits

22. Repetitions

23. CALIBRATION