Parkinson's Disease


Parkinson's disease is a progressive neurological disease which causes a gradual loss in movement skills and stability, it can also cause a tremor which can impair the individual in everyday activities.

Maintaining an active body and working on balance and other skills most affected by this condition have great benefits for both the individual and their family and supporters, and there is increasing evidence of activity “slowing down” the deterioration many Parkinson's patients may expect.  In the early stages most forms of activity are appropriate, perhaps supported by Parkinson's-specific activities at home.  Timing of activity in relation to medication can also be important as there is a period of optimal efficacy for certain drugs. Recent research into Tai Chi is showing considerable benefits for Parkinson's affected people.

                                                       
For more information use the link below:
                    Relevant Qualifications:
Modern Pilates Stage 2 Core Stability and Postural Alignment 2006
                                          Later Life Training: Exercise for the Prevention of Falls and Injuries in Frailer Older People, 2009
                                          Balanced Approach: The Use of Tai Chi & Chi Kung for Falls Prevention and Rehabilitation, 2014



Research


In 2003, the Parkinson’s Disease Society 
produced Keeping Moving, an exercise 
programme for people with Parkinson’s 
disease, devised by Bhanu Ramaswamy 
MCSP and Richard Webber MCSP, two 
senior physiotherapists in Sheffield. 

The evidence available to practitioners with 
regard to appropriate physiotherapy intervention 
for people with Parkinson’s up until the recent 
Rescue Project randomised control trial has either 
been of poor quality or absent. Physiotherapy 
has therefore had to rely on unsubstantiated 
anecdotal reports from professionals, people with 
Parkinson’s or carers regarding the effectiveness 
of input.

Clinical symptoms of Parkinson’s that may 
be influenced by physical therapies 
Considering the World Health Organization’s 
classification of consequences of disease 
(1980), physiotherapy has most effect on 
the management of disabilities (abilities),  
impairment (participation) and health of 
someone with Parkinson’s compared with 
anti-Parkinson’s medications that influence the 
disability. Physiotherapy is therefore advocated 
in combination with optimal timing of the effect 
of medications.

Underlying themes common to Alexander Technique, Pilates, Cunductive Education and Tai Chi 
all seemed to be the use of cognition to 
promote posture and body awareness or control 
of movement with emphasis on slow, flowing 
movements. All were timed with breathing to 
induce relaxation.  
A person can  do these exercises in class or at home on an individual basis if a class 
is not available, which is why we have produced 
a DVD and booklet containing the programme.

The Keeping Moving programme has been 
based on this concept of action systems of 
motor control described above and three 
therapeutic models outlined as follows:
1 The Movement Enablement Through Exercise 
Regimes and Strategies (METERS) advocates 
the promotion, maintenance and use of quality
functional performance by focusing on four 
core areas of physiotherapy practice – gait, 
balance, posture and transfers outlined in 
Plant et al (2000) and detailed further in the 
Guidelines for Physiotherapy Practice in 
Parkinson’s Disease (Plant et al, 2001). 
2 A model put forward by Morris (2000) for 
physical therapists promotes a task-specific 
approach to training in the context of 
functional tasks.
3 A rationale for the management of individuals 
with Parkinson’s by Schenkman et al (1989 and 
1998), uses a systematic approach to evaluate, 
interpret and treat people with Parkinson’s. 
The Keeping Moving programme emphasises 
minimising musculoskeletal limitations and 
postural deformities in order to preserve the 
individual’s capability for independent function 
as long as possible. Clinically, the authors have 
found rotation useful in inducing relaxation and 
decreasing rigidity. It is also a necessary part of 
balance reactions and functional activities.

 
The exercises progress through postural sets 
of lying, sitting and standing. Work on core 
stability and single limb range of movement in 
lying progresses to more complex sequences          
involving bilateral or diagonal limb movements 
where the base of support is progressively 
decreased and the complexity of the movements 
increased. Elements of strengthening, balance, 
co-ordination of movements and flexibility are 
incorporated into the exercises and most of the 
exercises are synchronised with breathing. All 
are done at a cognitive level and with auditory 
cues
Morris (2000) points out that there is little 
use in working on individual symptoms if the 
training does not relate to functions such as 
standing and walking, so the final exercises 
concentrate on aspects of stepping and sit-to stand 
control, hopefully resulting in modified or 
use of skills to gait and transfers.
No specific bed mobility or floor transfer 
exercises are done, as the task of getting on to 
and off the floor to perform the lying exercises 
requires similar skills. The therapist assists and 
instructs the person in how to get on or off the 
floor as necessary. 
All the exercises can be modified should the 
person with Parkinson’s experience difficulty 
in any one postural set. Some of the standing 
exercises are done with arm support if the 
person is very unstable, or sitting where their 
bottom becomes the base of support. 
Throughout the sitting and standing exercises, 
maintenance of best postural alignment 
is stressed.

Obtaining the programme/further information
The Keeping Moving programme is available from PDS.
The booklet is also available to download on
the PDS website at www.parkinsons.org.uk



Tai Chi and Postural Stability in Patients with Parkinson's Disease
Fuzhong Li, Ph.D., Peter Harmer, Ph.D., M.P.H., Kathleen Fitzgerald, M.D., Elizabeth Eckstrom, M.D., M.P.H., Ronald
Stock, M.D., Johnny Galver, P.T., Gianni Maddalozzo, Ph.D., and Sara S. Batya, M.D.
N Engl J Med 2012; 366:511-519February 9, 2012
Background
Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective.
Methods
We conducted a randomized, controlled trial to determine whether a tailored Tai Chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: Tai Chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. 

The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls.

Results
The Tai Chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed.

Conclusions
Tai Chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.)  Supported by a grant (NS047130) from the National Institute of Neurological Disorders and Stroke.  Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.