PARKINSON’S

Treatment for Parkinson’s Disease

Parkinson’s disease is a neurodegenerative condition, which means it gradually worsens over time. Parkinson’s disease is idiopathic (unknown cause), and actually falls under an umbrella term of movement disorders called Parkinsonism. Other forms of parkinsonism include vascular parkinsonism, drug-induced parkinsonism and juvenile parkinsonism and conditions such as Multi Systems Atrophy (MSA) and Progressive Supranuclear Palsy (PSP).

Parkinson’s can be tracked along the disease progression through many diffierent outcome measures, however it is commonly classified according to the Hoehn and Yahr 5-Stage Scale.

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The physical effect of Parkinson’s

Parkinson’s disease results as a primary deficiency of dopamine, a important neurotransmitter in the basal ganglia, a part of the brain responsible for influencing automatic and fluid motor function. In Parkinson’s, the cells that normally produce dopamine die. When there is less dopamine, central drive for producing motor function reduces. This causes movements to be rigid, stiff and shaky (tremor) which is more pronounced at rest. Movement also becomes slower (bradykinesia) and freezing and shuffling also occur, which means people become more prone to losing their balance and not being able to recover quickly from falling.

Other effects of Parkinson’s

Aside from the motor aspects, Parkinson’s can affect facial and speech expression, respiratory function, mood, behaviour and cognitive (thinking) abilities. Swallowing can also begin to be more difficult and hence the risk of choking or aspirating food increases. This is often made worse by the stooping posture in more severe stages of the disease.

These other effects are important to consider when caring for or providing therapy for people with Parkinson’s, and often many health professionals need to be involved to coordinate and adapt care while the condition changes with time.

Medications

Neurologists with an interest in Parkinson’s often prescribe necessary medication in correct doses to provide relief from symptoms whilst minimising any side effects, and keep adverse drug interactions at bay. Speak with us if you would like recommendations on a neurologist.

Typically, people with Parkinson’s rely on classes of medications such as:

  • Levodopa agents (e.g. Sinemet, Madopar) – stimulates dopamine production in remaining neurons
  • MAO inhibitors (e.g. Seleguline, Deprenyl) – prevents breakdown of dopamine
  • Anticholinergics (e.g. Artane) – helps correct imbalance of reduced dopamine
  • Amantadine derivatives (e.g. Symmetrel) – enhance dopamine action
  • Dopaminergic agonists (e.g. Requip) – increases dopamine uptake

Timing of medication is paramount for improving physical function. You may have heard about the ‘on’ phase, when medication is having its best effect; and the ‘off’ phase, when medication levels are low in the body and the effect has worn off. Knowing when this occurs is helpful in planning therapy.

Neurological Physiotherapy for Parkinson’s

While there is no cure for Parkinson’s, neurological physiotherapy can help immensely with the symptoms of fatigue and overcome difficulties associated with freezing, shuffling and slow movement. Aside from cognitive strategies of redirecting attention and focussing on short and simpler tasks, neurological physiotherapy can combat some of the secondary effects such as stiffness, poor posture and loss of balance control.

There is also some evidence to suggest that exercise, particular intensive and aerobic components, can also provide a protective effect on neurons and neural circuits in the brain, potentially slowing the progression of the disease. Results have yet to be conclusive but it is promising to know that there are many benefits to exercise.

There is also some evidence that hydrotherapy – or water based physical activity – can improve balance more than just land-based programs in people with Parkinson’s.

Music and Dance

In addition, physical activity associated with music and dance has anecdotally shown be helpful in improving many aspects of Parkinson’s. For example, tango and group dance classes have been shown to be particularly beneficial for mood, posture, turning and stepping backwards which are all things that are typically affected in Parkinson’s. And often because it is done in a fun and lively environment and attention and concentration is required, movement can become very much more fluid in such settings.

Into the Future

As Parkinson’s progresses, there may be further challenges associated with reduced mobility. Transferring and toileting become much more problematic and thus manual handling can pose significant risks to carers and sufferers alike. Wheelchairs and walkers may also become necessary aids to assist with maintaining community access and societal participation. Skin, respiratory function and dangers associated with fragility, deconditioning and depressed mood can also begin to significantly impact quality of life and should be considered areas in helping people with Parkinson’s.

For more information and helpful advice, contact us today!