Management of Parkinson's Disease

​​ Medical Management

Primarily, most cases of PD will be managed by the administration of drugs designed to increase the levels of dopamine in the brain (such as Levodopa), drugs to increase the production of dopamine supplements in the brain (dopamine agonists) and drugs to reduce the breakdown of dopamine in the brain (e.g. MAO-B / COMT inhibitors).
In more extreme interventions, when dopamine supplementation no longer help, people with PD also have the option of undergoing deep brain stimulation surgery (an implant which increased under active parts of the brain influencing PD symptoms) or lesional surgery (to remove / cut overactive parts of the brain influencing PD symptoms) (NCGC, 2006).
Although PD itself is progressive, loss of function is only associated with PD in the early stages. This means that loss of function is not necessarily progressive too. With ongoing management, interventions such as physiotherapy can help.
 
 
Physio management
 
Physiotherapy for parkinson’s can help in many ways. Manual therapy and exercise prescription (including treadmill training (Yun-Hee, 2015)) can help to reduce symptoms and maintain function, as well as preventing onset (Ahlskog, 2011). At Physioimpulse in Bath we provide you with bespoke exercise guidance to ensure your self-management is appropriate for your symptomatic level.
 
The following video helps to explain why exercise is important in PD management:
https://www.youtube.com/watch?v=e7dmw4Wuhzs#t=74
 
NICE guidelines (2006) for PD highlights the ways in which physiotherapy can help people with PD, at any stage of progression:

• gait (walking) re-education, improvement of balance and flexibility
• enhancement of aerobic capacity (breathing)
• improvement of movement initiation
• improvement of functional independence, including mobility and activities of daily living
• provision of advice regarding safety in the home environment.

 
At Physioimpulse we focus on the following outcomes for people with Parkinson’s, with particular focus on balance attention and cueing strategies and continual diagnosis to ensure any co-morbidities are highlighted and managed effectively with continual support and encouragement (O’Brien’s et al., 2016; Wong-Yu & Mak, 2015) :

• Maintaining and improving levels of function and independence, which will help to improve a person’s quality of life
• Use exercise and movement strategies to improve mobility
• Correct and improve abnormal movement patterns and posture, where possible
• Maximise muscle strength and joint flexibility
• Correct and improve posture and balance, and minimise risks of falls
• Maintain a good breathing pattern and effective cough
• Educate the person with Parkinson’s and their carer or family members
• Enhance the effects of drug therapy

                                                                                                    (Physio-pedia, 2016b)
 
Physiotherapy and exercise alone are by no means the ultimate solution to managing PD. Low outcome expectation from exercise, lack of time to exercise, and fear of falling are often concerns with PD and so careful approaches are needed to manage PD successfully (Ellis et. al, 2013). This is unsurprising given the longevity of rehab in PD with outcome effects taking up to 4-16 months to show major results in late stage PD with ongoing exercise management (Schenkman et al., 2012). Patience can be one of the most important factors of managing PD symptoms at times.


At Physioimpulse we take the time and care to ensure that you are managed effectively and with compassion. Move4parkinsons (2016) highlight how no one intervention alone is suggested for the complete management for PD, but instead all elements of emotional and physical wellbeing:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 








​


​For further information and support, please see the following websites:
http://www.move4parkinsons.com/
http://www.parkinsons.org.uk/
http://www.epda.eu.com/en/


 
To book an appointment or speak to our physio team about Parkinson's management please contact us:
therapists@physioimpulse.co.uk
www.physioimpulse.co.uk facebook.com/physioimpulse
twitter: @physioimpulse
01225 683007

---