Ayesha Raza (Doctor of Physiotherapy)
ROLE OF PHYSIOTHERAPY FOR PARKINSON’S DISEASE
Abstract:
Parkinson’s disease is a neurodegenerative disorder with characteristic symptoms such as resting tremors, uncoordinated movements, immobility, and a decline in cognitive function ultimately arising a need for physiotherapy. It has been established that physiotherapy has a beneficial effect on the general physical condition of Parkinson’s disease sufferers. This research was mainly a literature review and questionnaire-based to confirm the effects of physiotherapy on the patients of Parkinson’s disease. Moreover, a physiotherapy regimen intended to overcome individual deficiencies to enhance the overall functional ability of patients was designed. All these studies confirmed that physiotherapy is effective in lessening the symptoms of Parkinson’s disease but there is a need to establish an optimal exercise program.
Introduction:
Parkinson’s
disease (PD) is a disorder that represents itself as dysfunction in motor and
non-motor activities and is thus challenging in terms of various treatment
protocols. Pharmacological and surgical treatment protocols mainly focus on the
administration of dopamine and dopamine agonists (Sethi, 2008). Symptoms such
as resting tremors, uncoordinated movements (uncontrolled gait, postural
instability, poorly managed transfers and activities of daily living),
immobility and concentration problems are linked with the disease which
inversely affect the quality of a patient’s life (Rochester et al., 2011). The
subsequent decline of cognitive capacities and increased rate of depression
also hinder physical functioning (Lord et al., 2010; Rochester et al., 2008;
Yogev et al., 2005) making patient management a more difficult task. This
arises a need for physiotherapy (PT) for the management of falls, impaired
gait, and poorly controlled activities of daily living (ADLs). For this
purpose, physiotherapy employs several techniques either independently or in
combination. The main aims of physiotherapy as proposed in evidence-based
research include (Keus et al., 2007):
Balance
Gait
Transfers
Posture
Stiffness
General
Physical Condition
Physiotherapy a strategic remedy
for Parkinson's disease:
The
main focus of physiotherapy interventions is to enable PD sufferers to maintain
balance and actively perform their ADLs through strategic and systematic
exercises. This is achieved with a focus on strength, endurance, range of
motion, and general mobility (Jesse et al., 1992). It is believed that physical
therapy can enhance benefits for patients as a surplus treatment approach by
enabling practice and supervision in therapeutic interventions such as gait,
mobility, muscle strengthening, stretching, transfer, balance, relaxation, and
breathing exercises (Gondim et al., 2016). There is increasing evidence to
support the fact that physical therapy has benefits regarding neuroplasticity
and the capability of the brain of self-healing (Kumar et al., 2017). It has
been proposed that a physiotherapy program can improve the overall abilities of
PD sufferers in conjunction with pharmacological treatment (Deane et al.,
2009).
Trials of physiotherapy practices in
literature for PD:
Many different kinds of physiotherapy
interventions were performed to study the role of physiotherapy for Parkinson’s
disease. Various articles from the
following databases like Science Direct, PubMed, and Cochrane were retrieved. A
total of 20 articles were taken and studied, out of which 13 review literature,
6 experimental studies and 1 case study was included (Kumar et al., 2017).
Relevant trials were recognized by electric examinations of wide-ranging
biomedical and science databases: MEDLINE (1966-2000), EMBASE(1974-2000),
CINAHL (1982-2000), ISI-SCI ((1981-2000); rehabilitation databases: AMED
(1985-2000), MANTIS(1880-2000), REHABDATA (1956-2000), REHADAT, GEROLIT
(1979-2000); English language databases of foreign language research and third
world publications: Pascal (1984-2000), LILACS (1982-2000), MedCarib (17th
Century-2000), JICST-EPlus (1985-2000), AIM (1993-2000), IMEMR (1984-2000) and
thorough searching of suitable journals. Relevant trials were included in the
Group’s specialized register of randomized controlled trials. (Deane et al.,
2009). Questionnaires approved by the Ethics Committee of General University The hospital in Prague was sent to 368 PD patients. The questionnaire assessed the
patients’ restrictions in activities of daily living, limitations in 6 core
areas (gait, transfers, manual dexterity, stability and falls, posture, and
physical condition), and frequency of falls, relative importance to the
patient, and the patient’s motivation to improve in them. Questionnaires were
returned by 248 patients and 157 physiotherapists (PTs). PT was prescribed to
70/248 patients. The effects were satisfactory in 79% and lasted >3 months
in 60/64. About half of the PTs have no experience with PD patients, 26%
reported <3, and 5% see >10 yearly. The most widely used techniques were
neurodevelopmental treatments (Gal et al., 2017).
Besides
these questionnaires and electronic studies, a physiotherapy program was
designed for patients in which each patient was assessed on an individual basis
leading to advanced levels of function. The goal was to enable the patient to
function with minimal aid and maximal independence. Goals were developed
according to specific deficiencies found in the initial assessment for which
therapists designed specific programs to enhance overall functional ability.
For example, an increased range of motion in the arm might result in an
improvement in the patient’s capability to eat independently. But the crucial
aspect of this program was repetition and teaching of coping strategies because
in PD there is the dysfunction of motor learning and inability to “run” previously
learned motor programs. It was found that development inclined to be replicated
in a requisite for less support from the therapist as treatment progressed. It
was also found that varying degrees of aid provided by the therapist could
change the time required for a patient to carry out a given task. (Jesse et
al., 1992).
Conclusions:
It
can be concluded that exercise is effective in enhancing physical functioning
and Health-related quality of life (HRQoL), leg strength, balance, and walking
in patients with Parkinson’s disease. A widespread range of physiotherapy
interventions comprising of diverse combinations proved to be useful in the
treatment of PD. However, there is a need to develop a consensus as to ‘best
practice’ physiotherapy for Parkinson’s disease. Employment of European Physiotherapy
Guideline for Parkinson’s Disease (EPGPD) and the introduction of an effective model such as ParkinsonNet are mandatory to enhance the awareness of the
neurologists regarding advantages of physiotherapy in PD, its prescription
rate and the vast number of PD patients treated yearly by PTs. There is no
doubt that physiotherapy is beneficial in reducing the signs and symptoms of PD
but there is a requirement to establish an optimal exercise program for PD with
respect to dosage, duration, physiotherapy techniques, and the targeted stage
of disease.
Author's Details
Ayesha Raza (Doctor of Physiotherapy)
Government college university Faisalabad, Pakistan.
Reviewed and Edited by
Dr. Amna Khalid (Research officer)
College of physiotherapy.
Government college university Faisalabad, Pakistan.
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de
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