What is Parkinson’s Disease?
Parkinson Disease (PD) is a progressive movement disorder that can affect people aged 50 years and above, with 32 cases occurring per 100,000 people . The cause of PD is unclear, but the result is a slow but continuous degeneration of an area of the brain (the Substantia Nigra) that releases dopamine, a chemical which is needed for movement control and coordination. As PD progresses, less and less dopamine is produced, causing one to lose the ability to control movement normally.
PD manifests in four cardinal signs :
- Bradykinesia (slowness of movement)
- Tremor in the hands, arms, legs
- Postural instability (imbalance, lack of coordination)
- Rigidity (abnormal stiffness)
Some people with PD may experience “freezing”, where they temporarily lose the ability to move. This occurs especially when attempting to start to walk.
Another sign in some other people with PD is having difficulty in stopping when walking, also known as “perseveration”. As a result of these two phenomenon, their risk of falling significantly increases.
Treatment for People with PD
Treatment for PD targets the disease at different levels. Medication may be prescribed to increase dopamine levels in the brain. Depending on the severity and suitability, a device called a deep brain stimulator (DBS) may be implanted into the individual. At the level of movement impairment, physiotherapy is the main management approach to address this deficit, with the broader aim of improving the quality of life of people with PD.
A physiotherapy management strategy found to be helpful for PD patients involves specific training of functional activities, walking and balance using external cues, such as auditory and visual feedback. This mainly addresses the freezing and perseveration phenomena, to decrease the risk of falls. Other functional training encompasses strategies to get in and out of bed or chairs safely at home to minimize fall risk when moving about at home or outside.
Recently, a new approach to treat people with PD has been gaining traction: LSVT (Lee Silverman Voice Technique). LSVT is centered around the concept of neuroplasticity, which is the ability of the brain to form new neural connections throughout life as part of learning. It has been proven that LSVT-LOUD (the speech treatment arm of LSVT) is effective in improving impaired voice and swallowing in PD patients. LSVT-BIG is a movement intervention which includes exercises with large amplitude and big movement patterns. It can help in improving patients’ movement and increases patients’ confidence level in moving safely. 
PD patients also improve with forced exercises (FE), which requires patients to move considerably faster than they possibly can. It has benefits in improving aerobic fitness of an individual, and is thought to increase dopamine levels in the brain by increasing input at the muscular level, which in turn has an impact on individual’s functional level . Ridgel, Vitek, and Alberts (2009) found that FE significantly improved the motor function and bi-manual dexterity in PD patients as compared to voluntary exercises. Grip control and coordination, as well as clinical measures of rigidity and bradykinesia, also showed significant improvement . However, these physical activities should be sustained and ongoing . These may include routine activities such as jogging, walking, swimming, etc.
Examples of FE that we practice with our PD patients involves stationary cycling and boxing.
Fast cycling on stationary bikes has been shown to benefit PD patients’ voluntary task control at the brain level. In particular, it was concluded that a faster pedaling rate was key in these improvements. This mode of exercise is recommended because it is an effective and low-cost therapy for people with PD .
Boxing is another treatment method which improves the quality of life of people with PD. Boxing is a full-body exercise and requires hand-eye and foot coordination to perform. The demand of speed and coordination in sports such as boxing enhances the relationship between the body and brain function. It is easily practiced in a safe environment under close instruction and supervision, and helps in raising patient’s self-confidence and potentially delaying some symptoms of PD.
We employ a range of exercise and movement strategies to maintain and improve levels of functional independence, thereby improving our patients’ quality of life. The carefully selected exercises focus on maximizing muscle strength and joint flexibility. Where possible, we also help to improve and correct abnormal movement patterns and posture to maintain balance and minimize risk of falls. Part of the treatment program also entails maintaining a good breathing pattern and effective cough. We also believe in thorough patient education and strive to advise our patients, their care-givers or family members.
Some free resources relevant to the rehabilitation of people with PD can be found below:
- Tan, L.C., et. al. (2007) Incidence of Parkinson’s disease in Singapore. Parkinsonism Relat Disord. 13(1). P.40-43.
- Parkinson’s Disease Foundation. (2017) What is Parkinson’s Disease. [Online] Available at: http://www.pdf.org/about_pd [Accessed on 11th July 2017]
- Gilbert, B. (2015) What is LSVT and how does it help Parkinson’s Disease? [Online] Available at: https://www.burke.org/blog/2015/6/what-is-lsvt-and-how-does-it-help-parkinson-s-disease/43 [Accessed on 12th July 2017].
- Albert,J.L. et.al (2011) It Is Not About the Bike, It Is About the Pedaling: Forced Exercise and Parkinson’s Disease. Exercise & Sport Sciences Reviews. 39(4). P. 177-186.
- Ridgel, A.L., Vitek,J.L and Albert, J.L (2009). Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson’s Disease Patients. SAGE Journal. 23(6). P.600-608.
- Ahlskog, J.E. (2011). Does vigorous exercise have neuroprotective effect in Parkinson Disease? Neurology. 77(3): 288–294
- Paddock, C. (2012) Fast cycling benefits for Parkinson’s patients. [Online] Available at: http://www.medicalnewstoday.com/articles/253197.php [Accessed on 14th July 2017].
- Rush I.R. (2014) Boxing can help patient with Parkinson’s. Northwest Parkinson’s Foundation. [Online] Available at:< https://nwpf.org/stay-informed/news/2014/04/boxing-can-help-patients-with-parkinsons/> [Accessed on 14th July 2017].
- Fox,C. et.al. (2012) LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinsons Dis.
- Qutunbudin, A. et.al. (2013) Parkinson’s Disease and Forced Exercise: A Preliminary Study. Rehabilitation research and practice. [Online] Available at: < https://www.hindawi.com/journals/rerp/2013/375267/#B12> [Accessed on 14th July 2017].
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