Parkinsons disease treatment

Question 1

Impaired Mobility and Gait

Answer 1

Relevant Symptoms: Shuffling/festinating gait, minimal arm swing, freezing, falls.
*Physiotherapy Plan:
>Gait cueing:
- Use visual cues (e.g., floor strips or stepping targets) to improve stride length and rhythm.
- Use auditory cues (e.g., metronome or clapping) to promote rhythmic stepping.
- Marching on the spot, stepping backward, and rocking movements to initiate walking and reduce freezing.
- Treadmill training (if available) to improve step regularity.
- Arm swing drills during walking: exaggerate arm movement to rebalance gait.
>Avoid dual-tasking: Teach him to stop walking before talking or turning.

Question 2

Postural Instability and Poor Balance

Answer 2

Relevant Symptoms: Hesitation when turning, history of falls, poor sit-to-stand.
*Physiotherapy Plan:
>Balance training:
- Lateral weight transfers and multidirectional stepping.
- Reaching tasks outside base of support.
>Sit-to-stand practice:
- Using external verbal cues: e.g., “nose over toes, push through heels”.
- Breaking the task into small, manageable steps.
- Use rocking movements before standing to overcome bradykinesia.
- Introduce balance circuit with support to challenge postural control.

Question 3

Postural Deformities

Answer 3

*Relevant Symptoms: Thoracic kyphosis, neck protraction, forward head.
*Physiotherapy Plan:
>Postural extension exercises:
- Wall slides, thoracic extensions over a foam roller.
- Shoulder retraction and chin tucks.
>Trunk rotation exercises:
- Seated or supine trunk twists.
- Facilitate better posture in sitting and standing with tactile cueing and mirrors.
- Breathing exercises to improve thoracic expansion and reduce rigidity.

Question 3

Tremor and Reduced Fine Motor Control

Answer 3

*Relevant Symptoms: Resting tremor, difficulty with cutlery and fine tasks.
*Physiotherapy Plan:
>Task-specific hand therapy:
- Use of weighted cutlery or utensils.
- Practice with putty, squeezing balls, and threading tasks.
>Closed-chain upper limb exercises:
- Wall press-ups, table slides for proprioceptive input.
>Motor control tasks:
- Pouring water between cups, catching and releasing a ball to refine coordination.
- Provide breaks to avoid fatigue and tremor worsening.

Question 4

Difficulty with Transfers (e.g., Sit-to-Stand)

Answer 4

*Relevant Symptoms: Needs wife’s assistance to stand, difficulty rising.
*Physiotherapy Plan:
>Sit-to-stand retraining:
- Use proprioceptive cueing (e.g., tapping legs or rocking) before standing.
>Train the sequence: shuffle forward – nose over toes – push through heels.
>Strengthening: Focus on lower limb strength with chair squats or mini squats.
- Educate caregiver on safe assistance while encouraging independence.

Question 5

Cognitive Load / Dual Tasking Difficulty

Answer 5

*Relevant Symptoms: Increased freezing and falls during multitasking.
*Physiotherapy Plan:
>Educate on avoiding dual-tasking: Encourage one task at a time.
- Use external cues (visual or verbal) to assist with movement sequencing.
- Encourage routine-based activity with consistent motor tasks to reduce cognitive load.
- Gradual exposure to dual-task training in a safe, structured way (e.g., walking and answering simple questions once basic gait is stable).