#ParkinsonsDiseaseAwarenessMonth: Physical Therapy for Parkinson’s Disease
April is #ParkinsonsDiseaseAwarenessMonth. Parkinson’s disease is a neurodegenerative condition that can negatively impact an individual’s physical and cognitive abilities, including mobility limitations, balance issues, and gait problems. Physical therapy helps Parkinson’s disease patients manage the disease and delay progression of symptoms using a customized exercise program, including the innovative treatment of therapeutic boxing. Physical therapy helps Parkinson’s disease patients enhance mobility, balance, and coordination and improve quality of life and functional independence.
Understanding Parkinson’s Disease
Parkinson’s disease is a progressive, neurodegenerative disorder that affects an individual’s physical and cognitive abilities. Parkinson’s disease negatively impacts dopamine-producing neurons, nerve cells that control movement, and neurotransmitters that control many automatic functions in the body. It affects 50% more men than women and often develops around age 60.
Symptoms of Parkinson’s disease develop gradually and can worsen over time with progression of the disease. Symptoms may begin on one side of the body or even in one limb in the body and from there, spread to the rest of the body. Nearly 80% of Parkinson’s disease patients present with a tremor. A hallmark symptom of Parkinson’s disease is a slow, short-stepped, shuffling, forward-stooped gait with an asymmetrical arm swing.
Symptoms of Parkinson’s disease include:
Stiffness of limbs and trunk
Slowness of movement or difficulty initiating or continuing movement
Difficulty walking or shuffling steps with reduced swinging of arms
Tremor (trembling) in hands, arms, legs, jaw, or head
Impaired balance and coordination
Difficulty swallowing, chewing, or speaking
Urinary issues and constipation
Voice change, such as a softer or lower voice
Decreased facial expression
Sleep disruptions
Freezing when walking
Depression
Loss of smell
Restless legs
Physical Therapy for Parkinson’s Disease
Physical therapy can help a patient with Parkinson’s disease combat movement dysfunction and impaired balance and coordination and improve posture, strength, flexibility, and mobility through a personalized treatment plan. Physical therapy can help patients at all stages of the disease, tailoring treatment to the patient’s condition and symptoms and working with the patient’s team of doctors to coordinate care. Physical therapy not only helps patients improve their daily functioning and have greater independence, but also addresses secondary health issues that are associated with the decreased activity, strength, and endurance often found in Parkinson’s patients.
Physical therapists utilize cueing strategies to improve gait, which means using stimuli from the environment or from the patient to facilitate an automatic, repetitive movement. The cues can be auditory, visual, tactile (such as tapping the hip), and cognitive. Cognitive movement strategies are used to improve transfer performance, such as getting up from a chair or turning. Complex automated movements, like getting up from a chair, are broken down into a series of sub-movements that are executed in a fixed order so that the patient can perform the movement consciously, bypassing the internal control dysfunction that can occur with Parkinson’s disease.
An important aspect of physical therapy care for Parkinson’s disease is a customized exercise program, including balance training, aerobic conditioning, and strength training (particularly of the lower extremities). Research has shown that exercise for Parkinson’s disease patients helps to build physical and functional capacity, suppresses motor symptoms, improves non-motor symptoms like fatigue, apathy, and depression, and can improve cognitive issues associated with the condition. A systemic review of the impact of exercise on Parkinson’s disease patients reveals that aerobic exercise significantly improves motor action, balance, and gait including stride and step length and walking ability.
Therapeutic Boxing Exercise for Parkinson’s Disease
At Mangiarelli Rehabilitation, we offer a unique treatment option for Parkinson’s disease—therapeutic boxing exercise, which helps to build strength, counter muscle rigidity and improve hand-eye coordination, balance, posture, and agility. Boxing exercise requires whole-body movement, combining upper-body punching motions with lower-body footwork. Therapeutic boxing addresses symptoms of tremors, postural rigidity and instability, balance issues, and gait mobility by encouraging agility of movement in multiple directions, coordination of movement at faster speeds, and flexibility of the spine.
In our clinic, our therapist, Bobby, holds focus mitts as targets, calling out instructions for punching patterns so that the patient knows which boxing pattern to follow to hit the focus mitts. Bobby has the patient alternate throwing punches with the left and right hands as well as alternating high and low punches while moving around the clinic in order to improve coordination, gait, step width, and stride length simultaneously. Check out a video of Bobby boxing with a Parkinson’s disease patient!
Therapeutic boxing exercise for Parkinson’s disease was pioneered by Rock Steady Boxing in 2006. A two-year study compared 39 Rock Steady boxers with 26 other exercisers, all of whom have Parkinson’s disease. After one year, while all participants benefited from the exercise, the boxers demonstrated significant improvements in walking speed and no progression of symptoms. Another study of Rock Steady Boxers showed improvements in balance, gait, disability, and quality of life in the majority of patients at 12 weeks and all patients made improvements at the 24-week and 26-week mark.
Physical therapy can help a Parkinson’s disease patient manage the condition, enhance mobility and coordination, and improve quality of life and functional independence. Using a customized exercise program, including therapeutic boxing, the therapist helps the patient build strength, posture, and agility gradually and counter muscle rigidity, freezing, and gait problems. Managing Parkinson’s disease is a marathon, and our physical therapists are here to accompany you as you navigate the condition to maximize your quality of life.
