Department of Physiotherapy
THE AGA KHAN UNIVERSITY HOSPITAL
STAYING FIT!
by
Dr. MUHAMMAD ARIF ALI
Sr. Physical Therapist
PROFILE OF PARKINSON'S
DISEASE


It is estimated that millions of people all over
the world have Parkinson's disease.
Most people are diagnosed in their 50's or 60's,
although 10% are classified as "young onset",
diagnosed prior to age 40.
The etiology (cause)




This chronic neurological disorder remains a mystery
James Parkinson, a London physician, first described the
syndrome in 1817 as the "shaking palsy“ Parkinson's
disease
Results from a deficiency of dopamine, a
neurotransmitter (chemical messenger) produced in the
midbrain region called the substantia nigra
Early symptoms are typically unilateral (present only on
one side of the body). Both symptoms and rate of
progression vary from person to person
Signs and symptoms of Parkinson's
disease include











Bradykinesia - profound slowness of movement
Resting tremor - shaking, worse on the affected side
Rigidity - marked stiffness, worse on the affected side
Decreased arm swing on the affected side
Problems with walking and balance - may experience a shuffling gait
or episodes of "freezing", being unable to initiate a step forward
Micrographia - small, cramped handwriting
Masked face - reduced facial expression
Dysarthria - lower volume or husky quality to the voice
Impaired manual dexterity
Depression, anxiety or other mood disorder
Some people fatigue easily and have increased PD symptoms in
response to external stress
How physical therapist can help ?






Design an exercise program to meet your particular
needs.
Evaluate and treat problems of mobility and walking.
Evaluate and treat joint or muscle pain which interferes
with the activities of daily living.
Help with poor balance or frequent falling.
Treat difficulties accomplishing activities of daily living
Recommend and teach the correct use of adaptive
equipment.
Essential PD rehabilitation components
in early and middle stage








Breathing control
Stretching knowledge
Strength training
Aerobic activity
Balance training
Posture correction
Speech and Swallowing Rehab
Role of adaptive and assistive devices
Breathing exercises
Stretches
SEATED NECK AND
CHEST STRETCH
SEATED ROTATION
STRETCH
OVERHEAD STRETCH
STANDING BACK STRETCH
HAMSTRING
STRETCH
LYING SHOULDER
STRETCH
SEATED SIDE STRETCH
STANDING SHOULDER
STRETCH
ROTATION STRETCH
CALF STRETCH
ANKLE CIRCLES
Strengthening Exercises
BRIDGING
SHOULDER BLADE SQUEEZE
SHOULDER BLADE SQUEEZES
QUAD STRENGTHENING
QUADRAPED TRUNK
PRONE ON ELBOWS
Aerobic activity
Aerobic activity
Balance, Falls, and Posture


Balance problems are one of the main
symptoms of PD. Another name for
balance problems is postural instability.
Balance problems increase the risk of
falling, especially when combined with
other symptoms and complications of PD,
including:






Slowness of movement, also called
bradykinesia, which causes delayed
reaction time.
Stooped posture
Shuffling walk.
Freezing
Falling backwards, also called retropulsion
Quick, short steps forward, festination
BALANCE EXERCISES
Preventing Falls

DO NOT pivot your body over your feet when
turning. Instead try:
“U-turn” while walking
“U-turn” - Useful for more open
areas. Move your feet & body together
in an arc...
Clock-turn
“Clock-turn” Technique - Useful
in small areas & for when you
are stopped & must turn. Start
at 12PM & take 2 slow steps to
3PM, and so on
Avoid walking backwards
try:
 ■ Stepping sideways
“Side-step Arc” Technique Useful in
small spaces & as a way to avoid
stepping
backwards. Take slow sidesteps in an
arc...
Tripods
No
Avoid tripod or
quad canes
One point cane
Yes
A straight cane with a rubber
tip is better.
Posture




PD can cause many changes in the body.
One easily recognizable change is posture. The
characteristic changes in posture can include:
A forward head position.
Rounding of the shoulders and upper back.
A forward trunk position with increased
bending of the hips and knees.
Some typical Poor positions




Sitting on the couch watching TV.
Leaning over to work on the computer.
Driving/riding in the car.
Looking downward while reading, or propping
your head against the headboard while reading.
Example of poor sitting posture
Example of good sitting posture
What are Assistive\adaptive aids?


Adaptive aids are items that can help you stay as
independent as possible for as long as possible.
These devices can make your daily life easier and safer,
and improve your quality of life.
Assistive aids

A urinal (available for both men and women),
bedpan, or bedside commode can help reduce
bathroom trips at night
Condom catheters for bladder incontinence for
men
Bathing and toileting aids
Continu…
Dressing



Do a few stretching exercises before
getting dressed to “warm up” muscles.
Sit down when dressing.
Allow plenty of time for dressings
Helpful bedroom aids
Helping handle/bed rail
Eating Aids
Speech and Swallowing difficulties
in Parkinson Disease
The same PD symptoms that occur in muscles of the body-tremor, stiffness, and slow movement- can occur in the
muscles used in speaking and swallowing. This can
cause





A soft voice
Mumbled or fast speech
Loss of facial expression
Problems communicating
Trouble swallowing
Facial Exercises

Smile - hold - relax - repeat.
Pucker your lips - hold - relax - repeat.
Alternate puckering, then smiling.
Open your mouth and move the tip of your tongue all around the
lips.
Open your mouth and move the tongue around the gum line

Open your mouth as wide as you can - hold - relax - repeat.






Say "KA" - a prolonged sound - as loud and hard as you can.
Say "PA"/"TA"/"KA" - as loud and fast as you can.
swallowing










Always sit upright
Chew small amounts of food well and swallow it all before adding
more.
Put your fork down between bites to slow yourself down
Make yourself swallow twice after every bite.
Take small sips when drinking. Alternate bites of food and sips.
Take only one sip at a time. Do not drink gulp after gulp.
Use of straws!!
Keep your chin slightly down or at least parallel to the table.
Don’t try to drink out of a can. Use a glass instead.
Don’t talk with food in your mouth
Tips about Drooling
If you tend to drool, you probably don’t have more saliva then you
used to have; you are just not swallowing it as automatically as
before.



Frequent sips of water or sucking on ice chips during the day can
help you swallow more often
Always keep your head up, with your chin parallel to the floor, and
your lips closed
Drinking more water will help thinning the phlegm
We wish you all a very happy and
healthy life
Thank You