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Physiotherapy

Physiotherapy aims to keep you moving safely and independently, with your body in as good a working condition as possible. You can help to achieve this by:

  • exercising regularly
  • recognising when you may need to see a physiotherapist
  • ensuring that you get the most out of your physiotherapy appointments.

A physiotherapist’s role is to prevent, stabilise and reduce movement related problems. In Parkinson’s this generally means focussing on functional activity and your ability to perform transfers (for example, getting in and out of bed or a chair), posture, safe reaching and grasping, dexterity, balance and walking (gait).

Physiotherapists work in hospital and community settings as well as in people’s homes. Ideally they work as part of a multidisciplinary team involving many different types of healthcare professionals to offer comprehensive care and so improve quality of life.

Much of this information is taken from the European Physiotherapy Guideline for Parkinson’s Disease which can be downloaded to help you and your physiotherapist. Our thanks to ParkinsonNet and the Royal Dutch Society for Physical Therapy (KNGF), the Netherlands, for permission to use this information.

Exercising regularly and safely

It is thought that people with Parkinson’s are around a third less active than the general population of the same age. Not exercising can harm your health and you are more likely to develop other conditions such as heart disease, type 2 diabetes and osteoporosis. You should therefore try to make exercise part of your regular routine.

The following tips should help you to exercise effectively and safely:

  • Try to exercise for at least 150 minutes each week. During each session you should aim to get warm, sweat lightly and be out of breath to the point that it is hard to keep up a conversation. How you make up the total time is up to you; you could try 5 sessions of 30 minutes but if that is too long at once, then repetitions of say two 15 minute periods or 3 bursts of 10 minutes each is also fine. It is better to exercise two or three times a week for shorter periods than just a long session at weekends.
  • Try to reduce the amount of time you sit each day, for example by walking rather than driving short distances, getting off the bus one stop early or making a walk part of your daily routine. Where possible take the stairs rather than a lift or escalator.
  • Make sure you include different styles of exercise that will extend your endurance, build and maintain muscle strength, and maintain joint flexibility and your ability to stretch.
  • Ideally, do exercises that will improve your functional mobility, for example try making large movements when you are sitting, lying down, standing or walking. These will help with daily activities such as walking and balance.
  • Develop an exercise programme that includes exercise you enjoy and which suits your daily routine and physical capabilities. You are far more likely to maintain your regime if you enjoy what you are doing and feel able to cope!
  • An exercise ‘buddy’ or group sessions can add a welcome social dimension and motivation. Consider joining organised or group classes at your local gym or other public venues, particularly if they are Parkinson’s specific or provide recognised benefits for people with Parkinson’s such as dance or Tai Chi.
  • Choose a time to exercise when movement when medication is working well and you are feeling rested as movement will then be easier for you.
  • It is normal to feel tired and sweat when exercising but stop if anything hurts or feels uncomfortable. You should talk to your doctor if you experience any of the following when exercising: pain, nausea, light-headedness, dizziness, a tight chest for more than a few minutes, or if you feel your heart missing or adding beats. Listen to your body and learn to recognise when to stop.
  • If you have recently had a heart attack, have any other heart problems or have been told that you are a risk of heart disease then you should consult with your doctor before you embark on an exercise programme. You should also talk with your doctor before exercising if you have been inactive for a long time.

For more information on the benefits of exercise and how tips for exercising safely see Exercise.

When should I see a physiotherapist?

A physiotherapist can provide advice and suggest strategies to help you at any stage of your Parkinson’s. If appropriate, a physiotherapist can provide treatment to prevent, stabilise or reduce any problems you experience relating to movement.

It is recommended that you talk with a physiotherapist as soon as possible after your diagnosis so that they can support you to self-manage your Parkinson’s.

You should also talk with a physiotherapist if:

  • you find regular exercise difficult or you are uncertain about what type of exercise to do
  • you have queries on the frequency, intensity and safety aspects of exercising
  • you experience walking problems, for example slowness, shuffling, hesitation or ‘freezing’ (when your feet feel glued to the floor)
  • you experience balance problems resulting in falls, nearly falling or fear of falling
  • you find it difficult to get out of a chair, bed or car, or if turning in bed is difficult
  • you experience pain, for example in your neck, back or shoulders.

You should always let your neurologist know if you are seeing a physiotherapist.

Physiotherapy and carers

Physiotherapists can also advise your carer and family how to help you stay as independent as possible. In addition they can advise carers and family on ways to look after their own health, for example their back if they help you with getting out of bed, chair or car.

Getting the most out of physiotherapy appointments

Your physiotherapist will assess your mobility problems and why they occur. This may take one or two appointments and your physiotherapist may want to assess you at home if problems mainly occur there.

If appropriate, your physiotherapist will work with you to set goals according to your specific needs and together, you will agree a treatment plan. Generally this will be a combination of advice and education, plus an exercise programme and strategies to better manage your daily activities. When and how often you see your physiotherapist will depend on your individual goals and treatment plan.

Before your appointment

  • Write a list of any problems you experience and questions you want to ask, leaving space to write notes when you talk with your physiotherapist. The Pre-assessment Information Form (PIF) within the European Physiotherapy Guideline for Parkinson’s Disease will help you to prepare.

During your appointment

  • Be honest. It won’t help to put on a brave face if you are struggling to cope – your physiotherapist can only act on the information you provide, so let them know how you really feel.
  • If you don’t fully understand something, ask the physiotherapist to explain again.
  • Consider taking a friend or carer with you who can help take notes or prompt you on questions to raise if you find it difficult. Make sure they understand what you want to say so that they can help to explain things if necessary.
  • Be prepared to explain your key problems and how they affect your daily life. It’s useful to think in advance how to describe difficulties as it’s easy to get tongue-tied when under pressure during an appointment.
  • Be clear what you hope to gain from your appointment and treatment plan.
  • Let your physiotherapist know if you have had any treatment before or tried different methods to overcome these problems, and explain how effective these were.
  • If your physiotherapist is unable to help with a particular problem, he or she will be able to suggest other healthcare professionals who may be able to help.

You and your physiotherapist are partners in managing your Parkinson’s. Here are some aspects of your care you might both want to focus on:

  • Jointly agree on your goals of treatment, in particular what you should achieve and when.
  • Agree on a treatment plan that is tailored to your daily routine and abilities.
  • Agree how to liaise on an ongoing basis, including follow-up appointments which enable you to ask for feedback, for example if you want to check that you have been doing exercises properly. Always get in touch between scheduled follow-up appointments though if you have any queries.
  • Discuss any problems you have with adhering to your agreed programme so that it can be adjusted to enable you to continue properly.
  • Plan in advance how you will maintain an exercise regime independently once your treatment has finished.
  • Agree on what information your physiotherapist will share with your doctor.

For more information and advice see Appointments with your healthcare team.

How do I find a physiotherapist?

As Parkinson’s is complex to manage, it is important to be seen by a physiotherapist who has experience of the condition. If you cannot find a physiotherapist with Parkinson’s experience, you may want to share with the physiotherapist the European Physiotherapy Guideline for Parkinson’s Disease and Pre-Assessment Information Form (PIF).

Referral procedures depend on the country in which you live; in some countries physiotherapy is prescribed by a doctor but in others you can contact a physiotherapist direct. Depending on where you live, treatment may or may not be accessible through your country’s national health system. In some countries you need to be referred by your neurologist in order to get the cost of physiotherapy reimbursed.

Training and accreditation varies throughout Europe so you should always check the experience of anyone you consult and the likely costs before treatment starts.

Your national Parkinson’s organisation may be able to provide information based on members’ experiences. See also, Other Parkinson’s organisations.

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