Parkinson’s Disease: Overcoming Movement Difficulties – Lauren Turner AEP

Parkinson’s Disease is a chronic neurological condition which affects the central nervous system’s (brain and spinal cord) ability to communicate due to a reduction of the neurotransmitter called dopamine. As a result, people with Parkinson’s disease have difficulty with motor learning and processing. People with Parkinson’s disease present with one or more of the following symptoms:

• Resting tremor (involuntary movements)
• Bradykinesia (slow movements)
• Rigidity
• Gait and postural abnormalities (Parkinsonian gait)

Parkinson’s Disease is a degenerative condition and the decline in the disease and function is inevitable. However, studies have shown that exercise can be beneficial in slowing the progression of the disease and improving quality of life.  The benefits of regular exercise include:

• Improved balance, aerobic capacity, and gait
• Increased speed of movement and force production, increased flexibility
• Improved psychological indices and quality of life
• Reduction in measures of disability and impairment

When getting involved in an exercise program there are a few things that need to be considered. As there is variability of patient presentation and severity of disability between people with Parkinson’s disease, it is highly important that the program developed is individualised to each person’s needs and goals.

One major component that should be considered in any exercise program for people with Parkinson’s disease is implementing motor learning strategies. As the main disfunction of the condition is the decreased ability of the neural pathways to communicate in order to carry out movements, people with Parkinson’s disease can experience postural instability, the inability to initiate movements (freezing episodes), Parkinsonian gait, increased resistance to passive movements and difficulties with complex movements, transitioning between movements and performing simultaneous or sequential movements. This can make it challenging to participate in a standard exercise program. Here are some strategies that we implement to help decrease incidences of freezing episodes, help initiate movements, and improve movement patterns:

1. Performing a large amount of repetitions: This principle allows the same neural pathway to be stimulated repetitively to help reinforce and strengthen the connection of the neural pathway. This in turn helps to develop and improve the ability to perform functional skills and promotes neuroplasticity within the brain.
2. Have a clutter free environment:  Freezing episodes occur in people with Parkinson’s disease when performing dual-tasks or entering a narrow or cluttered space. By reducing the amount of clutter in the environment; the incidence of freezing episodes can be reduced.
3. Use structured instructions: When providing instructions on how to perform an exercise or activity, it is important to consistently use the same language and phrases to describe the exercise. This allows the person to process verbal instructions more effectively and as a result develop the skill more efficiently.
4. Avoid random order practice: People with Parkinson’s disease have difficulty task-switching which involves rapidly and effectively switching from one task to another. To optimise patient outcomes, exercises should be performed in a sequential pattern. For example exercise A should be completed repetitively without any variation between repetitions before moving onto exercise B.
5. Use external cues: Studies have shown that implementing external cues to stimulate different areas of the brain can help facilitate movement in those with Parkinson’s disease. This can be achieved by using rhythmic auditory stimulation, visual cues, auditory cues, multisensory cues and pulsed cues. Here are some examples:

• • Placing flat markers on the ground and cuing the person to place one foot on each marker as they perform an exaggerated walking activity.

• • Setting a metronome to an appropriate speed and asking the person to step up onto a step, in time with the beat.

• • Having the person count each repetition as they stand out of a chair and sit down.

Through the implementation of the above principles, people with Parkinson’s disease can optimise their physical outcomes and develop their skills effectively and efficiently.