Parkinson’s disease: physiotherapy and aids

Rehabilitation and physiotherapy for Parkinson’s disease

Through physiotherapy, the function of the limbs can be maintained or restored for the performance of everyday activities.

The speech therapist can improve the quality of speech.
In the initial stages of the disease, motor activities such as dancing are recommended.

In the advanced stages, gymnastic exercises for motor rehabilitation are performed:

• In group rehabilitation sessions, the patient is better motivated because he understands that he can perform the same activities as the others, thus creating a kind of “competition”.
• Individual physiotherapy for an adapted movement based on the patient’s needs.
• Respiratory gymnastics is very important because patients with Parkinson’s disease adopt a forward-tilted posture, which leads to shortening of the diaphragmatic muscle. This is the most important respiratory muscle.

Rehabilitation consists of:

Stretching exercises – required to prevent the forward-tilted posture.
Example: The patient sits on the floor with his legs outstretched and his back leaning straight against the wall.

Balance Restoration

In the initial stages of the disease:

• Hopping on one leg from one point to another.
• Go through an obstacle course (for example, steps) and jump over the obstacles.
• Exercises with a gymnastics ball (65 cm diameter): in the prone position with the
• Put your stomach on the ball. Alternately raise the opposite arms and legs together,
• With the support of the therapist, maintain an upright position while the physiotherapist applies small nudges on the shoulder in all directions.

Coordination

• In supine position with raised knees. You take a stick with both hands, which initially rests on the pelvis. Then you lift the stick and guide it behind the head. At the same time, you stretch your knees and then return to the starting position.
• Get up from sitting on a stool (without armrests).
• When sitting, raise your arms and tilt sideways until you touch the floor with your hand on one side. On the other hand, repeat.
• Sitting on a stool, stomping your feet alternately on the floor.
• Bending one arm and stretching the other at the same time.
• When sitting, spread your arms and then bring them together again. Once the left hand remains on the right hand, the next time the left hand remains under the right hand.
• Sitting on a stool, raise your right arm and left leg at the same time. Then repeat the exercise with the opposite limbs.

Exercises for hands and fingers
While sitting, throw a ball to another person or against the wall and then catch it again.

Functional exercises – i.e. for activities of daily life

• When sitting, you start with your hands lying on your thighs. With a tennis ball, you perform the movement of combing hair, then put your hand back on your thigh and repeat the movement with the other hand.
• You put a rope or a rubber band behind your back and stretch one arm while you bend the other, as if you were scrubbing your back.
• Sitting on a stool with your back leaning against the wall, you put a small ball behind your neck and raise and lower your arms without the ball falling down.

How to get
up from lying down In the supine position, bend the knees, turn the body towards the edge of the bed, take the upper arm in front of the shoulder, let the feet hang out of the bed and press the body with your hand into the sitting position.

Improving running
Exercises in the advanced stage of Parkinson’s disease:

• When standing, raise the knees as much as possible. This is to avoid tripping and not shuffling your feet on the floor.
• Walk diagonally over a few cushions. The cushions are not lined up one behind the other, but offset laterally.
• Mit ausgebreiteten Armen und Tennisbällen in den Händen gehen.
• Rückwärts gehen.
• Seitwärts gehen.
• Ein Bein seitlich ausstellen und dann wieder zurückziehen, dann mit dem anderen Bein wiederholen. Dieselbe Übung mit dem Ausstellen eines Beins nach vorne wiederholen.
• Slalom in einem Hindernisparcours.
• Gegen das Phänomen des Einfrierens (der Patient blockiert vor dem Losgehen) kann man ein kleines Hindernis vor dem Patienten aufstellen. Man bittet den Patienten, die Knie so weit wie möglich anzuheben und lässt ihn dann über das Hindernis springen.

Körperhaltung
Der Physiotherapeut versucht, an der Körperhaltung zu arbeiten, denn durch die nach vorne geneigte Haltung verkürzt sich das Zwerchfell oder zieht sich zurück und der Patient atmet schwerer.

Die Haltung ändern

• Die Füße nicht unter den Stuhl stellen.
• Nicht nur den unteren Rückenbereich anlehnen, sondern auch den oberen.

Hilfsmittel für Parkinson-Patienten

Der Beschäftigungstherapeut vermittelt Tätigkeiten des täglichen Lebens mit Hilfsmitteln.

Er bringt dem Patienten bei, wie man einen Stock mit anatomischem Griff verwendet, um folgende Beschwerden zu verhindern:

• Rhizarthrose (Arthrose der Daumen-Grundgelenke).
• Karpaltunnelsyndrom.

Hilfsmittel zum Essen bei Tremor:

• Das Besteck hat einen größeren Griff.
• Der Teller hat einen höheren Rand, damit die Lebensmittel nicht rechts oder links herausrutschen.
• Rutschfeste Tischdecken und Teller, damit sie nicht verrutschen können.

Recommendations for the treatment of the disease

Daily activities
Rehabilitation exercises are very important in this disease, but often become difficult when an advanced stage is reached. The patient must regularly perform gymnastic exercises, depending on the severity of the disease.
You can walk slower than before, but a walk a day is a good exercise and helps to loosen the stiffened muscles. The patient must try to carry out all the activities that are possible without having them done by relatives or friends, because they are faster.

Depression
Depression is common in people with Parkinson’s and can cause symptoms that the patient perceives as an exacerbation of the condition (such as lack of energy and slowing down).
If it seems to the patient that a deterioration has occurred very quickly over the course of a few weeks, depression may be the cause.
In this case, the doctor should be informed.
The depression can be treated.

Some practical advice
For example:
– Get up from a higher chair rather than from a low couch.
– When walking, use a walking stick that increases self-confidence and stability.

• Symptoms of Parkinson’s disease and causes
• Physiotherapy and physiotherapy
• Parkinson’s disease: treatment and prognosis