Parkinson’s: The Shaking Palsy

Parkinson disease is related to a loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine and other brain chemicals are normally in balance and are important for the control of body movements, thought processes, decision-making, moods, and other behaviors.

The exact cause of PD is not yet known. Family history, aging, or exposure to certain environmental toxins may contribute to the onset of PD. It is a chronic degenerative disease, which means that it gets worse over time; however, people usually do not die from it.

The severity and symptoms of PD can vary widely. Some people have the disease for 20 to 30 years and experience a slower decline in mobility and thinking over a longer period of time. Others may experience difficulty with physical movements and thought processes within 5 to 10 years, as the disease progresses more rapidly.

Nonmotor symptoms of PD, such as a decreased sense of smell, sleep problems, and lightheadedness when first standing up, can begin many years before motor (movement) symptoms develop. Motor symptoms of PD, which typically include muscle and joint stiffness (rigidity), shaking (tremors) in the hands and limbs, slowed movement, and balance problems, most often begin at or around age 60. However, early-onset PD can affect people at a younger age.

The motor symptoms of PD can be very mild at first. A common early symptom is a tremor in 1 hand, most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Since the tremors are most apparent during rest, they usually go away when moving and typically don’t interfere substantially with daily functions.

As the condition progresses, people with PD may notice other motor symptoms, such as:

• Movements that become smaller, possibly resulting in:
  • Shuffling when walking.
  • The arms swinging less when walking.
  • The voice becoming quieter.

• Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders.
• Pain due to muscle stiffness.
• Postural instability, resulting in poor balance and a greater risk of falling.
• Movements that become slower during daily activities such as dressing, showering, or moving in bed.
• A feeling of the feet being “frozen” to the floor, making it hard to take a first step, or to turn around when walking.
• Stooped posture.
• Difficulty speaking at a normal voice level.
• Difficulty swallowing.
• Difficulty performing tasks that were once easy to do, such as gardening or swinging a tennis racquet or golf club.
• Difficulty making facial expressions.
• Difficulty holding and releasing urine (bladder urgency and incontinence).

Nonmotor symptoms might include:

• Difficulty paying attention to a task for a long period of time or dividing attention between 2 or more tasks.
• Fatigue.
• Lack of motivation.
• Lightheadedness.
• Depression.
• Anxiety.
• Disturbed sleep.

Because there is not one definitive test for PD, it can be difficult to diagnose. A diagnosis is usually made based on a person’s medical history and a neurological examination. If your physical therapist suspects that you have symptoms of PD, you may be referred to a neurologist for further examination.

A diagnosis of PD may be made if a person is found to have:

• Slowing of motion and tremor when resting, or muscle rigidity
• A significant improvement in symptoms when taking a medication to treat PD.
• Initial symptoms on 1 side of the body only.

Because PD affects each person differently, your physical therapist will partner with you to manage your specific situation—now and as your condition changes. You are not alone!

Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.

Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:

• Improve your fitness level, strength, and flexibility.
• Develop more effective strategies to get in and out of bed, chairs, and cars.
• Turn over in bed more easily.
• Stand and turn to change directions more efficiently.
• Improve the smoothness and coordination of your walking.
• Improve your ability to perform hand movements.
• Decrease your risk of falling.
• Improve your ability to climb and descend stairs and curbs.
• Perform more than 1 task at a time more efficiently.
• Participate in activities that are important to you.

Some of the medications designed to manage PD symptoms may have an immediate positive effect. For example, movement is typically much easier shortly after you begin taking certain PD medications. Your physical therapist will know how to time treatments, exercise, and activity based on both the schedule and the effects of your medications to get the best results.

Parkinson’s disease can make daily activities seem frustrating and time-consuming. Your physical therapist will become a partner with you and your family to help you combat and manage the symptoms of PD. As your condition changes, your treatment program will be adjusted to help you be as independent and as active as possible.

Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if any of these devices may be helpful to you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can team with you and your family to develop strategies to make moving easier and help prevent injury. In addition, your physical therapist can make suggestions on changes to your home environment to optimize safe and efficient daily function at home.

To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.

All physical therapists are prepared through education and experience to treat patients with PD. You may want to consider:

• A physical therapist who is experienced in treating people with neurological disorders. Some physical therapists have a practice with a neurological focus.
• A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with PD.

During your first visit with the physical therapist, be prepared to describe your concerns in as much detail as possible, and let the physical therapist know what you would like to accomplish by going to physical therapy.