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Physiotherapists have been trained to treat a variety of conditions. We are commonly known for our expertise in treating musculoskeletal conditions and sports injuries, however we also work in conjunction with other medical professionals to help manage various neurological, cardiovascular and genetic disorders.
Parkinsons Disease Boxing legend Muhammad Ali was perhaps the most well known Parkinsons Disease (PD) patient, but approximately 70,000 Australians are living with Parkinsons (Parkinson’s Australia, 2015).
Parkinsonism is characterised by a disorder of movement consisting of tremor, rigidity or increased stiffness in joints, slowness of movement, slowness in initiating movement and freezing while moving (Carr and Shepherd, 2010).
The role of physiotherapy in the early stages of PD is promoting physical activity as a means of maintaining an active lifestyle, a flexible neuromusculoskeletal system, cardiorespiratory fitness, muscle strength and balance. In the middle stage of the disease, cueing and cognitive strategies are of greatest importance for optimising the performance of everyday tasks. The appropriate prescription of gait aids is also necessary when moving from the middle to later stages of the disease (Carr and Shepherd, 2010).
Walking The benefits of walking practice have been well established for people with PD (Carr and Shepherd, 2010). The aim of walking practice is to increase the stride length in order to increase overall walking speed, as opposed to increasing the cadence (amount of steps). In the early to middle stages of PD, moderate to high intensity walking may also have positive effects on maintaining muscle length and cardiovascular fitness. Given that in PD walking speed and stride length is most greatly affected under more complex walking conditions, incorporating backwards walking, dual tasking and negotiating obstacles is recommended.
Treadmill walking has been found to have an immediate effect of promoting a walking consistency significantly greater than that for normal overground walking (Frenkel-Toledo et al 2005; Bello et al 2008). Upon the completion of a treadmill-walking programme, several studies have found people with PD have gained the ability to walk faster and further (Miyai et al 2000, 2002; Cakit et al 2007).
Balance Training to improve balance involves methods that safely challenge a persons ability to make postural adjustments. Since impairment of reactive postural adjustments is a problem for people with PD, specific training is recommended in order to decrease the occurrence of falls. This type of training is however difficult to do at home without the supervision of physiotherapists due to safety concerns.
:paragraph!Standing up and sitting down People with PD are slow to stand up from sitting. Physiotherapists help people with PD use cognitive strategies and cues to train a more effective motor pattern. Improvements in time to stand up, peak horizontal and vertical speeds have been found in PD patients who participate in motor skill therapy with cueing (Mak & Hui-Chan 2008).
http://www.parkinsons.org.au/what-is-parkinsons Bello, O., Sanchez, J. A., & Fernandez‐del‐Olmo, M. (2008). Treadmill walking in Parkinsons disease patients: adaptation and generalization effect. Movement Disorders, 23(9), 1243-1249. Carr, J. H. (2010). Neurological Rehabilitation, Optimizing motor performance. Elsevier India. Cakit, B. D., Saracoglu, M., Genc, H., Erdem, H. R., & Inan, L. (2007). The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinsons disease. Clinical Rehabilitation, 21(8), 698-705. Frenkel‐Toledo, S., Giladi, N., Peretz, C., Herman, T., Gruendlinger, L., & Hausdorff, J. M. (2005). Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinsons disease. Movement Disorders, 20(9), 1109-1114. Mak, M. K., & Hui‐Chan, C. W. (2008). Cued task‐specific training is better than exercise in improving sit‐to‐stand in patients with Parkinsons disease: A randomized controlled trial. Movement Disorders, 23(__4), 501-509. Miyai, I., Fujimoto, Y., Ueda, Y., Yamamoto, H., Nozaki, S., Saito, T., & Kang, J. (2000). Treadmill training with body weight support: its effect on Parkinsons disease. Archives of physical medicine and rehabilitation, 81(7), 849-852. Miyai, I., Fujimoto, Y., Yamamoto, H., Ueda, Y., Saito, T., Nozaki, S., & Kang, J. (2002). Long-term effect of body weight–supported treadmill training in Parkinsons disease: A randomized controlled trial. Archives of physical medicine and rehabilitation, 83(10), 1370-1373.
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