PARKINSON S DISEASE AND MOVEMENT DISORDER SOCIETY PDMDS-S1 PHYSIOTHERAPY 1 HANDOUT

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1 Page1 PHYSIOTHERAPY 1 HANDOUT THE BENEFITS OF IN PARKINSON S DISEASE A regular exercise routine can help you - strengthen your muscles, - increase movement in your joints, body and limbs (arms and legs) - improve your flexibility, and - build up your general fitness and health. It also helps to maintain and improve your balance and walking ability. Daily activities like dressing, brushing teeth, eating, bathing, cooking etc can also improve with exercise. Other symptoms such as stress, anxiety, depression, sleep disturbances and constipation also improve with exercise. Most importantly recent research says that exercise has the potential to slow down the progression of Parkinson's. This it does by protecting the nerve cells that produce dopamine, thus, helping them work better and survive longer. PRECAUTIONS: If you have undergone any surgery such as, knee or hip replacements, heart surgery, spine surgery etc, or if you have any ailment like Heart or lung disease, back problems, fractures, vertigo, dizziness, history of frequent falls, please consult your physician before undertaking any exercise program. Your physician may ask you to take a few precautions when you are exercising. If during the exercise you experience dizziness, breathlessness or difficulty in breathing, pain or tightness in the chest, palpitations or a feeling that your heart is racing, increased pain, an unusual or uncomfortable feeling, please stop doing the exercise and rest or bring it to someone s attention. You could also take slow, deep breaths. If that doesn t help then you may need a physician visit. GENERAL SUGGESTIONS: You should exercise for at least 30 minutes to 1 hour, EVERYDAY. Even if you are active with other things during the day, you must still dedicate special time for your exercises. You can exercise at any time of the day, but preferably not before going to sleep, and not immediately after meals (keep at least a one hour gap before exercising) If you get tired quickly, take more rest periods between exercises.

2 Page2 POSTURE CORRECTION 1. Sit up straight in your chair. 2. Place one hand on your chest. 3. Now slouch (bend your neck and back) and relax completely. 4. Feel your chest go inwards with your hand. Next, 5. Sit up straight, pull your shoulders back, stick your chest out and look straight ahead. 6. Feel your chest pushing outwards and upwards with your hand. 7. Hold this position for 5 counts ( ). 8. Repeat 5 times. 1. Sit straight in your chair. 2. Hold your arms at the side with the elbows bent (as shown in the figure). 3. Now maintain this position & pull your arms and elbows in, as far back as you can i.e. pull in your shoulder blades. 4. Hold this position for 5 counts ( ) 5. Then bring your hands back to the starting position. 6. Repeat 10 times. 1. Stand against a wall, a closed door or any stable cupboard. 2. Try and touch your buttocks and shoulders to the wall (this will straighten your back). 3. Now try and touch the back of your head to the wall by tucking in your chin. (DO NOT TIP YOUR HEAD BACK TO TOUCH THE WALL.) 4. Make sure your knees are straight and place both your hands & palms flat on the wall, with your fingers spread. 5. Hold this position for 5 counts. 6. Now maintaining this position, take 2 steps forward. 7. Hold this position for 5 more counts. 8. To get back, take 2 steps back slowly 9. Repeat 5 times. [Note: If any of you are unable to stand, then you must place a chair near the wall, sit on the chair and then follow the same instructions as above.] TREMORS

3 Page3 When the tremor is bothering you, you must perform ANY ACTION, such as o touch each finger with your thumb, o make a fist, o squeeze a ball, etc. This will temporarily reduce the tremor. One can also try to relax with deep breathing or meditation You can direct your attention toward minimizing the tremor by trying to make the arm or leg go loose GAIT TRAINING 1. You must stand up straight 2. When taking a step, first put your heel on the ground, and then place your toes on the ground. 3. Then you must take big steps. (Note: only if you are able to take big steps carry on with instruction 4. Otherwise, focus only on taking big steps.) 4. Then swing both your hands as much as you can, but in opposite directions. Remember that both your hands should be opposite to each other, and also to your leg i.e. as if you are marching. TURNING When there is a large space to take a turn, then you must: Follow a U shaped turn or a large arc of movement, i.e., your strides should be big (as drawn in the picture). To make it easier to do this, imagine that you are a vehicle trying to take a u-turn around the divider. When there is a small space to turn in, then you must: When there is not enough space to take a U shaped turn then we can use a clock turn or 360 degree turn. 1. Gently march in place. 2. Now along with the gentle marching, turn around in a circle at the same spot, do this until u have turned in the direction that u want to turn in. Note: You should not pivot i.e. one leg is on the ground and you are trying to turn around. This can lead to falls. Make sure you lift each leg when turning.

4 Page4 FREEZING The following tips help you to distract your brain from the activity that is causing the freezing. If you experience freezing do not panic. Keep calm and try these tips. a. The weight shift method When you freeze, shift your weight from one foot to the other a few times (i.e. move your body from side to side as you are shifting your weight from one leg to the other. OR in other words, lift one leg off the ground alternately without bending you knees) and when you feel your feet getting unstuck then take a step forward and continue walking. b. Sound cues Another strategy is to use sound cues. When you freeze, you can use sound to help you begin walking again. You can use any of the following sound cues to help you during freezing episodes. Say one, two, three, step and just when you say step place your leg forward. Repeat this for every step. OR, Say left, right, left, right and march in place. When your legs feel free, step forward. You can also use musical beats to reduce freezing. Hum a tune with a beat and move your feet along with the beat. When your legs feel free, step forward. Using a metronome also helps. A metronome is an instrument which can produce beats of different speeds & thus you follow the beat to move your feet. c. Visual cues Visual cues are also very helpful ways to overcome freezing episodes. They can be in the following forms. You can either try to step over them or step on the line. Laser lights/ beams Laser pointers available in any stationery shop can be used. When freezing occurs, shine the laser light on the ground, a little distance ahead of your feet, and then step on it. Floor strips (colored tape) This is coloured sticky tape, again available in stationery shops. You can buy a colour that is in contrast to the colour of your floor. This can be put in certain areas in the house where you freeze frequently e.g narrow passageways, bathroom entrance, room entrances, lift entranes etc. The distance between the tapes should be the length of one of your feet. Others If a Caregiver is with you when you freeze, ask them to place one of their feet, horizontally in front of your foot. You should step over their foot. Then repeat this with the other foot, & for as long as you overcome your freezing.

5 Page5 CHART DATE AEROBIC (walking/ cycling/swimming/ dancing etc) DURATION OF EG - 1/1/2013 Walking 30 mins STRETCHING + STRENGTHENING + BALANCE S. Warm up, stretching, balance exercises DURATION OF 30 mins REASON FOR NOT EXERCISING -