Amanda is a member of the Association of Chartered Physiotherapists in Neurology (ACPIN) and has many years experience of working with people living with neurological conditions such as Parkinson's disease,  Alzheimer's, dementia, stroke, Multiple Sclerosis and Huntington's disease. Helping people to continue to do the things they enjoy the most is a key part of any physiotherapy programme. Physio In The Sticks provide home visits which are great for helping improve mobility and independence.

"A huge thank you for all your help and support shown to my husband over the past year as he fought against Parkinson's disease" A.W.

Stroke

In the early stages, physiotherapy focuses on preventing complications and helping your recovery. Later, it can help you find ways to enable you to do things that are important to you, such as getting in and out of bed, walking or doing sports. You might use equipment, or find different movements patterns to complete a task. A physiotherapist can also help you adapt an activity or task so you can do it independently.

Good care in the early days is important to help prevent joint stiffness or muscle tightness. A therapist will advise on how to get comfortable and to move around if your mobility is limited. For example how to roll over or to get in and out of bed. They can advise on when and how you can get up and about and what equipment (such as a walking stick or splint) might help you. If you have one-sided paralysis, correct positioning is important to prevent spasm or injury.

The more therapy you have and the more active you are after a stroke, the better. Guidelines recommend that you should receive at least 45 minutes of each type of therapy you need per day for as long as you need it. Once you are medically stable, the aim will be to get you moving and doing as much for yourself as you can as soon as possible. Depending on how much you are able to do, this may include moving around your bed, then from bed to chair. It can also include standing balance, and walking with and without support. For many people this is a gradual process, and it is important to get each step right so that you are safe and regain your confidence. It is important to get out of bed as soon as possible, even if this is just to sit in a chair. Moving helps your balance, aids breathing and skin care, and prevents blood clots in your legs. The physiotherapist will advise on the best type of chair and position for you. They can advise how to use cushions to support you, particularly for a weak arm. If you cannot stand unaided, the physiotherapist may help you get onto your feet. This will give you a chance to support your own weight and encourage the muscles of your trunk, hips and legs to work. Your therapist may not encourage you to walk straight away if you need time to recover your strength and stamina.

During physiotherapy you may do exercises to strengthen weak muscles and build up your stamina. Stretching exercises can reduce muscle and joint stiffness. You may also work on specific skills that you need to improve. For example, if you are having difficulty keeping your balance, you may be asked to stand up a lot. If you have difficulty lifting your arm, you will need to do activities that make you lift and use your arm. If you are having difficulty walking you need to walk as much as possible. There are many ways to exercise and practise. You may work on a one-to-one basis with a physiotherapist, particularly on the tasks and the movements you are learning to do and you will have activities to practise on your own outside of therapy sessions. Video with permission.

Parkinson's

There are many ways that we can help you manage the challenges and ongoing symptoms of Parkinson's. Adopting a sedentary lifestyle can speed up the development and symptoms of Parkinson's and lead to mood changes, loss of fitness, social isolation, reduction in daily activity and participation. Learning how to move your body more to avoid deconditioning should be an integral part of treatment from diagnosis. Specific exercises have been shown to help re-wire the brain, creating new neural pathways. Finding an exercise that you enjoy is key! If you are just getting started with exercise, contact us for more advice and help planning the right exercise programme tailored to you.

Exercise has been used to treat Parkinson's for many decades, in recent years exercise programmes have been researched further and finely tuned to improve strength, balance, speech, function, heart and lung fitness and cognitive function.

In the mild stage of idiopathic Parkinson's exercising to the level where you feel you are working hard is essential to maintain long-term control of symptoms. Vigorous exercise that works the whole body and gets you hot and sweaty such as cycling, gym, running, circuit training, bootcamp and high energy Parkinson's programmes are ideal - building up to two and a half hours of exercise a week.

If your symptoms are progressing you need to focus on an exercise that requires effort and pushes you, this could be a fast paced 20 minute walk using nordic walking poles to keep your muscles and heart and lungs fit. Add in tai chi, pilates, yoga or a Parkinson's exercise class to help improve your balance, flexibility, strength and movement. Regular exercise can also help with sleep, tiredness, your mood and mental health. Focussing on the rewards of exercise such as keeping your body fit will motivate you to continue doing the things that matter to you. Exercises that work the body and mind at the same time are really good to manage Parkinson’s. Learning another language, answering quiz questions or mental arithmetic whilst doing your exercises are all great ways of doing this.

If you have more complex symptoms your exercise should focus on everyday activities and movements that you may find difficult such as getting up from a chair. You can still do an effective exercise programme sitting down. The right exercise programme will strengthen your muscles, increase mobility in your joints and maintain your general health and fitness. It's never too late to start exercising or push yourself to do a little bit more.

How can physiotherapy help?

Your physiotherapist will assess how Parkinson’s affects your movement, whether you are newly diagnosed, or you have had the condition for a while. This means they can help to maintain your fitness levels, good posture and balance as your condition progresses, which will help you remain independent.

You may feel that your mobility is very good and that you are exercising without any problems, however a  physiotherapist can also help you maintain your mobility to help avoid any future issues.

Your physiotherapist should form part of your support network, involving your family and carers, in helping you manage your Parkinson’s.

Seeing a physiotherapist can have several benefits for people with Parkinson’s and their carers.

Improving or maintaining fitness

A physiotherapist with expertise in Parkinson’s can give you advice and support about what will help you. They can develop an exercise programme to follow at home if you prefer to exercise alone. They can give you advice on sports you can do, like golf, or an exercise class you could join, such as pilates, yoga or tai chi. You can get walking advice and suggested routes from the Disabled Ramblers website. The Nationwide Disabled Access Register lets you find accessible nature reserves and other places of interest.

They can show you how to stretch and exercise to keep your joints and muscles flexible, to help relieve stiffness and slowness, and help you move more smoothly.

As well as helping with your symptoms, exercise can help with your overall health, improving your circulation and helping prevent heart and lung disease.

Exercise can also help you manage stress, fatigue and improve your mood and sleep quality and quantity. The more you can do, the more benefits you will see.

Helping you stay independent

People with Parkinson’s say certain movements become more difficult as the condition progresses. These include turning in bed, walking, and sitting down and standing up (especially to get into and out of a car). Your physiotherapist can teach you techniques to help make these movements easier.

A physiotherapist or an occupational therapist can also give advice on daily living equipment you could use or alterations you could make to your home to make it easier and safer to move around.

Always check with a therapist before you buy any piece of equipment or assistive device. Parkinson’s affects everyone differently, so what might work for one person may not suit another.

Equipment may also be available to help your carer.

Helping to prevent or manage falls

Your physiotherapist can work with you on strength and balance training to improve any problems you may have with walking, especially when you are turning around or towards the left or right.

People who experience freezing or who are stiffer or weaker are more at risk of falling

Your physiotherapist can help you improve your confidence and reduce any fear of falling. They can also teach you techniques to help you get down safely on to the floor, and up again if you fall. Often, a physiotherapist will work with an occupational therapist to help you remove any tripping hazards from your home.

Providing pain relief

Parkinson’s can cause different types of pain. A physiotherapist can assess your pain to try to find the cause. Your physiotherapist can use different methods to help ease pain in your muscles and bones (musculoskeletal pain), and from involuntary muscle spasms (dystonic pain). These include manual therapy and stretching, as well as applying heat or cold to the affected area.

Not all pain is related to Parkinson’s, and you may have a condition like arthritis, or another injury that needs physiotherapy. So it’s important to mention any specific pain apart from your Parkinson’s to make sure you get the right support for you. 

Advice for carers

If you’re a carer and help a person with Parkinson’s move around, it is important that you get advice from a physiotherapist about caring for your own body, most importantly your back.

A physiotherapist can also give you advice on the best way to help the person you’re caring for to move. If the physiotherapist recommends exercises to the person you care for, make sure you understand them. This will mean you can support the person with Parkinson’s to get the most out of them.

If it you need to have equipment in the house to help you with these tasks, a physiotherapist or an occupational therapist can advise you on the most suitable type to use and the best places to put it.

A physiotherapist will help

• to maintain and improve functional ability and independence
• to improve posture and balance
• to minimise the risk of falls
• to allow strength and flexibility to be maintained
• to enhance daily activities (getting in and out of bed, rising from a chair)
• to maintain a safe walking pattern (with or without mobility aids)
• if freezing is evident, coping strategies such as auditory or visual cues may be taught
• to improve manual activities (reaching and grasping)
• to maintain respiratory function through breathing exercises
• to teach relaxation techniques and provide gentle massage to help with cramps
• to educate carers, suggest useful equipment