One of the most complicated neurological conditions that are addressed in physical therapy practice is Parkinson’s disease. It is a progressive condition affecting movement across multiple levels with a constellation of physical changes that interact with each other to generate requirements that cannot be well met by conventional physical therapy regimens in this patient population. Knowing why patients with Parkinson’s require specialized therapy and what that specialized therapy is and how it is different as compared to general physical therapy is important to patients, caregivers and families that have to find rehabilitation options they have at their disposal.
At iMotion Physical Therapy, the Parkinson’s Wellness Recovery (PWR!) program brings evidence-based, specialist-level neurological physical therapy to patients managing Parkinson’s disease in the Bay Area.Learn more about physical therapy in Fremont at iMotion to understand how this program is delivered and what it makes possible for patients at every stage of their condition.
How Parkinson’s Disease Affects Movement
Parkinson disease is characterized by the gradual degeneration of dopaminergic neurons in the substantia nigra, which is a part of the brain that is central to the formation and control of movement. The neurotransmitter that enables the generation and execution of motor commands that are smooth, controlled, and appropriately timed is dopamine. The process of the loss of dopamine-producing cells gradually deprives the movement system of its automatic efficiency, on which healthy movement is based.
The physical appearances of this process are typical and, in most instances, familiar. Resting tremor is an involuntary trembling occurring when the affected limb is at rest and decreases during voluntary movement. Rigidity is the resistance to passive movement that is more pronounced in the limbs and the trunk, and this gives the stiffness that patients usually complain of when being locked or frozen in position. Bradykinesia refers to slow movements, especially in the size and speed of voluntary motor actions. Postural instability is a sign of the disruption of the postural reflexes that provide automatic responses to maintain balance in response to a challenge to equilibrium.
Together, these aspects result in the mobility issues that characterize the effect of Parkinson’s disease on daily functioning: the shuffling walk with a shortened gait, the bent posture, the inability to start the movement, the pauses that take place during walking without any warning, and the risk of falling that is high due to the postural instability and the inability to perform rapid corrective actions.
What makes Parkinson’s disease particularly challenging from a rehabilitation perspective is that these changes do not simply represent weakness or reduced range of motion that exercise can directly address. They represent a fundamental disruption of the neural systems that regulate movement amplitude, timing, and automatic postural control. Treating Parkinson’s disease with the same approaches used for musculoskeletal conditions misses the neurological specificity that the condition requires.
Why Specialized Therapy Is Essential
Even in the case of general physical therapy, regardless of how conscientious and competent, the particular neurological processes of Parkinson’s disease are not approached with the specificity that the best results demand. Specialized Parkinson’s physical therapy is constructed on an alternative concept of the issue and operates on different principles to manage it.
The most important principle in Parkinson’s rehabilitation research is the concept of movement amplitude. The neurological process that Parkinson’s disease produces consistently tends toward reduced movement amplitude: smaller steps, softer voice, reduced arm swing, smaller facial expressions and more compact overall movement. Without specific intervention, the brain learns to treat these reduced amplitudes as normal, progressively compressing the movement range that the patient uses and further accelerating functional decline.
Parkinson’s therapy overcomes this inclination directly by conditioning the patient to produce movements consciously and of deliberately large amplitude. This method most rigorously designed and studied within the PWR! framework, involves certain exercise programs that repeatedly practice large-amplitude movement across the following categories of movement that are most impacted by Parkinson disease: trunk and limb extension, rotation, weight shifting, and transitional movements between the positions.
The evidence base of this approach is laid down. Functional capacity has been shown to last longer in patients who undergo regular, structured, high-amplitude movement training, their balance scores are better, and their functional decline is slower than in patients who do not receive movement-specific neurological rehabilitation.
The PWR! Program at iMotion
The Parkinson’s Wellness Recovery program, delivered at the iMotion Mowry Avenue clinic in Fremont, is a structured neurological physical therapy approach that translates the research evidence for Parkinson’s rehabilitation into a clinically deliverable program for individual patients.
The program starts with a detailed assessment where the actual functional limitations faced by each patient are evaluated at the stage of the disease he or she is at. Gait analysis is used to look at the stride length, cadence, arm swing, and the occurrence and rate of freezing. A balance assessment is used to determine how the patient reacts to perturbations, changes weight across the base of support and completes a dual-task task that demands postural control as well as a cognitive task. The measures of strength and flexibility give the initial point on which exercise progression will be implemented.
The PWR! movement training sessions are combined with balance training that is gradually challenging the postural system in a way that develops the reserve capacity to respond to the unpredictable perturbations of daily life and gait training that specifically targets the aspects of Parkinsonian gait that predispose to falls. Manual therapy is used to treat the rigidity and the soft tissue constraints that add to the neurological movement limitations.
The program is personalized. A patient with Parkinson’s disease in an early phase has other functional priorities and other exercise capacities as compared to a patient with the later symptoms. The same principles of treatment are used and the specific exercises, intensive, and functional goals are determined, but they are programmed to the present state and realistic objectives of an individual.
Education of the caregiver is incorporated into the program. Those families and care partners who are informed about the movement principles underlying specialized Parkinson’s therapy are in a better position to help sustain the practice, identify changes in functioning, and promote the active lifestyle that will sustain the gains made during formal therapy sessions.
What Specialized Therapy Makes Possible
Parkinson disease is a progressive disease without treatment. That path is altered through regular specialized physical therapy. Not cured, not reversed, but changed significantly in the way of improved functioning sustained longer and of a higher quality during the progression of the disease.
Patients undergoing specialized Parkinson therapy continually report feeling more confident about their movement, less fear of falling and more physically capable than they thought they would be at their stage of the disease. These cannot be small changes. To a person who lives with a progressive neurological disorder, they are the difference between living a full, active life and one that is more and more one of physical limitation and withdrawal.
The Fremont-based iMotion physical therapy has a specialized Parkinson’s program that offers this opportunity with the clinical experience and the evidence-based approach that it needs. This is the level of care that Parkinson’s disease requires and which iMotion provides to the patients and their families in the Bay Area who are in need of special neurological rehabilitation.
To learn about iMotion’s Parkinson’s Wellness Recovery program and other specialized physical therapy services, contact iMotion Physical Therapy today. Fremont: (510) 745-7700 | San Jose: (408) 275-1500 | Los Gatos: (408) 358-3631 | Visit imotionpt.com to request an evaluation.