PHYSIOTHERAPY IN PARKINSON

DISEASE
 PURPOSES OF PHYSIOTHERAPY

• PROTECT AND ENHANCE MOBILITY

• PROTECT AND ENHANCE ROM
• PREVENT ADVERSE EFFECTS OF IMMOBILIZATION, SUCH AS
CONTRACTURES AND PAIN
• INCREASE BALANCE AND COORDINATION
• IMPROVE VOLUNTARY MOVEMENTS SUCH AS MOTOR FORCE,
SPEED AND MOVEMENT
• IMPROVE WALKING, REDUCE AND PREVENT FALLS
• TO TEACH THE PATIENT THE CORRECT POSTURE IN BED, SITTING OR
STANDING
• MAKING THE SPEECH UNDERSTANDABLE
• TO INCREASE THE MOBILITY AND RESPIRATORY CAPACITY OF THE
CHEST WITH BREATHING EXERCISES
• PROVIDE MOTIVATION AND PSYCHO-SOCIAL SUPPORT
• REHABILITATION SHOULD BE STARTED WITH MEDICAL TREATMENT IN
THE EARLY PERIOD!
• THE GOALS OF PHYSICAL THERAPY VARY ACCORDING TO
THE PERIOD OF THE PATIENT.
• THE STAGE OF THE DISEASE IS DETERMINED BY THE
MODIFIED HOEHN AND YAHR SCALE.
• SCALA EXAMINES THE STAGES OF THE DISEASE IN 5
CATEGORIES.
MODIFIED HOEHN AND YAHR SCALE
 ACCORDING TO SCALE PURPOSES OF
1-3 PHASE PHYSIOTHERAPY

• REDUCE RIGIDITY AND PAIN

• TO STIMULATE RECIPROCAL MOVEMENTS
• MAINTAINING AND IMPROVING RESPIRATORY CAPACITY
• IMPROVE POSTURE, POSTURAL REACTIONS, BALANCE AND
GAIT
• TO PROVIDE FUNCTIONAL INDEPENDENCE
 ACCORDING TO SCALE PURPOSES OF
4-5 PHASE PHYSIOTHERAPY

• TO CONTINUE MOBILIZATION AS MUCH AS POSSIBLE

• APPROPRIATE WALKING AIDS AND COMPENSATIONS
• AVAILABLE WHEELCHAIR AND BED SELECTION
• KEEPING THE QUALITY OF LIFE AS HIGH AS POSSIBLE WITH
IN-HOUSE ARRANGEMENTS
• PREVENTION OF BED COMPLICATIONS
 EVALUATION

RESPIRATORY:
• THORACIC EXPANSION AND LUNG CAPACITIES SHOULD BE
MEASURED.
• IF NECK IS IN FLEXION DIFFICULTY SWALLOWING
• KYPHOSIS CAUSED BY WEAKENING OF RIGIDITY AND
POSTURAL REACTIONS REDUCES THORACIC EXPANSION.
• SIGNIFICANT RESTRICTIVE TYPE RESPIRATORY PROBLEMS
CAN BE SEEN
• ROM: IMPORTANT JOINT LIMITATIONS DUE TO RIGIDITY AND
AKINETIC TREMOR

• SHORTNESS TESTS: ESPECIALLY PECTORAL, HAMSTRING

SHORTNESS IS COMMON

• RIGIDITY:CAN BE CLASSIFIED AS MINIMAL, MEDIUM AND

SEVERE ACCORDING TO RESISTANCE

• POSTURE ANALYSIS: DISEASE MAKES THE PERSON

INCREASINGLY DEPENDENT ON THE FLEXION POSTURE.
THREE-WAY, DETAILED, ESPECIALLY EVALUATED FROM THE
LATERAL

• PAIN: SEVERE JOINT AND MUSCLE PAINS DUE TO RIGIDITY

CAN BE SEEN
• PAIN AND LOCALIZATION OF PAIN SHOULD BE DETERMINED
WITH VAS OR MCGILL PAIN QUESTIONNAIRE
 BALANCE AND COORDİNATİON
TESTS

• VOLUNTARY MOVEMENTS, BALANCE AND COORDINATION

TESTS ARE USED.
• BALANCE LOSSES ARE OBVIOUS
• WHEN THE PATIENT IS PULLED BACKWARDS, THE ANKLE, HIP
SYNERGIES, AND STEP-TAKING REACTION ARE DELAYED OR
THE BALANCE IS BROKEN AS A WHOLE.
• IN THE COORDINATION THERE ARE MORE PROBLEMS IN
MAKING ALTERNATIVE MOVEMENTS EG DISDIADOCOKINESIS
 PRİNCİPLES OF TREATMENT

IN THE OFF PERIOD:

-APPLICATIONS WITHOUT ACTIVE PARTICIPATION SHOULD BE

PREFERRED
-CHEST PHYSIOTHERAPY
-STRETCHING FOR RIGIDITY AND PAIN INHIBITION
DURING THE ”ON” PERIOD:

-EXERCISES THAT REQUIRE PATIENT PARTICIPATION ARE

SELECTED
-BALANCE
-COORDINATION
-POSTURE
-WALKING EXERCISES WITH OR WITHOUT DEVICE
AT EVERY STAGE OF THE DISEASE:
-RESPIRATORY
-POSTURE
-STRENGTHENING THE ANTIGRAVITY MUSCLES
-APPROACHES TO THE PREVENTION OF RIGIDITY MUST BE AT
THE FOREFRONT
-AFTER THESE ARE ACQUIRED, OTHER EXERCISES SHOULD BE
STARTED.
-EXERCISES FROM PART TO WHOLE
-IT MUST MOVE FROM CONSCIOUSNESS TO AUTOMATIC
-AVOID LONG-TERM TRAINING IN THE STATIC POSITION
-VISUAL AND ACOUSTIC FEEDBACK THAT FACILITATES
MOVEMENT DURING EXERCISE
 TREATMENT PROGRAM

CHEST PHYSIOTHERAPY:
• SELECTED ACCORDING TO THE NEEDS OF THE PATIENT
RIGIDITY INHIBITION:
• RELAXATION EXERCISES
• HOT BATHROOMS (32-34 DEGREES)
• HOT-PACK
• CLASSICAL MASSAGE
• TENS
• BIOFEEDBACK
PAIN INHIBITION:
• TENS
• HOT-PACK
COMBINED POSTURE EXERCISES WITH BREATHING
STRETCHING TO SHORT MUSCLES
BALANCE TRAINING: STATIC-DYNAMIC
WALKING TRAINING:
• LARGE ENVIRONMENTS
• WALKING ON THE SURFACE OF THE FLOOR WITH VERBAL
COMMANDS BY DRAWING SHAPE ON THE GROUND
• SKIPPING JUMP
• UPPER EXTREMITIES IN COMBINATION WITH WALKING IN
THE UPPER STAGES, ROTATION AROUND THE OBJECTS
DAILY LIFE ACTIVITIES TRAINING
EXERCISES FOR LYING ON
SUPINE

1. Pull both legs with the knee flexion, and then

pull the other leg out of the bed and Press. In
the meantime you can get support from your
hands
2. Taking support from your hands, pull both
your knees bending
towards your stomach.
3. Each leg in turn,
Lift your legs without bending in the knee.

4. Open and close your legs individually

5. Pull your feet without bending your knees
towards you from the ankle and keep 5 sec.

6. Extending your left arm up, pull

your right leg towards your stomach. Repeat
the procedure for the opposite sides.
7. Both legs are close and knees
are in bending position.
With hip motion, try to touch the opssite side
With turning knees
left and right

8. When making the previous move

turn your head to the opposite direction of
knees.
EXERCİSES ON THE PRONE
EXERCİSES ON THE SITTING
POSITION
GETTING OUT AND SITTING ON THE
CHAIR
EXERCISES ON STANDING