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Physiokinesis therapy in Parkinson’s disease PDF Print
In the previous section of this guide we have described the pharmacological therapy for Parkinson’s disease and nutritional aspects; here we shall adopt a different approach, which is just as advisable and consists in the performance of a series of suitable physical exercises within the context of a program of physiokinesis therapy. The most common questions that we are asked, as rehabilitation specialists, are: “Is physiotherapy useful for Parkinson’s disease ?” or “Is it necessary?” and also “Do I have to always continue ?” “When should I start?" These questions go in the right direction and the most significant answers are provided by the patients who have “tried it”: It works. Physiokinesis therapy is not a miracle therapy able to cure the disease or even only slow its progression; It only supports pharmacological therapy right from the beginning with the aim of counteracting some of the symptoms of the disease and preventing the secondary damage produced by the disease. Which symptoms can be corrected by physiokinesis therapy ?If we define disease as a movement disorder, rehabilitation becomes constant and systematic  movement "retraining” with the purpose of counteracting slowness, poor fluidity and poor coordination of movements by repeating well designed exercises. Remember !Physical exercises performed accurately and constantly not only counteract motor symptoms of the disease, but also improve mood and reduce anxiety.

Rigidity and motor slowness alter posture (one' s attitude in the standing position), gait and balance in general, with repercussions also on the spinal column and individual joints that become “fixed” in inappropriate positions. Exercise is designed to correct these attitudes and prevent the onset of painful disorders of the various parts of the skeleton. On the contrary, little can be done to counteract tremor.  A certain benefit may be achieved via improvement of physical performance, whereby the patient acquires greater confidence in moving. This improves mood and reduces anxiety. The most evident result reported by patients who have followed a program of physiokinesis therapy regularly, is an increase in independence in daily life.  This is what we feel that we can guarantee. The exercises that we propose below are a short summary of a more extensive rehabilitation program, which is structured in such a way that the patient can carry it out at home. We have subdivided the exercises into four groups according to the aims to be achieved:
1  stretching and mobilizing exercises.  Aims: Prevention of muscle and tendon retractions involving individual joints and of the onset of painful bone disorders, correction of inappropriate postural attitudes.
2 functional exercises.  Aims: Improvement in the capacity to change position (lying down, sitting, standing) and of performing daily life movements (e.g. turning in bed).
3  exercises improving balance.   Aims: Improvement in balance.
4  exercises improving coordination.   Aims: Improvement in the fluidity and precision of movements

The patient will choose the level of difficulty of the exercises according to the extent of his independence.

    1st level exercises:the patient who can benefit from these exercises is independent and can perform all daily activities2nd  level exercises:The patient who can benefit from exercises of this level is partly independent; he or she needs a little help to perform the usual activities of daily life, but still has the ability to get up and sit on a chair safely and keeps his/her balance with minimal support.

These exercises should be performed regularly, possibly every day, during the period of maximum physical performance that varies from person to person.  Examples of 1st level exercisesExercises lying down1. Starting position Lie on your back with arms along your hips, knees bent and the soles of your feet on the floorFinal position. Lift you knee up to your chest helping yourself with your hands and stretch out your other leg; keep your position, counting up to 20 and then return to your initial position.   Repeat three times per leg.
2. Starting from the kneeling position on your heels, stretch your arms and back as much as possible without lifting your bottom. Remain in that position counting up to 20.  Relax. Repeat three times. 3. Sit, right leg bent and left leg stretched out, bend your back as much as possible, lengthening it in the direction of your left foot until you feel a pull under your left thigh. Keep in that position counting up to 20 and then relax.   Repeat three times per leg.Coordination exercises1. Starting position Lie on your back with arms and legs stretched out;2. Bend your left leg and touch its knee with your right hand;3. Return to your starting position;  Repeat ten times You may increase the difficulty of the exercise by increasing the rhythm. Exercises to be performed sitting on a chair without armsCoordination exercises1. Starting position Sit comfortably on a chair, legs bent with feet under the chair, hands on your shoulders2. At the same time stretch your legs forwards and your arms outward
3. Return to the starting position
Repeat ten times
You may increase the difficulty of the exercise by increasing the speed at which you perform it  Exercises to be performed standingStretching and mobilizing exercises1. Starting position Stand with your arms folded and your hands on your shoulders2. Final position. Extend your elbows and your arms as far out as possible; lift your hands and open up your fingers.
Keep the position counting up to 10 and then return to your initial position.
Repeat ten times Advise to face up to everyday activities as best you canPD patients may find it difficult to perform everyday tasks This advice may help them to overcome a few of their problems:TremorAt times tremor may interfere with hand movements; in order to control it keep your elbows against your hips and then do what you have to do as quickly as possibleGetting dressedGetting dressed and undressed can be a very tiring and lengthy process. Ensure that you have enough time to get dressed to that you do not have to rush and need the help of a family member -  use loose and comfortable clothing;

- put your clothes on on the most rigid side and do the same taking them off;

- if balance is an issue sit on the bed or on a chair;

- use elastic bands or velcro instead of buttons and zippers;

- wear sweaters without buttons;

- choose clothes that fasten up in front;

- wear mocassins or shoes with elastic shoe-strings;

- use a shoehorn with a long handle;«<0}FigureReplace shirts with buttons with button-neck sweaters to make getting dressed easier
- ask a family member to give the last touches to your clothes  The bathroomThe bathroom usually is the most dangerous place for people with balance and gait disorders, and with tremor. Many bathrooms are small, have tiled floors and a porcelain bathtub. When these surfaces are damp they are very slippery. The following measures can be taken to prevent accidents:- put a rough mat in the bathtub or shower;

- remove glass doors from the bathtub;

- use a seat in the bathtub;

- use a shower with a long and flexible hose that can reach you even when you sit down;

- attach the soap to a little rope so that you can catch it more easily;

- do not use towel rails for support, because they are not robust;

- use handles fixed onto the wall if you need support.

Furthermore an elevated toilet seat may make it easier for you to get up and arms attached to the toilet may enable you to push yourself up. Getting out of bedPatients often find it difficult to get out of bed in the morning because they are rigid. When you want to get up roll over on your side near the edge of the bed, let your legs fall out of bed, pushing yourself up at the same time to get up.WalkingThe typical stooped posture of PD patients facilitates their tendency to walk on tiptoe with elevated heels. This gait often becomes faster and steps become shorter after a little while. When this happens:-stop walking;- make sure that the distance between your feet is about 25 cm;- correct the position of your body as much as possible;- concentrate on lengthening your steps;- lift your feet well up from the ground as if you wanted to march;- first put your heel on the ground, then the whole foot and lastly the tip of the foot;- make the opposite arm to the leg that is making the step swing ahead; this improves the rhythm of your march and your postureA cane is not always useful; indeed, some patients are hindered by it because they are unable to use it correctly. Morevoer, a cane may encourage inappropriate posture.  
 
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