Parkinson’s Disease Rehabilitaion


Parkinson’s disease is a brain disease with loss of brain cells. It is a progressive neurological disease that is seen 1-2% in 65 years and older. Approximately 60% of the patients experience tremors in the fingers, hands or arms, and sometimes feet, which occur at rest, slowing movements and stiffness in limb movements occur in about 30% of the patients.

The disease usually begins insidiously and symptoms progress extremely slowly but gradually over the years. In the 1800s the disease was also called “shaky paralysis”.

What is Parkinson’s Disease?

Parkinson’s disease occurs as a result of the damage of the nerve cells that produce the chemical called dopamine in the nuclei located in deeply located structures in the brain, called the substantia nigra, and their number gradually decreases over the years.

Symptoms of the disease begin to appear when approximately 80% of these cells decrease. Although the causes of damage to the cells in question are not known, genetic predisposition and environmental factors are more prominent in Parkinson’s disease.

What are the Symptoms of Parkinson’s Disease?

In the vast majority of patients with Parkinson’s, the first symptom that attracts the attention of the patient and his family is the tremor in a finger or hand, which can come and go, triggered by excitement or stress. Sometimes a dull expression may develop on the patient’s face. Symptoms occur in a single half of the body in almost all patients and may manifest itself in the opposite half of the body, becoming milder over time.

Parkinson’s is a progressive brain disease characterized by slowing of movements, tremors in the arms and legs that occur at rest, stiffness and rigidity in the muscles, posture disorder (bending forward). In addition to these complaints, it can be seen in additional findings from many other systems. Sometimes a fast but inexhaustible gait called festination occurs.

The most important of these symptoms is slowing down of movements. In relation to this, the patient’s walking is also affected. While walking, the arm swaying less on the affected side, slower walking is observed with small steps.

When the same findings are on the face, a dull facial appearance with decreased facial expressions and expressions occurs. Tremors are most common in the hands and less frequently in the feet, chin and lips, especially when the patient is at rest. Tremor, which is a very important symptom of Parkinson’s disease, may not be seen in every patient.

As the disease progresses, forward and lateral bending of the body posture may occur. Difficulty in starting the movement called freezing, forgetfulness, constipation, urological symptoms, sleep and psychiatric disorders may occur. Sleep disturbances are seen in most patients.

There is a condition similar to Parkinson’s disease called Parkinsonism or Parkinson’s syndrome. Since these occur due to different reasons, the drugs used in the treatment of Parkinson usually cannot be responded to.

Some of these are Parkinson and its syndromes in which Parkinson findings and other system findings are together, and a group of symptoms called secondary (secondary) parkinsonism. Secondary parkinsonism; It may be due to vascular diseases, infections, tumors, drugs and some toxic events. First of all, their differential diagnosis should be made and these situations should be taken into consideration while planning treatment.

How Is Parkinson’s Disease Treated?

There is no treatment method to stop the progress of the disease completely. The primary treatment method in Parkinson’s disease is medication. The drug should be used for life. Surgical and infusion treatments can be applied according to the needs in the advanced stages of the disease.

Rehabilitation is very important in Parkinson’s patients. Attention should be paid to the acquisition of physical exercise habits in these patients, and attention should be paid to exercises that will ensure an upright posture. Another goal of rehabilitation should be to prevent complications in the musculoskeletal and heart-lung systems. Since the postural posture will prevent falling, patients should be taught to rotate with a wide opening while turning.

An appropriate rehabilitation program should be prepared according to the characteristics and needs of Parkinson’s disease. These include;

  • Relaxation exercises
  • Joint range of motion exercises
  • Aerobic exercises
  • Respiratory exercises
  • Strengthening exercises,
  • Balance and coordination exercises
  • Work and occupation therapy,
  • Dance practices,
  • Walking exercises,
  • Obstacle overcoming exercises,
  • Spinning exercises,
  • Upright posture exercises should be done.

After reducing stiffness with relaxation exercises, better progress will be made in the rehabilitation program.

In these patients, attention should be paid to gain the habit of doing physical exercises in order to prevent the decrease in physical activity. Exercises that will ensure an upright posture in patients should be given importance.