INTERVENTIONS FOR INDIVIDUALS WITH PARKINSON'S DISEASE
Parkinson’s disease is a
progressive neurodegenerative disorder that is characterized by bradykinesia,
tremors, postural instability, and/or muscle rigidity. Physical therapy interventions are often
aimed at addressing these motor impairments. Recent
research has highlighted the importance of programs addressing cognition in
addition to the physical symptoms. High
intensity aerobic exercise, forced cycling and exercises involving cognitive
engagement (feedback, cueing and dual tasking) and random practice (change tempo, activity or direction) have been
suggested to increase motor control and cognitive function.1,2 ACP offers several interventions to provide
properly-dosed exercises in this patient population.
therapeutically dosed aerobic exercise – Refer to AEAA course manual
2. Consider high intensity intervals
3. Consider varying direction and speed randomly throughout
4. Provide forced speed cycling vs. self-selected speed for
greater motor improvement (80-90 revolutions/minute is recommended3)
5. Use the biofeedback activities such as Soccer, Porcupine
or Traffic Jam to provide visual and auditory feedback, vary tempo, and provide
a dual task challenge.
Virtual Reality via OmniVR®:
1. Vary range of motion options in program settings to
practice greater amplitude movements (i.e. UE puzzle, Puzzle, Fox)
2. Vary speed with gait (Fox, Wolf, Stroll)
multi-directional movement (Mole, Flower Garden, Vegetable garden)
4. Vary the activity frequently with different difficulty
levels and provide visual and auditory feedback as well as results and
5. Engage posture by varying support – remove armrests, get
individual away from the back of the chair, change support surface (firm, foam,
balance ball/platform, etc.)
Omnistim® FX2 Patterned Electrical Neuromuscular Stimulation (PENS):
1. Use PENS UE and LE triphasic patterns to facilitate
extremity and trunk exercise targeting muscle strength and coordination. Apply during goal task activity when
2. Use PENS functional cycle or walk program to provide
input to the CNS for gait initiation, symmetry, and flow. Vary between slow and fast walk/cycle options
as clinically indicated.
1. Petzinger G, Fisher B, McEwan S, Beeler J, Walsh J,
Jakowec M. Exercise-enhanced
Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson’s Disease.
Lancet Neurology 2103, July;12(7);
2. Exercise and Physical Therapy/Parkinson’s Disease Clinic
and Research Center, http://pdcenter.neurology.ucsf.edu/patients-guide/exercise-and-physical-therapy
3. Ridgel A, Vitek J. Forced, Not Voluntary, Exercise
Improves Motor Function in Parkinson’s Disease Patients. Neurorehabilitation and Neural Repair 2009; 23(6); 600-608.
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