Parkinson's Disease - Exercise Testing and Prescription

Question 1

Parkinsonism is caused by a decrease in dopamine release from neurones in what are of the brain?

What is the main role of this centre?

Answer 1

Basal Ganglia

It is responsible for movement planning (non-cyclic and unlearned)

Question 2

If this area of the brain is associated with motor function, how can cognitive and sensory impairments also occur?

Answer 2

The basal ganglia have projections to other motor, sensory and cognitive/motivational areas.

These extensive projections ensure that propels are not only limited to motor function.

Question 3

What is the most common form of Parkinson’s Disease?

What portion of the PD patients show these symptoms?

Answer 3

Idiopathic PD most common.

Occurs in 75-90% of all cases.

Question 4

According to Hohn and Yahr’s staging of PD, what stage would someone be at if they had limited walking capacity, significant rigidity, tremor and slow movement?

Answer 4

Stage 4

Question 5

What are the 2 major benefits of the Unified Parkinson’s Disease Rating Scale?

Answer 5

1. It allows longitudinal ratings,
2. and of different areas such as mental behaviour and mood, ADL’s, motor performance and complications of therapy - so it’s broad based.

Question 6

A PD patient completes a 20m walk test. If they’re level 4 on the Hoehn & Yahr scale, what gait characteristics would you expect?

Answer 6

Slow shuffling gait, ‘freezing’ regularly, problems with starting/stopping, balance deficiencies and possible falls

Question 7

It’s very useful for PD patients to undergo strength, endurance and flexibility training to maintain functional performance and maintain QoL.

If you ran a full time clinic for PD patients, what might a typical day entail as far as exercise is concerned?

Remember to increase physical capacity and reduces anxiety and depression.

Answer 7

Incorporate numerous activities throughout the day: this should consist of light walking session early [focus on heal-toe walking with large strides] some obstacles or uneven terrain can be used in patients with reasonable good gait.

After lunch in social environment - perform specific movement practice where they perform chair raises, hip flexion and knee extension balance tasks, hand pronation and supination, recovery from balance perturbation and start-stopping over short distances.

After relaxing or cognitive function training games - eat - then perform some aqua aerobics sessions, a strength, balance or endurance training session.

Again, after more relaxation/memory games and dinner - do a dance class in the evenings. Dance is associated with both acute and chronic outcomes for PD patients.