Q: Kindly guide about physical therapy in Parkinson’s disease.
A: A person with Parkinson’s may experience multiple symptoms simultaneously. During your assessment, focus on identifying the main issues to prioritize in the management plan. Although physiotherapy mainly addresses physical symptoms, it's crucial to consider how other symptoms affect the person's daily life.

Personalized management of Parkinson's disease tailors to the individual's unique goals, as symptoms can vary widely and include both motor and non-motor issues. Achieving the best outcome involves collaborating with a team of health and social care professionals, including volunteers, family, and friends, who have expertise in different aspects of Parkinson’s. The aims of physical therapy include:

Maintaining and improving levels of function and independence to enhance quality of life. Using exercise and movement strategies to improve mobility. Correcting and improving abnormal movement patterns and posture when possible. Maximizing muscle strength and joint flexibility. Improving posture and balance, and minimizing fall risks. Maintaining a good breathing pattern and effective cough. Educating the person with Parkinson’s and their caregivers or family members. Enhancing the effects of drug therapy.

Exercise is proven to maintain health and well-being in Parkinson’s and plays a significant role in secondary prevention by focusing on strength, endurance, flexibility, functional practice, and balance. Exercise for neuroprotection emphasizes endurance and uses motor learning principles such as mental imagery and dual-task training. Introducing neuroprotection training early is beneficial, though it helps at all stages and involves complex, intensive exercises.

Group exercise provides social connections for those feeling increasingly isolated as the condition progresses, and newly diagnosed individuals can see the benefits of staying active. Group settings also allow time for questions and discussion of symptoms and management strategies. Physical activity, especially aerobic exercise, may slow motor skill degeneration and depression in Parkinson's disease and enhance quality of life.

There are positive outcomes with exercise and horticultural intervention programs for older adults with depression and memory issues. Quality of life may improve with strength training against external resistance, such as using a cycle ergometer, weight machines, therapeutic putty, elastic bands, and weight cuffs. Strength training can also enhance balance, gait, and physical performance.

Performing a dual task, like talking while walking, is often challenging for people with Parkinson’s. Training with motor-cognitive dual-task methods improves dual-task ability and might enhance gait, balance, and cognition.

Q: I am a 52-year-old female experiencing intense pain in my left arm, and it has been diagnosed as a frozen shoulder. The stiffness in my shoulder is impeding my ability to carry out daily activities.
A: It appears that you are dealing with Adhesive Capsulitis, commonly known as Frozen Shoulder, a condition whose diagnosis is confirmed through a thorough examination. This ailment arises due to inflammation in the shoulder joint, resulting in the thickening and tightening of the shoulder capsule. Adhesions form, and in many cases, there is a decrease in synovial fluid. The progression of Adhesive Capsulitis is characterized by stages, with initial pain dominating during the Freezing stage, lasting approximately 6 weeks to 9 months. Subsequently, the Frozen stage sets in, marked by increasing stiffness over about 4 to 6 months, followed by the Thawing stage, where normal strength and range gradually return over a period of 6 months to 2 years.

The causes of this condition can be varied, encompassing idiopathic origins with no specific reason, or it may be triggered by factors such as injury, stroke, surgery, altered movement patterns, and hesitancy in shoulder joint movements. Systemic causes like diabetes, extrinsic factors such as cardiopulmonary diseases (blood pressure), and intrinsic factors like arthritis or tendinopathy can contribute to the development of Frozen Shoulder. Typically affecting individuals between the ages of 40 and 60, with a higher prevalence among females, Frozen Shoulder tends to improve after an initial period of worsening symptoms. However, complete recovery may extend up to three years.

During any stage of Adhesive Capsulitis, a physical therapist plays a crucial role in addressing the associated challenges. Their interventions focus on alleviating pain, improving joint stiffness and range of motion, and addressing muscle weakness. This comprehensive approach involves the application of various modalities, techniques, and targeted exercises tailored to the specific needs of the individual. Seeking the guidance and expertise of a physical therapist can significantly contribute to managing and mitigating the impact of Frozen Shoulder, facilitating a more effective recovery process.