Parkinson’s disease (PD) is a neurodegenerative disease that afflicts many older adults. Patients with Parkinson’s disease can experience severe life dysfunction in the later stages of the disease, and there is no cure for the disease, except the use of medication to keep the patient’s symptoms under control and relieve their motor symptoms. In addition to medication, rehabilitation is also a non-essential treatment modality. Rehabilitation for Parkinson’s disease includes exercise therapy, occupational therapy, speech and swallowing therapy, and physical therapy.
I. Occupational therapy
The main purpose of occupational therapy is to maintain and improve the function of upper limbs, improve the ability to take care of oneself in daily life, and instruct family members how to take care of them. For psychiatric symptoms or cognitive disorders, group training or interest development methods to communicate with other patients are very therapeutic. Activities such as kneading Play-Doh, knitting, tying a rope belt, combining and separating bolts and nuts again, using typewriters and computer keyboards can increase the range of motion of joints and improve hand function. It is also important to train patients in dressing, putting on shoes and socks, standing, walking, eating, washing, rinsing, writing, combing hair and urinating and defecating, as well as some appropriate housework for daily living skills.
Physical therapy
1. Relaxation training
Help patients to move their limbs and trunk muscles rhythmically; joint range of motion training: instruct patients to move their joints throughout the body, 3-5 times for each joint, paying attention to slow and gentle movements to avoid pain caused by excessive stretching.
2.Training to enhance muscle strength
Focus on pectoral muscles, abdominal muscles, lumbar back muscles. Trunk training: trunk forward flexion, back extension, lateral flexion and rotation training; abdominal muscle training: supine flexion knee chest training, supine straight leg raise training, sit-up training; lumbar back muscle training: swallow training, five-point support training, three-point support training; gluteus training: prone position under the knee extension alternately lift the lower limbs upward.
3. Balance training
Balance function is the basis for maintaining normal body position, completing various transfer movements and walking. Patients sit on the bed, the bed to the feet can be placed flat on the ground as appropriate, some items are placed next to the body, then use the left hand or right hand to get the items from one side to the other side, to be repeatedly practiced, you can also practice from sitting to standing position, repeatedly, and gradually improve the speed and stability of standing up.
4.Walking training
Walking is the process of the body constantly moving the center, with good posture control and balance ability as a prerequisite. Walking training mainly corrects abnormal gait such as difficult starting, low leg lifting, short stride length, slow turning and uncoordinated upper and lower limb movements.
Walking training requires patients to do forward and backward stride exercise exercises, walking can be marked on the floor, also can set up 5-7cm obstacles, but also can carry out stepping, swing arm walking and other exercises.
Weight loss walking training mainly uses weight loss sling to suspend the patient’s body partly, so that the patient walks with less weight on the lower limbs to improve the walking ability, and the effect is better if the training is carried out with the exercise plate.
5.Exercise therapy
The principle of exercise therapy is to inhibit abnormal movement patterns and learn normal movement patterns. In exercise therapy, individualized training programs should be reflected, and the training process should fully mobilize the patient’s enthusiasm and attach importance to the patient’s active participation in order to adjust the efficacy of the therapy.
Third, physical therapy
1. Low-frequency repetitive transcranial magnetic stimulation
In Parkinson’s patients, degenerative nuclei become located in the substantia nigra-striatal system, while the cortical function is in a relatively excited state. The magnetic stimulator can generate a strong pulse magnetic field with a very short duration when the stimulus is rapidly discharged to the coil through the skin and skull of Parkinson’s patients, inhibiting the cerebral cortex, raising the resting threshold of the brain and reducing excitability, so as to achieve the purpose of treatment.
2. Transcranial direct current stimulation
Transcranial direct current stimulation (tDCS) is a non-invasive technique that uses a weak current (1-2mA) to regulate the activity of neurons in the cerebral cortex. As a new technique, it is not yet perfect, but its effectiveness in treating non-motor symptoms of Parkinson’s disease is still obvious.
The principle of transcranial direct current stimulation for Parkinson’s disease is believed to be that transcranial direct current stimulation induces changes in neuronal potentials, mechanically repairs neuronal receptors, and modifies neurons, thus activating the excitability of the cerebral cortex. Transcranial direct current stimulation method has a great effect on the improvement of Parkinson’s patients in terms of sleep and cognitive status.
3. External cueing training
The three main external cueing methods are auditory, visual, and somatosensory, and they can also be combined together as a stimulation method. Parkinson’s disease patients cueing system is damaged, resulting in impaired gait, as manifested by slow motor initiation, slowed gait speed, short stride length, and even freeze gait. External cues can compensate for this motor impairment by providing a temporal and spatial stimulus associated with motor initiation and motor facilitation, thus improving gait, such as rhythmic music, metronome, etc.
IV. Speech therapy and swallowing training
Patients with Parkinson’s have dysarthria and have impairments in speech phonology, storage of spontaneous verbal information, and comprehension of written or verbal commands. For the language therapy of Parkinson’s patients, they should speak more and practice more, pay attention to the pronunciation of each word as accurately as possible, starting from the sound and rhyme to the pronunciation of each word and word. They can practice facing the mirror, observe their mouth shape, tongue position and facial muscle expression, practice the lip and tongue movements, and strive for clear and accurate pronunciation.
Swallowing disorder is one of the common symptoms of digestive system dysfunction in Parkinson’s patients with non-motor symptoms, manifested as difficulty in eating and more obvious when eating hard food. Swallowing training is a functional intervention for the organs related to swallowing, including pharyngeal reflex training, atresia, supraglottis, and empty swallowing exercises, as well as motor training for the mouth, face, and tongue muscles. In case of swallowing disorders, the
You can also reduce the barriers to eating by adjusting the posture of ingestion, choosing soft, easy-to-chew food, and selecting appropriate tableware.
Summary: Parkinson’s is a degenerative disease of the central nervous system. The role of rehabilitation training for Parkinson’s patients is to promote the regeneration of axons of nerve member cells, dendritic sprouting and travel new prominent connections, so as to establish a new neural network close to normal function.