Physical Therapy for Parkinson’s Disease

Personal Training for Parkinson’s Disease – FYZICAL Therapy & Balance Centers of Rockville – Rockville, MD

Physical Therapy for Parkinson’s Disease | Johns Hopkins Medicine

The more you know about Parkinson’s, the better you can participate in the treatment of this disorder with your doctor, caregiver and physical therapist.

There are primary and secondary symptoms that may present themselves with this disease, but the important thing to remember is that not everyone has similar symptoms. It has been well stated that when you have seen one Parkinson’s patient, you have seen one Parkinson’s patient.

This means that treatments for this disease are specific to the individual being treated and the array of symptoms presented.

It is very important to remember that no matter the number or type of symptoms you develop, exercise is an important adjunct treatment for the symptoms of the disease. Those who exercise have more favorable outcomes than those patients who remain inactive.

If you have any of these symptoms, we can help:

    Gait Disorders (including reduced arm swing, short-stride, shuffling gait, and episodes of freezing) Postural Lean Tremor Rigidity Stiffness Bradykinesia (slow movements) Non-motor Symptoms (micrographia, constipation, masking, swallowing difficulties, etc.)

Parkinson’s Disease Treatment Services Offered:

    Personal evaluation of your Parkinson’s symptoms and musculoskeletal system. Science-based interventions and exercises using compensatory techniques (e.g. visual/auditory cues, focus drills and tasks). Individualized exercise programs and techniques which target symptoms. Parkinson’s disease information. Our goal is to treat your symptoms and the total person with gait training, postural exercises, stretching, strengthening, cardiovascular, and balance exercise programs.

Bob treats clients in a safe and clinical setting here at FYZICAL of Rockville. Stop struggling, give us a call – we’re here to help.

For more information and educational material about Parkinson’s Disease check out the links listed below:

  • The New Parkinson’s Disease Treatment Book: Partnering with Your Doctor to Get the Most from Your Medications by J. Eric Ahlskog, PhD., MD., Mayo Clinic Parkinson’s Specialist, Oxford University Press © 2015 In addition to providing information taken from treating people with Parkinson’s for over thirty years, the book examines the role of medications, nutrition, exercise, and physical therapy in effective long-term treatment.
  • Brain Storms: The Race to Unlock the Mysteries of Parkinson’s Disease by Jon Palfreman, PhD, Scientific American/Farrar, Straus and Giroux © 2015 The author shares how scientists have worked to crack the mystery of what was once called the shaking palsy. He shares inspiring stories of brave individuals living with Parkinson’s.
  • A Parkinson’s Primer by John M. Vine, Paul Dry Books © 2017 John Vine has written the book that he and his wife Joanne, wished they could have consulted when John was first diagnosed with Parkinson’s disease. The book is a nontechnical, personal guide written from a patient’s perspective. his experiences over the past 12 years, John writes knowledgeably about all aspects of the disease. John also interviewed other Parkinson’s patients and their partners, whose stories are included throughout the book.
  • How to Tame Parkinson’s By Keeping Fit: My Total Commitment + The Right Trainer by David H. Anderson, Authorhouse © 2005. If you or someone you know is diagnosed with Parkinson’s, how do you cope with the denial, anger and fear, as well as the symptoms? I haven’t discovered a cure for Parkinson’s, but I have found a way to tame many of its debilitating symptoms and return to a more normal existence. I’ve written this book, hoping others might benefit from my positive experiences with the right personal trainer, and use it as a guide to discover the simple routines that helped restore my balance, posture, walk and, most importantly, my usefulness and sense of humor. Restoring a positive mental attitude has been key. I’ll show you how I accomplished it. It’s as easy as Your Total Commitment + The Right Personal Trainer.
  • Delay the Disease: Exercise and Parkinson’s Disease by David Zid, Columbus Health Works Production © 2007 Second Printing. This book is a fitness program designed to empower people with Parkinson’s Disease (PD) by optimizing their physical function and helping to delay the progression of symptoms.


I’ve Made BIG Improvements with Parkinson’s Therapy Program

Physical Therapy for Parkinson’s Disease | Johns Hopkins Medicine

I have been seeing a physical therapist four times a week for the last month. I hadn’t injured myself, though I experience aches and pains with Parkinson’s disease.

My neurologist referred me to a physical therapist who teaches the BIG program. The LSVT BIG program is designed for people with Parkinson’s to bring their movements to a more “normal” state, as they tend to become slower and smaller over time.

My first session

My first appointment consisted of small “tests,” those performed during a Parkinson’s diagnostic exam but less extensive. The therapist examines and times your walking and tests your balance, among other abilities.

BIG is customized for people with Parkinson’s. Perhaps you struggle with getting bed. Though this specific activity isn’t included in the standard routine of the BIG program, it can be worked into your tailored activities. The therapy can help you no matter what stage of the disease you are at and it’s recommended that you start treatment as early as possible.

What improved?

The BIG treatment improved my walking in general, and I gained confidence with “stair-stepping.” I no longer take each stair sideways, with extreme caution, and slower than molasses. The program helped me to be more intentional in my activities and how I carry them out.

At my therapy sessions, we started with the exercises that are specific to the BIG program. I completed two exercises while sitting in a chair, stretching down, up, and back, and ending with a “BIG” finish.

The rest of the exercises — except for the last — are performed while standing and are aimed at balance and coordination, and also end with a “BIG” finish.

The program strives to teach the person with Parkinson’s to emulate the bigger movements of those around them who walk and interact “normally.”

After the “regular” exercises, we practiced tasks tailored to my needs. These included cutting up food, buttoning/unbuttoning and zipping/unzipping my coat or sweater, and other tasks. After those exercises, we walked around the neighborhood for a half-hour, practicing arm swings and balance.

Was it worth it?

My sessions are over, and as my movements have improved, my outlook has, too. While the exercises are not difficult to do, they must be practiced daily for continuous improvement. I noticed that if I skipped even one day, it made a difference to my ease of movement. I realize that if I want to live BIG, I need to exercise BIG, and that means I must think BIG.


Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.


Bringing Harmony to the Brain: The Neuroscience of Music and Parkinson’s Disease

Physical Therapy for Parkinson’s Disease | Johns Hopkins Medicine

As anyone who has heard “their song” can attest, the right music has the power to make you move. Now healthcare providers are trying to harness this power to help patients with a neurological motor disorder, Parkinson’s disease (PD).

Over the past three decades, researchers have begun to uncover the neural basis of music’s effect on the brain with an eye toward treating diseases PD. A growing body of research reveals that the influence of music is far-reaching—shaping connections in the brain, improving our senses and movement, and enhancing our mood.

The Many Disharmonies of Parkinson’s Disease

As the second-most common neurodegenerative disease following Alzheimer’s, Parkinson’s disease (PD) affects more than 10 million people worldwide and is projected to afflict almost 1 million Americans by 2020.

At its core, PD is marked by a host of movement-related problems, including tremor, rigidity of muscles, slowness of movement, and postural instability. The disease can affect the patient’s throat muscles, resulting in softer or slurred speech, as well as the muscles in their limbs.

Patients often describe challenges with everyday tasks that require fine motor control, writing or buttoning their clothing. As the disease progresses, patients may develop a slow, shuffling gait and experience challenges with maintaining their balance.

With less mobility and daily autonomy, patients’ quality of life can take a nosedive.

Though PD is most often associated with motor impairment, symptoms related to deficits in mood, behavior, and cognition also surface throughout the course of the disease, further complicating treatment and reducing quality of life for patients. Approximately 40% of PD patients also have anxiety and depression.

These mood disorders often develop years before the onset of PD’s motor symptoms, suggesting that they may be part of the disease process as opposed to a response to coping with PD. In addition, PD negatively affects nearly every cognitive function, and patients can experience deficits in attention, verbal fluency, memory, impulse control, and processing speed.

Studies tracking the long-term health of PD patients found that nearly all of them eventually develop dementia.

Imperfect Treatments for a Complex Disease

As a neurodegenerative disease, PD symptoms are caused by both the loss of neurons in the brain as well as aberrant activity or connections in the surviving brain cells. The biological hallmark of PD is Lewy bodies, which are abnormal protein build-ups in neurons.

Lewy bodies are often (though not always) coupled with neuron death, most notably of dopamine-producing neurons.

Numerous studies in humans and animal subjects have found that the degeneration of dopamine neurons leads to profound, aberrant changes in the neural activity of the basal ganglia, a brain region essential to motor control.

In 2005, neurologists Tao Wu and Mark Hallett found that PD patients use more brain activity to perform what would normally be automatic movements in order to compensate for dysfunction of the basal ganglia.

Traditionally, the symptoms of PD are treated with medications that target the dopamine system with the goal of compensating for the patient’s lost dopamine production.

However, many nonmotor symptoms of PD, such as cognitive decline, dementia, and attention deficits, do not respond to these conventional medications.

Deep brain stimulation is the most common neurosurgical intervention for PD and is believed to compensate for some of the aberrant brain activity caused by the disease.

Unfortunately, these medications and surgeries become increasingly ineffective with extended treatment in most patients.

Physical therapy can help patients improve their motor function at least in the short-term, but the benefits typically don’t last more than a couple of months.

In order to address PD and all its complexities, healthcare providers are exploring different treatment strategies to complement more traditional pharmacological interventions.

A Brain Shaped by Music

Music touches many areas of the brain. Image: Sound Health at the Kennedy Center

Music may be uniquely suited to address the different challenges patients with PD face in ways more traditional medical interventions cannot.

The brain is not a static object. It is malleable and plastic, able to change its connections and activity a person’s experience. It turns out that music has a profound ability to mold the brain and its functioning.

Musical training, for example, can change the structure and function of the brain.

Musicians of all ages are better at processing auditory information than their non-musician counterparts; they have better perception of speech, enhanced auditory memory, and more consistent brain responses to sounds.

Interestingly, both fine motor skills and touch sensitivity are also augmented in musicians probably because music performance engages many different brain areas.

The multifaceted skills required to engage with music— by keeping a rhythm, hitting the correct notes, or coordinating specific body parts, for example—might make it particularly effective in activating and shaping many parts of the brain.

Getting Back into the Rhythm

Music therapy may be one promising option that can address many of the underlying mechanisms and symptoms of PD. Therapeutic music performance can improve gross and fine motor skills through a process called rhythmic entrainment, which sets body movements to the beat of music.

In a series of seminal studies, researchers provided a rhythmic beat to PD patients instructed to walk. Normally, PD makes it difficult to produce and maintain rhythmic movement as is required for walking, but the rhythmic auditory cues essentially provided a metronome to help patients sync their steps, leading to improvements in gait speed and cadence.

Because the brain’s auditory system is intricately connected with the brain areas important for movement, music may bypass brain circuits that are damaged by PD and activate movement circuits indirectly.

By circumventing faulty brain circuits, music may help strengthen or build new brain connections for motor functions, thereby improving movement in PD patients.

A systematic review conducted in 2018 of previous research studies found that rhythmic auditory stimulation improves walking speed and increases the length of each stride in PD patients.

Previous studies also indicate that using a rhythmic beat is more effective at improving movement than therapies using other senses, vision or touch, or using more traditional physical rehabilitation techniques. From these results, the authors recommend “early incorporation of rhythmic auditory cueing for gait performance” in PD patients.

In the real world, programs that take advantage of the rhythm of music, such as Dance for PD, have helped improve movement and quality of life for PD patients.

Music Sets Emotions in Motion

Listening to and producing music has been correlated with increased activity in brain areas involved with reward and emotion, and leads to increased release of dopamine.

By naturally increasing the brain’s dopamine levels, music may partially counteract the loss of dopamine neurons from the progression of PD.

As an added benefit, because music is intrinsically motivating, music therapy is more effective compared to other perhaps less-rewarding training regimens, conventional physical therapy.

In addition, music-based therapies often occur in a group setting, which provides a social context that also improves mood and enhances brain plasticity.

As Simone Bella, a psychology professor at the University of Montreal, summarized in a paper last year, “Converging evidence shows that music, apart from being an enjoyable activity, is a highly powerful stimulus capable of activating multiple brain networks and showing high potential for supporting or recovering brain functioning, thus enhancing well-being throughout the life span.”

Recent studies conducted by neurologist Alexander Pantelyat of Johns Hopkins University found that regular choir, guitar, or drum sessions helped patients with Parkinson’s disease improve in both physical and emotional health. Consistent practice in making music helped PD patients improve their movement and coordination, and it also improved their mood.

The group music sessions were inherently social, establishing a community for PD patients who may otherwise find themselves isolated and lonely. Allowing PD patients to experience camaraderie and develop social bonds ly benefits their mood and quality of life.

Filling the Gaps in the Music Therapy

There are still many open questions about how music affects the brain and PD.

In an interview with IAM Lab, Pantelyat notes that there are relatively few studies involving large numbers of research subjects that investigate the systematic changes music can have on PD.

The studies that have been published “generally lack scientific rigor in terms of clinical studies being appropriately designed and powered to detect meaningful differences,” he says.

As a result, scientists do not have a clear idea about what kinds of music therapy work best for particular subgroups of the PD population. Increasing this knowledge would improve the targeting and efficacy of music therapy in PD patients.

But Pantelyat remains optimistic. “I am heartened to say, though, when looking at the [systematic reviews of research] on music and arts-based interventions, that the overall level of evidence for diseases PD is rising,” says Pantelyat. With a growing body of evidence, music may help bring harmony to the brain and life of patients with Parkinson’s disease.

Written and reported by IAM Lab Editorial Assistant Richard Sima. Richard received his Ph.D. in neuroscience from Johns Hopkins and is a science writer living in Baltimore, Maryland. 

Lead Image: Adobe Stock / Lightfield Images

Brain Science Medicine Movement Music Research Science


Physical Therapy for Parkinson’s Disease

Physical Therapy for Parkinson’s Disease | Johns Hopkins Medicine

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It’s well-known that exercise of all kinds is beneficial for patients with Parkinson’s disease. But physical therapy, in particular, is key.

Why? A professional can guide you through the right moves to increase mobility, strength and balance, and help you remain independent, says Denise Padilla-Davidson, a Johns Hopkins physical therapist who works with patients who have Parkinson’s. Here are things a therapist may work on:

Note: Please discuss any exercise program with your physician/neurologist and get a referral to a physical therapist or trainer with expertise in Parkinson’s disease before starting any specific program.

A specific form of physical therapy for Parkinson’s disease is called LSVT BIG training. (LSVT is Lee Silverman Voice Treatment. LSVT LOUD is therapy to amplify the voice.) “It’s meant to help patients with Parkinson’s increase what we call ‘amplitude of movement,’” says Padilla-Davidson.

In LSVT BIG, you make overexaggerated physical movements, high steps and arm swings. It’s a way to retrain the muscles and slow down the progression of hypokinesia, the increasingly smaller, more shuffling movements that happen with Parkinson’s.

Ask your doctor or physical therapist about LSVT BIG.

Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. Parkinson’s disease may affect these patterns.

Your therapist may help you reinforce reciprocal patterns by the use of a recumbent bicycle (a stationary bike in which you sit in a reclined position) or elliptical machine (in which you use your arms and legs).

On your own, says Padilla-Davidson, “Practice walking, keeping in mind the swinging of your arms. It may help to chant or sing to keep the rhythm.” Dance classes and tai chi are also useful.

Normal balance, explains Padilla-Davidson, is an interplay among what you see (visual feedback), your inner ear (which helps you orient yourself) and how your feet sense the ground beneath them.

Parkinson’s disease can affect this balance system, making your gait (how you walk) unstable, which in turn may make you fearful to be in public or crowded spaces. Gait training (practice walking) can help.

Exercises that aim to improve balance should be guided by a physical therapist, who can work with you to understand any issues with balance and teach you ways to compensate.

It’s common for patients with Parkinson’s disease to develop tight hip flexor, hamstring and calf muscles. To counteract that stiffness, it’s best to stretch at frequent intervals throughout the day, rather than just once, says Padilla-Davidson. Ask a qualified trainer or therapist who specializes in Parkinson’s to show you how. 

Muscles naturally weaken with age, so strength training is important for everyone. But research suggests that muscle weakness is a bigger problem for patients with Parkinson’s disease, says Padilla-Davidson.

Depending on what stage of the disease you are in, a therapist might have you do resistance exercises with light dumbbells or a resistance band (a kind of thick rubber band).

Pool-based classes, using the water’s resistance to strengthen muscles, can also be a good fit, she says. 

Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.