Physical, Occupational & Speech Therapies

A physical therapist is uniquely trained to design an exercise routine that targets specific motor impairments. Physical therapists also have an opportunity to provide frequent, direct feedback to help make you aware of how to exercise most effectively and safely.

A physical therapist can provide:

• Education and self-management advice.
• Exercise routines that have been associated with improvements (or slower declines) in mobility, quality of life and disease severity.
• Answers to questions about the type, intensity, frequency or duration of exercise that is best for you.
• Ways to maintain safety when exercising.
• Help with:
  • Normal physical activity routine
  • Walking (slowness, small steps)
  • Freezing of gait (feeling glued to the floor or difficulty getting started)
  • Balance or stability
  • Posture
  • Pain
  • Moving around the house (getting up from a chair, moving around in bed)
  • Getting around (in/out of a car or bus, elevators, stairs and uneven ground)
• Address fear of falling, fall prevention or worries about your safety.
• Other health problems that affect mobility, including joint or muscle pain from arthritis, problems with endurance due to a heart or lung condition or a broken bone or surgery.

Physical therapists can be helpful at all stages of PD. Movement impairments in the early stages of the disease may not be obvious. By engaging a physical therapist with neurological specialization as part of their medical team, people with Parkinson’s disease can address bothersome symptoms and learn ways to prevent falls before they happen. Talk to your doctor about getting a baseline physical therapy evaluation and then continue with periodic re-evaluations.

According to the Parkinson’s Outcomes Project, the largest clinical study of Parkinson’s disease through our Global Care Network, increasing physical activity to at least 2.5 hours a week can slow decline in quality of life. The Parkinson’s Foundation has identified specific care approaches associated with better outcomes across people who seek expert care at our designated Centers of Excellence. Among others, best practices include early referral to physical therapy and encouragement of exercise as part of treatment.

Each individual works with their physical therapist to set personalized movement goals. Physical therapists can help you optimize your exercise routine based on the latest research, re-learn challenging tasks or stay safe and independent in the home.

Some of the most common movement goals for people with Parkinson’s include:

• Learning about exercises
• Improving walking, balance or posture
• Addressing fall risk
• Treating pain

Before your first visit, think about your movement goals and write down your problems and questions. This will help you organize your thoughts. You can do this for future visits, too.

An occupational therapist identifies strategies that allow you to continue doing activities that are important to you. Each person with PD will have different goals based on his or her symptoms and disease progression, as well as individual lifestyles, interests and priorities.

Whether you have lived with PD for one month or 20 years an occupational therapist works to find ways to match your personal strengths with activities and an environment that will help you reach your goals.

We use our hands throughout the day in all activities. People with PD may notice changes in the ease in which they perform hand and finger motions. An occupational therapist can help evaluate and make recommendations to improve hand coordination, including:

• Exercise hands and fingers regularly
• Engage in enjoyable and stimulating hand exercises, such as gardening or knitting
• Use toothbrushes, hairbrushes, silverware and writing tools with larger handles
• Use both hands in tasks — don’t favor one hand over the other
• Schedule tasks that require greater hand control for times when you are well-rested and medications are working well

Which activities are most important to you? Once you answer, try the strategies below to see which ones work for you for each activity.

Use Personal Strengths

How can you build on your strengths and minimize your limitations? For example, if you have the strength of helping children enjoy reading, you could exercise that strength by reading to your grandchildren, by listening to them as they read or by playing a reading game that stimulates both your imagination and theirs.

One of your strengths may be thinking skills. One thinking skill is imagining doing the activity before doing it. For example, imagining writing big can actually help you write big. Another thinking skill is speaking the steps out loud. When combing your hair, try saying “hold and comb,” to avoid dropping the comb.

Make sure you are exercising. Improving strength, balance and endurance through exercise supports your participation in all sorts of activities. Whether it is dancing or walking to a neighbor’s house, find an enjoyable way to exercise

Lastly, be positive. Think, “I will do…” rather than “I’ll try to…” and you may be more successful.

Change the Environment

Take a look at your environment. How can you adapt your surroundings to support your chosen activity? Will a different physical or social setting for the activity, or different objects and tools help? Create a quiet space with conveniently arranged furniture to make activities easier. Look into adaptive devices such as a tub seat to make showering safer or a swivel seat cushion in the car to make getting in and out easier. Additionally, think about the social environment and choose places where people will understand your needs.

Adapt the Activity

Which activities do you enjoy and how can you adapt that activity to make sure you can still do it? For example, if you love baking, perhaps substitute complex recipes with simpler ones.

To get started, write down your goals or say them aloud to yourself or to someone else. Then ask, are there ways to simplify or modify the activity? For example, if you love golfing with friends, but now find it challenging, ask yourself is it the golf you enjoy or the socializing that goes with it? Based on your answer, can you meet your friends to grab a bite to eat after they finish their round? Can you play nine holes instead of 18? Can you use the golf cart instead of walking the course

Lastly, focus on one activity at a time. Parkinson’s can make it difficult to multitask. If someone is talking to you while you are eating, tell him or her that you will continue the conversation as soon as you finish your meal.

Many people with Parkinson’s will benefit from occupational therapy. Request a referral for occupational therapy from your neurologist or movement disorder specialist. Ask them if they can recommend an occupational therapist with knowledge and experience in the management of PD. You can also contact your state OT association, a hospital outpatient rehabilitation, a local rehabilitation facility or home care agency to find an OT.

Find more information on the American Occupational Therapy Association website at www.aota.org.

There are several reasons people with PD have reduced loudness and a monotone, breathy voice. One reason is directly related to the disordered movement system that accompanies PD, including rigidity, slowness of movement and tremor. For example, the poor muscle activation that leads to bradykinesia (slow movement) and hypokinesia (small movements) in the limbs can translate to the muscles involved in speech. These problems with muscle activation can result in reduced movements of the respiratory system (reduced breath support) and articulatory system (reduced clarity and faster rate of speech).

Another cause of speech and voice impairment in PD is a change in sensory processing that is related to speech. It is believed that people with PD may have reduced awareness that their speech is getting softer and more difficult to understand. When people in this situation are asked to bring their voice to normal loudness, they often feel as if they are shouting, even though they are perceived by listeners to be speaking normally.

People with PD may also have a problem with “cueing” themselves to produce speech with adequate loudness. Individuals with PD can respond to an external cue (e.g., an instruction from someone else to “speak loudly”), but their ability to cue themselves internally to use a louder voice is impaired. These problems can be frustrating both for the person and the family.

In addition to speech changes, a speech therapist can address swallowing safety. People with Parkinson’s can develop changes to swallowing liquids or solids which can lead to malnutrition, dehydration, choking or aspiration. A speech therapist can perform a swallow test using video X-ray or an endoscopy to determine when and where the trouble in swallowing is occurring.

Many people with Parkinson’s use these statements to describe speech-related issues. Choose the response that indicates how frequently you experience the below (0 = never, 1 = almost never, 2 = sometimes, 3 = almost always, 4 = always).

• It is difficult for people to hear me
  0 1 2 3 4
• People have difficulty understanding me in a noisy room
  0 1 2 3 4
• My voice difficulties restrict personal and social life
  0 1 2 3 4
• I feel left out of conversations because of my voice
  0 1 2 3 4
• My voice problem causes me to lose income
  0 1 2 3 4
• I feel as though I have to strain to produce voice
  0 1 2 3 4
• The clarity of my voice is unpredictable
  0 1 2 3 4
• My voice problem upsets me
  0 1 2 3 4
• My voice problem makes me feel handicapped
  0 1 2 3 4
• People ask, “What’s wrong with your voice?”
  0 1 2 3 4

To find your score, add up your answers. A score of 10 or higher indicates you might have a speech or voice problem that is affecting your quality of life and you should ask for a referral to a speech pathologist.

Tell your doctor if you are experiencing any changes in your speech, voice or swallowing. Ask for a referral to a speech language pathologist to evaluate and address these symptoms. If you have not noticed changes in your speech, but a spouse, care partner or friend has, pay attention to their comments. The sooner you get a speech evaluation and start speech therapy, the better.

Speech therapists work in many settings, including hospitals, outpatient rehabilitation centers and private practice offices. To locate one in your area:

• Ask your neurologist
• Contact the American Speech-Language-Hearing Association (ASHA) at www.asha.org
• Find a therapist certified in the Lee Silverman Voice Treatment (LSVT) at www.lsvtglobal.com
• Find a therapist trained in the Parkinson’s Voice Project SPEAK OUT! program at www.parkinsonvoiceproject.org

Ideally, you should see a speech therapist face-to-face for a complete voice and speech evaluation and treatment. However, if a speech therapist is not available in your area, LSVT LOUD — the most researched voice treatment for people with PD — is virtually offered in select states. The speech therapist interacts with you in your home or office live through your computer screen.