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Physical Therapy Could Help Parkinson's Patients

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WebMD Health News

May 25, 2001 -- What can be done for those with Parkinson's disease, a devastating neurological condition? Research to date suggests that exercise or physical therapy, when combined with medication, may help some people control their symptoms, at least for a while.

Parkinson's disease is a progressive neurological condition that usually, but not always, affects older individuals -- think of actor Michael J. Fox, who developed the disease in his 30s. In Parkinson's, the part of the brain responsible for movement starts to break down. Symptoms include difficulty initiating movement, uncontrollable tremors, stiffness, and problems with balance and walking.

Currently, about one and a half million Americans have Parkinson's disease, but these numbers are expected to increase along with the average age of the U.S. population. While medications are available to help deal with symptoms of Parkinson's, there is currently no cure.

Physical therapy or physiotherapy is a common approach to many conditions that affect the ability of the body to move and function normally. It typically involves performing specific exercises under the guidance of a physical therapist. Many experts believe that physical therapy can help people with Parkinson's disease by improving balance, muscle tone, and ability to move. The true benefits of physical therapy for Parkinson's disease are not clear, however, since few appropriate studies have been done to test its benefit.

To try to shed light on the issue, a Dutch group of researchers have looked at all the best studies to date on physical therapy and Parkinson's disease. They analyzed the results of 12 studies on this topic published between 1966 and 1999 and found that physical therapy does appear to offer people with Parkinson's disease a small benefit.

Two of these researchers, Cees J. T. de Goede, MSc, and Gert Kwakkel, PhD, told WebMD via an email message that, "Physical therapy is a good adjunct to medical treatment [for people with Parkinson's]. ... Patients with Parkinson's disease do benefit from a physical therapy training program when applied on a regular basis (i.e., about 1-3 times a week). ... However, the [optimal] amount and content of physical therapy needs further investigation."

Both Goede and Kwakkel are from the departments of physiotherapy at the University Hospital Vrije and the Research Institute for Fundamental and Clinical Human Movement Sciences in Amsterdam, the Netherlands. Their research is published in the April issue of the journal Archives of Physiotherapy and Medical Rehabilitation.

"There have been inadequate studies of physical therapy and fitness in Parkinson's disease," says Lisa M. Shulman, MD, associate professor of neurology at the University of Maryland School of Medicine and co-director of the Maryland Parkinson's Disease and Movement Disorders Center at the University of Maryland Medical Center in Baltimore. "It's laudable that these authors took a look at the cluster of studies that have been done in this area, but unfortunately and regrettably they are limited."

A key issue that remains unclear, she says, is whether physical therapy performed in a special facility under the guidance of a physiotherapist offers benefits over a general exercise and fitness program that individuals with Parkinson's disease can practice at home.

The problem with physical therapy, she says, is that it costs money and is designed to last for only a few weeks or months. Studies have already shown that when physical therapy stops, people with Parkinson's disease soon lose any benefits they may have attained. A better approach might be home exercise, which individuals with Parkinson's disease can to perform at home on a long-term basis. Future studies need to look at which approach is best, she says.

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