Other considerations
Physiotherapy is recommended by NICE 2006 guidelines as well as in the European journal of Physiotherapy 2013
Alongside drug management of PD, the role of physiotherapy is increasingly being recognised as important in maximising functional ability of PD patients. This is achieved through work on transferring, posture control, upper limb function, balance and falls prevention, gait education, speed, stride length, trunk and arm swing movement, chest wall mobility and vital capacity. It also uses cueing strategies, cognitive movement strategies, and exercise to maintain or increase independence, safety and quality of life.
Tai chi has also shown promise in aiding with balance, walking and falls prevention (8).
OT enabling teaching of adaptive skills, use of adaptive equipment and technology to help minimise falls.
End of life care
Aim of palliative care is to maximize the quality of life for the person with the disease and those around him or her. In PD because the response to treatment tends to fluctuate, it is often hard to determine when someone is reaching the final stages of their life and in need of palliative care. Ideally palliative care should be started at diagnosis, because many aspects can be applied to all phases of life with Parkinson’s (4). Some central issues of palliative care are:
- Care in the community- while adequate care can be given here, domiciliary visits from clinicians may prove helpful in monitoring medication effects, and so allowing prompt reduction or withdrawal of medication to reduce drug side effects e.g.; with dyskinesias.
- Preventing pressure ulcers by management of pressure areas of inactive people, physiotherapy can help with strategies to maintain movement- in so preventing stiffening and contractures.
- Bladder and bowel difficulties- as Parkinson’s medication becomes less effective, bladder control might be lost and bowel difficulties such as constipation may worsen.
- Swallowing difficulties and persistent drooling of saliva are common and speech and language therapy input should be sought. In so doing it may help to reduce the risk of aspiration pneumonia.
- Facilitating end-of-life decisions for the person as well as involved friends and relatives.