Parkinson's: Non-drug treatment
In addition to medication, exercises and speech therapy are important elements of treatment for Parkinson's disease.
Many people with Parkinson’s do exercises or sports to prevent restrictions in movement and stiff muscles or to become more flexible again. The aim of occupational therapy is to maintain independence in everyday life. If speech becomes increasingly difficult, speech therapy can be a good idea. Relaxation exercises and therapies like progressive muscle relaxation, heat therapy and massages are sometimes also used.
These therapies aim to relieve symptoms that cannot be improved enough by taking medication. But the positive psychological effect of movement, relaxation and other exercises should not be underestimated – and nor should the active support of therapists.
Sports and exercise
People with Parkinson's move slower and slower as the disease progresses. Sometimes they are not able to walk at all, and they may also have problems with balance and coordination. Because people can move increasingly poorly, their muscles gradually become weaker. Exercises and sports aim to slow down that process. Exercises may include the following: Stretching, endurance training, muscle activation and relaxation, weight training, balance training, dancing, musical therapy, tai chi, qigong, and walking and running.
It is possible to engage the support of physiotherapists. They can teach you exercises and show you how to do them on your own. Which exercises are useful depends on your personal preferences and general physical condition. For example, if the disease is not very advanced more strenuous exercises can be performed than if symptoms are already more serious. The treatment also has different focal points depending on the phase of the illness: In an early stage the emphasis is usually on maintaining physical fitness and flexibility. If the disease is more advanced, the focus is more on avoiding falls and stiff joints.
Studies show the possible positive effects of movement exercises: They can improve flexibility and speed of movement, at least in the short term. They can also improve coordination, meaning an improvement in balance. That makes it easier to carry out everyday activities like shopping.
Occupational therapy aims to maintain independence in day-to-day life for as long as possible, so that you can look after yourself. One aim of the exercises is to train gross and fine motor skills. Things such as getting dressed, preparing meals and using special aids (walkers or special knives and forks) are practiced in occupational therapy. Crafts and creative activities like painting can also be part of occupational therapy. The aims and suitable exercises are decided upon together with the therapist.
Lots of people particularly link Parkinson's with difficulties moving. But the increasing difficulties to talk are often especially difficult to cope with. Many people's speech becomes more and more slurred, monotone and quiet. That is because the muscles in the voice box, tongue and face become less flexible. Added to that, people may have difficulty finding the right words or understanding others.
Speech therapy practices speaking louder and more clearly and precisely. There are also exercises that train the facial muscles, expressions and breathing using special relaxation and speech techniques or with singing. The type of speech therapy used depends on individual symptoms and personal preferences.
The aim is to be able to express yourself better again. Many people avoid speaking to others more and more because they feel insecure and embarrassed. That is why it is also important to gain more confidence in conversation. Trouble swallowing can also be treated.
Severe psychological stress is particularly common in advanced stages of the disease. But even in the early stages it can be difficult to deal with the diagnosis and the knowledge that the symptoms will get considerably worse over time. That is why psychological support can be a good idea. Over the course of their illness, some people also develop depressive symptoms or even depression that requires treatment.
There are also various psychological support options for friends and family, as well as lots of self-help groups that can be an important point of contact.
Unanswered research questions
Physiotherapy, occupational therapy and speech therapy are often used to relieve symptoms of Parkinson's. Many people find them very helpful. But as yet there are hardly any good-quality, conclusive scientific studies on their effectiveness. Many important questions therefore remain unanswered.
For instance, no research has been done on the long-term influence of regular movement and coordination exercises. It is not known whether they can delay the progress of the disease. It is also unclear whether occupational therapy really has an effect on the symptoms and development of Parkinson's.
There are unanswered questions concerning speech therapy as well: So far it has been difficult to assess to what extent it fulfills the aforementioned goals and relieves symptoms. Studies so far are not able to say which speech therapy methods are most effective either.
de Dreu MJ, van der Wilk AS, Poppe E, Kwakkel G, van Wegen EE. Rehabilitation, exercise therapy and music in patients with Parkinson´s disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life. Parkinsonism Relat Disord 2012; 18: 114-119.
Herd CP, Tomlinson CL, Deane KH, Brady MC et al. Speech and language therapy versus placebo or no intervention for speech problems in Parkinson´s disease. Cochrane Database Syst Rev 2012; (8): CD002812.
Herd CP, Tomlinson CL, Deane KH, Brady MC et al. Comparison of speech and language therapy techniques for speech problems in Parkinson´s disease. Cochrane Database Syst Rev 2012; (8): CD002814.
Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M. Treadmill training for patients with Parkinson´s disease. Cochrane Database Syst Rev 2015; (8): CD007830.
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