Parkinson's: Non-drug treatment
Other than medication, the main elements of treatment for Parkinson’s disease are exercises and speech therapy.
Many people with Parkinson’s do exercises or sports – either to prevent muscle stiffness and restrictions in movement, or to improve their ability to move. The aim of these measures (occupational therapy) is to maintain independence in everyday life. If speech becomes more and more difficult, speech therapy may be a good idea. Relaxation exercises and treatments like progressive muscle relaxation, heat therapy and massages are sometimes also used.
The main aim of these treatments is to relieve symptoms that can't be improved enough by taking medication. But movement, relaxation and other exercises can have positive psychological effects too. Getting professional support from a therapist is important.
Sports and exercise
People with Parkinson's move more slowly as the disease progresses. Sometimes they aren't able to walk at all, and they may also have problems with balance and coordination. Because people move less, their muscles gradually become weaker. Exercises and sports can help to slow down that process. Examples include stretching, endurance training, muscle activation and relaxation, weight training, balance training, dancing, music therapy, tai chi, qigong, and walking and jogging.
Studies show that physical exercise can help to improve the ability to move and walk faster. It improves coordination and balance too. That reduces the risk of falls. Doing these forms of exercise can also help you to better manage everyday activities like doing the shopping.
It's possible to get help from a physiotherapist. They can teach you exercises and show you how to do them on your own. In Germany, the costs of this physiotherapy are covered by statutory health insurers. Different exercises will be suitable for different people, depending on their personal preferences and general physical condition: For example, if the disease is in an early stage, more strenuous exercises can be done. The main focus of the treatment depends on the phase of the illness: In early stages, the emphasis is usually on maintaining physical fitness and the ability to move. If the disease is more advanced, the focus turns more to avoiding falls and joint stiffness.
Occupational therapy aims to help maintain independence in everyday life for as long as possible, so that you can manage on your own. That may include adapting your home and workplace to suit your needs. You can work with a therapist to find ways to cope better with the symptoms. Occupational therapy exercises can also improve your gross and fine motor skills. Things like getting dressed, preparing meals and using special aids (walkers or special knives and forks) are practiced. Crafts and creative activities like making things or painting can also be part of occupational therapy. The aims and suitable exercises are decided upon together with the therapist.
Lots of people mainly associate Parkinson's with difficulties moving. But the increasing difficulties with speaking are often especially difficult to cope with. Because the muscles in the voice box, tongue and face become less flexible, it causes the voice to sound quieter and more monotonous. Difficulty finding the right words or understanding other people can also be a problem.
In speech therapy you practice speaking louder, more clearly and more precisely. Various loosening, speech and singing exercises can improve your ability to move your facial muscles, show facial expressions and breathe. The type of speech therapy used will depend on your symptoms and personal preferences.
Many people increasingly avoid speaking to others because they feel unsure of themselves and ashamed. So another aim of speech therapy is to gain more confidence in conversation and communicating. Trouble swallowing can also be treated.
Parkinson’s disease can be very hard to cope with psychologically, particularly in the advanced stages. As it progresses, some people feel quite down or even develop depression that needs to be treated. 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’s why psychological support can be a good idea.
There are also various psychological support options for friends and family, as well as many support groups that can be an important place to turn to.
Unanswered research questions
Occupational therapy and speech therapy are often used to relieve the symptoms of Parkinson's. Many people find them very helpful. But there are hardly any good-quality, conclusive scientific studies on their effectiveness. Because of this, many important questions remain unanswered. It is currently difficult to say how well the treatments can reach their goals and relieve the symptoms. The available studies don't say which occupational therapy and speech therapy approaches are most effective either.
There has been more research on the effects of regularly doing exercises to improve movement and coordination – at least over short time periods of up to a year. But little is known about the effects of these exercises over longer time periods. For instance, it's not known whether they can delay the progress of the disease.
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Song R, Grabowska W, Park M, Osypiuk K, Vergara-Diaz GP, Bonato P et al. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2017; 41: 3-13.
Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R et al. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev 2013; (9): CD002817.
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