A physical therapist helping a patient exercise with focus on his nervous system.

My Parkinson’s Life with Neurological Physical Therapy

At one time or another, most of us have been prescribed physical therapy to aid in the treatment and recovery from a surgery or injury. Some of us have gone to a physical therapist for treatment of Parkinson’s disease symptoms, ranging from ratcheting shoulders to urinary dysfunction.

Parkinson’s has caused some of my neural pathways to either stop working or to work in different than intended ways. Take walking as an example. Walking used to be autonomous. My gait had become slow, erratic, difficult to initiate and was a major component in falls. My arms no longer responded in aiding my walking speed and steadiness.

I tried working with other types of physical therapy, but gaining strength and flexibility alone did not equate to much improvement in balance or stability. For the past year, I have been having sessions with a neurological physical therapist.

What is a neurological physical therapist?

Neurological physical therapy is a speciality area within physical therapy. The American Physical Therapy association states that it, "includes the treatment of developmental, systemic, and traumatic disorders that affect the neuromuscular system." Therapist use preventative and rehabilitative procedures for treatment of people with neurologic dysfunction.1

The Academy of Neurological Physical Therapy has a locator application on their website. I used this tool to find one. The site also has further descriptions of neuro physical therapists.

How does it work from my perspective?

After the most comprehensive movement disorder evaluation I’ve ever experienced, "Ryan" and I decided to work initially on my gait and balance issues.

The process in restoring my walking abilities is fairly complicated. All of the exercises are aimed at developing new neural pathways or repairing the damaged ones through intensive exercises that develop new, remembered, or reinforced muscle memory. My treatment is tailored to my unique symptoms and individual needs. Each session is unique in addressing various impairments and not solely the same session day after day.

"Ryan" is adept at setting exercises that are challenging. If I’m having difficulty, he immediately changes the exercise to be slightly simpler. If I succeed, we work back to the original exercise and perform that exercise for multiple sets. Success often does result in the addition of another challenge.

Exercise examples

An example: In an exercise called axeman ( picture yourself chopping wood with an axe), I had difficulty with combining the head, eye, and body movement as part of the exercise and maintaining balance. He broke the exercise down.

I could do the exercise if I didn’t move my head or, on moving to my knees, I could do the arms, head ,and eye movements, so he added a 5 pound hand held weight. Three 3 of 15, and we moved back to standing. Transitioned from no weight and head movement to doing reps with weight and head movements. And faster! In one exercise, we worked on muscle memory, dynamic balance, coordination, core strength, and pace. All are important factors in successful walking.

I do multiple sets of sit/stand and then sit/stand/go. Add hand weight. Once again, muscle memory, balance, coordination, core strength, and pace. Improved static balance, moving balance, core strength and muscle patterning are the components in my being able to walk more naturally, safely, and at pace

My observations

Intensive work twice a week for a year has had the following results.

  • Static balance greatly improved
  • Corrected arm swings aid both gait as well as speed
  • My stride is longer (far less shuffle)
  • Core strength improved
  • Coordination improved
  • Walking gait much improved (faster, closer to normal)
  • Fall risk lessened

All in all, a whole body approach to correcting problems resulted in safer, closer to normal walking. Note that I didn’t say "fixed." I am a work in progress! Parkinson’s is sneaky and often looks like 2 steps forward and 3 to the side and 2 back and all the other variations of this "dance."

Working with "Ryan" is essential to my progress. He is always patient and guides my less than perfect path forward.

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