Parkinson's Drugs Physiotherapy Implications

Original Editor - Andrew Bennett Lee Price Top Contributors - Lucinda hampton, Vidya Acharya, Lauren Lopez, Kim Jackson, Andrew Bennett Lee Price and Lauren Greeson

Introduction

Exercise (increasingly considered to be a complementary strategy to Parkinson’s (PD) medications) is a major component of physiotherapy for Parkinson’s management. This less than 5 minute video outlines the importance of exercise in PD>

Pre Exercise Assessment

A pre-exercise subjective assessment should be undertaken to find if common side effects from the drugs may impact on treatment. The therapist needs to be be aware of possible side effects and monitor accordingly or/or adjust treatment. Adverse effects of each of these drug classes will require monitoring. A clear understanding of the general yellow flags to improper dosing is vital. These adverse effects result from the poly-pharmaceutical approach to PD management.  Being aware of them allows us to alter our plan of care and not compromise the patient’s safety. If left unaddressed, these adverse effects could substantially decrease our overall quality of care that we administer.

Timing

Exercise is a critical part of treatment for Parkinson's and should be in done in the time slot that suits the clients "on" times. It may be appropriate for the client to keep a diary of symptoms. This may be helpful to track when symptoms occur so that your exercise sessions occur at the most effective timing.

Taking Parkinson’s medication can cause side effects, including:

• Orthostatic hypotension (link provides physiotherapy strategies used to manage this condition).
• Psychosis (report to specialist and curtail treatment).
• Dyskinesias (monitor carefully as potential falls risk).
• Confusion/memory loss (instruct at appropriate level so they understand and follow commands).
• Psychological changes (report to a specialist)
• Sleepiness, fainting or dizziness (monitor, don't compromise the patients safety).

• Nausea
• Involuntary movements
• Behavioral problems, such as feeling an uncontrollable need to gamble, have sex or pursue hobbies.

Levodopa - On Off Times

Overtime as Parkinson’s progresses the levodopa dose will need to be adjusted. Many people will become more aware that symptoms sometimes return between doses of medication. This is called ‘wearing off’ and is a sign your dose needs to be adjusted.

Wearing Off: Physical therapy treatment should be administered during the peak effective time of each individual medication; or ideal treatment effects may be compromised due to a negative event known as End of Dose Dyskinesia. ie check the timing of physiotherapy sessions with the client so they will benefit maximally from there exercises. The 2 minute video below outlines this phenomena

Patient Education for Parkinson's Drugs

Providing patients with disease and treatment related information is an important role that we can play as physical therapists in helping to improve their quality of life. While levodopa has remained the most effective treatment for improving motor function in Parkinson’s patients, it comes with several dangerous side effects, as mentioned previously. The biggest problem of levodopa, however, seems to be its weakened efficacy after prolonged use, typically 3-4 years. For a patient who has experienced significant gain in their symptoms, this can be extremely devastating. With knowledge of this as a physical therapist, we can recommend them discussing with their physician on initial use of an alternative drug, specifically Monoamine Oxidase B Inhibitors. Another important piece of education to our patients is on orthostatic hypotension. Patients should avoid sudden postural changes and getting up too fast. For patients getting out of bed, it would be advisable to sit on the side of the bed for about 30 seconds before standing and then standing for 30 more seconds before walking in order to prevent falls.

Conclusion

Exercise is essential in the management of Parkinsons. However, clients with Parkinsons are most likely taking medications that can possibly have an effect on their physical response and tolerance to exercise. Therefore physiotherapists need to be aware of potential side effects and then time, dose and monitor exercise accordingly. The above gives you guidance on the best way to monitor and administer your exercise sessions