Parkinson’s Disease

Parkinson’s Disease

What is Parkinson’s disease?

Parkinson’s disease is a progressive neurological condition that affects movement and can also cause a range of non-movement symptoms.

It is associated with the loss of dopamine-producing nerve cells in an area of the brain called the substantia nigra. Dopamine is a chemical messenger involved in controlling and coordinating movement. As dopamine levels reduce, movement can become slower, less automatic and more difficult to control.

Parkinson’s disease was first described by James Parkinson in 1817, when he published observations of what he called “the shaking palsy.”

Everyone experiences Parkinson’s differently, and symptoms and their impact on everyday life can vary considerably.

What causes Parkinson’s disease?

In most cases, the exact cause of Parkinson’s disease is not known.

Research suggests that Parkinson’s may develop through a combination of genetic and environmental factors. Some genetic changes can increase the likelihood of developing Parkinson’s, although inherited Parkinson’s is relatively uncommon. Environmental factors have also been investigated, but the causes are not fully understood.

Parkinson’s disease and other forms of parkinsonism

Parkinsonism is a term used to describe a group of movement symptoms that can include slowness of movement, stiffness and tremor.

Parkinson’s disease is the most common cause of parkinsonism, but other conditions can cause similar symptoms. These include:

• Parkinson’s disease – the most common form of parkinsonism, where the exact cause is usually unknown.

• Young-onset Parkinson’s disease – Parkinson’s diagnosed at a younger age, often before the age of 50.

• Drug-induced parkinsonism – caused by certain medications and may improve when the medication is changed or stopped under medical supervision.

• Vascular parkinsonism – associated with cerebrovascular disease, such as damage caused by multiple small strokes.

• Atypical parkinsonian syndromes – rarer neurological conditions such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration. These can share some features with Parkinson’s disease but tend to progress differently.

It is important to receive an accurate diagnosis from a healthcare professional because the underlying cause can influence treatment and rehabilitation.

Who is affected by Parkinson’s disease?

Parkinson’s disease is more common in older adults, and the likelihood of developing it increases with age. However, younger adults can also develop Parkinson’s disease.

It is more common in men than women.

Parkinson’s is one of the most common neurodegenerative conditions. Alzheimer’s disease is the most common.

What are the symptoms of Parkinson’s disease?

Parkinson’s can cause both movement-related (motor) and non-movement (non-motor) symptoms.

Common movement symptoms include:

• Tremor – often beginning in one hand or limb, although not everyone with Parkinson’s experiences tremor.

• Bradykinesia – slowness of movement, which can make activities such as dressing, writing, turning or walking take longer.

• Rigidity – muscle stiffness that can cause discomfort and make movement more difficult.

• Postural instability – reduced balance and slower reactions, which can increase the risk of falls.

• Changes in walking – including smaller steps, reduced arm swing, changes in posture, difficulty turning and episodes of freezing.

• Freezing of gait – when the feet temporarily feel as though they are stuck to the floor, often when starting to walk, turning or moving through a narrow space.

Other symptoms can include:

• Fatigue

• Sleep difficulties

• Changes in blood pressure, including postural hypotension

• Bladder and bowel problems

• Changes in sense of smell

• Pain

• Changes in mood

• Difficulties with memory or thinking

• Speech and communication changes

• Swallowing difficulties

Not everyone will experience all of these symptoms, and their severity can change over time.

How can Parkinson’s affect mobility and independence?

Because Parkinson’s is progressive, its impact on movement and everyday activities can change over time. However, progression is different for everyone.

In the earlier stages, a person may remain independent but notice that everyday activities take longer or require more concentration.

Walking may become slower, with smaller steps, reduced arm swing, difficulty turning or episodes of freezing. Balance and slower reactions can increase the risk of falls, which may also affect confidence.

Fine motor movements can become slower or less controlled, making activities such as writing, using cutlery or dressing more difficult.

Fatigue and fluctuations in symptoms can also affect participation in work, hobbies, exercise and social activities. Some people experience periods when their medication is working well and other periods when movement becomes more difficult.

As Parkinson’s progresses, some people may need additional support with daily activities, walking aids or other mobility equipment.

Can physiotherapy help with Parkinson’s disease?

Yes. Physiotherapy can help people with Parkinson’s manage movement difficulties, maintain physical function and remain as independent and active as possible.

Physiotherapy does not stop the underlying loss of dopamine-producing nerve cells or cure Parkinson’s disease. Instead, it works alongside medical management and other healthcare professionals to address the physical and functional challenges caused by the condition.

NICE recommends referral to physiotherapy for people with Parkinson’s who have problems with movement and balance, and physiotherapy can be offered early in the condition.

At Positive Steps, physiotherapy is individualised to the person rather than simply the diagnosis. Depending on someone's symptoms, abilities and goals, this may include:

Walking and gait

We can work on walking quality, step length, turning, starting and stopping and strategies for managing freezing.

External cues can be particularly useful for some people with Parkinson’s. These may include visual cues such as floor markings or auditory cues such as a rhythm or beat to help support movement and walking.

Balance and falls prevention

We can use targeted exercises and functional activities to challenge balance, coordination and reactions.

The aim is to help someone move more safely and confidently while reducing the risk and impact of falls.

Strength and functional exercise

Exercise can help people with Parkinson’s maintain strength, fitness and physical function.

Sessions may include functional activities such as:

• Sit-to-stand practice

• Stair practice

• Reaching

• Turning

• Getting in and out of bed or a chair

• Walking practice

• General strength and cardiovascular exercise

Exercise is adapted to the person's abilities, symptoms, fatigue and goals.

Flexibility and movement

Stretching and regular movement can help maintain flexibility and joint range of movement and may help manage stiffness associated with Parkinson’s.

We can also provide strategies to encourage larger, more efficient movements where appropriate.

Large-amplitude movement strategies

Some people with Parkinson’s benefit from structured movement approaches that focus on making movements deliberately larger and more purposeful.

These strategies can be incorporated into functional activities and everyday movements where appropriate.

Posture and movement strategies

Parkinson’s can affect posture and the way someone moves. Physiotherapy can help someone become more aware of their posture and develop strategies to make everyday movements easier and more efficient.

Fatigue and self-management

Fatigue can have a significant impact on life with Parkinson’s.

We can help individuals and families understand how symptoms may fluctuate, plan activity around energy levels and develop strategies to stay active without unnecessarily overdoing it.

Maintaining independence

Physiotherapy can also focus on practical strategies for everyday activities, helping someone continue to perform meaningful tasks as independently and safely as possible.

This may include advice about mobility, transfers, walking, exercise and when additional support or equipment may be appropriate.

Hydrotherapy for Parkinson’s disease

Hydrotherapy can be a useful part of rehabilitation for some people with Parkinson’s.

Exercising in warm water can provide buoyancy and support, making some movements easier to practise while reducing the amount of weight placed through the joints.

Sessions may include:

• Walking and stepping

• Balance activities

• Strengthening exercises

• Large movements

• Coordination activities

• Mobility and flexibility exercises

• Cardiovascular exercise where appropriate

The resistance provided by the water can also be used to challenge movement and strength.

Hydrotherapy is individually assessed and is not suitable for everyone.

Specialist equipment at Positive Steps

Where appropriate, we may incorporate specialist equipment into a person's physiotherapy programme. Equipment is selected according to the individual's symptoms, abilities, goals and safety.

EMA treadmill

Our EMA treadmill can provide controlled walking practice at different speeds and includes a backward-walking mode and gait analysis technology.

This can allow us to practise different aspects of walking, balance, coordination and motor planning in a controlled environment.

MOTOmed

The MOTOmed provides motor-assisted or active repetitive movement of the arms and legs.

It can be useful for people who find conventional exercise or repetitive movement difficult, allowing movement to be practised at an appropriate level of assistance.

Hypervibe

The Hypervibe is a whole-body vibration platform that may be incorporated into rehabilitation where clinically appropriate.

It can provide an additional way of challenging weight-bearing, muscle activation, balance and functional movement alongside other exercises.

It is not suitable for everyone, and its use would be determined following an individual assessment.

What does physiotherapy look like at Positive Steps?

There is no single physiotherapy programme for Parkinson’s disease.

We work with people at different stages, from those who have recently been diagnosed and want to remain active, to people experiencing more complex movement difficulties, falls or reduced independence.

Sessions are tailored around what matters most to the individual.

This may involve a combination of:

• Exercise

• Functional movement practice

• Walking and gait training

• Balance work

• Movement strategies and cueing

• Flexibility and posture

• Fatigue management

• Education and self-management

• Specialist equipment where appropriate

Progress is reviewed regularly so that physiotherapy can adapt as symptoms, abilities and goals change.

Working with the wider team

Parkinson’s is often managed by a multidisciplinary team.

Depending on an individual's needs, this may include:

• Neurologists

• Parkinson’s specialist nurses

• Physiotherapists

• Occupational therapists

• Speech and language therapists

• Dietitians

• GPs

• Other healthcare professionals

At Positive Steps, we value working alongside the individual, their family and the wider healthcare team to make sure physiotherapy supports the person's overall goals.

Positive Movement Class

Our Positive Movement class is designed for adults experiencing difficulties with balance, strength or mobility, including people living with neurological conditions such as Parkinson’s.

The supportive group environment provides an opportunity to stay active, practise movement and build confidence alongside other people experiencing similar challenges.

What are the goals of physiotherapy for Parkinson’s?

Goals will be different for everyone. They may include:

• Maintaining safe and confident mobility

• Supporting independence for as long as possible

• Improving walking and movement strategies

• Reducing the risk and impact of falls

• Maintaining strength and physical fitness

• Maintaining flexibility and joint range of movement

• Improving balance and coordination

• Managing stiffness

• Supporting confidence with everyday activities

• Managing fatigue and activity levels

• Maintaining participation in hobbies, exercise and social activities

• Helping individuals and families understand how to manage movement difficulties

How can Positive Steps help?

Parkinson’s is a progressive condition, but the right support can help people remain active, independent and involved in the things that matter to them.

At Positive Steps, we work with adults at different stages of Parkinson’s, providing personalised physiotherapy that adapts as their symptoms, abilities and goals change.

Our aim is to help each person move as safely, confidently and independently as possible, while supporting them to continue doing the activities that are important to them.

Always finding what can be done.

If you or someone you care for has Parkinson’s disease and would like to find out how physiotherapy could help, get in touch with the Positive Steps team to arrange an assessment

Contact us 

Find out more

For reliable information and support about Parkinson’s disease, we recommend:

• NHS – Parkinson’s disease

• Parkinson’s UK – information about symptoms, treatment, exercise, physiotherapy and living well with Parkinson’s

• Your Parkinson’s healthcare team – for individual medical advice and support

If you are concerned that you or someone you know may have symptoms of Parkinson’s, speak to your GP or another healthcare professional for assessment and appropriate referral.