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Rehabilitiation Issues

Rehabilitation Services for Patients with Parkinson’s Disease: The VA Process


The goals of rehabilitation of individuals with Parkinson’s disease are to maximize function and independence while maintaining safety.  During your initial therapy visits, you will receive an evaluation pertinent to the particular therapy.  The therapist uses the evaluation results along with your goals for rehab to determine your specific treatment plan.   

Physical Therapy  will focus on range of motion, posture, balance, and mobility, and may include stretching, postural exercises, balance, and coordination activities.  The physical therapist will evaluate your ability to walk and determine the most appropriate and safest method of walking.  This may include instruction in the use of adaptive equipment such as a cane as well as techniques such as using visual cues or a metronome to improve your ability to initiate movement.

Kinesiotherapy will usually include general conditioning exercises that aid in mobility and overall well-being.  They may also provide training in walking and the use of an assistive device if indicated.  They may instruct you in a stretching and strengthening program to continue at home.

Occupational Therapy  will address difficulties with self care.  They will instruct you in alternative methods or suggest and train you in the use of adaptive equipment to complete such activities as eating, bathing, grooming, dressing, toileting, cooking, cleaning, and other household tasks.  

Therapeutic Recreation  works with you to improve function and independence while reducing or eliminating the effects of illness or disability.   They assist you with incorporating activities and social interaction in your life as well as teaching adaptation of activities and equipment, teaching the skills to pursue your interest and how to access community resources.

Patient and family education is a key part of rehabilitation.  Patients are generally instructed in a home exercise program to continue after the course of therapy has ended.  Family or caregivers are asked to attend therapy sessions to learn how best to help you achieve maximum function while maintaining safety.


Speech Therapy Benefits Patients with Parkinson’s Disease

Do people ask you to repeat what you just said, or tell you should talk louder?  Do you sometimes think your spouse or best friend needs a hearing aid?  If your answer is “yes” to these questions, you may have speech and voice changes related to Parkinson’s disease (PD).  The same symptoms that can occur in your arms and legs like slow movement, rigidity, and tremors, can also take place in your speech.  

PD can affect breathing, voice production, the richness of the voice, and clarity of speech.  Sometimes people with PD take shallow breaths, less frequent breaths, or have problems coordinating breath and speech.

The vocal cords (small muscles that open and close quickly when we talk) are located in the voice box or larynx.  Changes within the voice box can reduce the loudness of speech, resulting in a soft voice or may cause your voice to be unsteady.  People might frequently ask you to talk louder or raise your voice.  The richness of speech can change when the soft palate moves inadequately.

Sometimes the words may not be clear and distinct because the muscles of the face, lips, tongue, and jaw are not well coordinated.

A speech-language pathologist (SLP) is a healthcare professional trained to evaluate and treat patients with the above problems.  Some are trained to treat patients with PD using the Lee Silverman Voice Treatment Technique (LSVT), a method founded by Dr. Lorraine Ramig, a speech-language pathologist. The LSVT technique focuses on vocal loudness and exercises muscles of the voice box and speech mechanisms.  The treatment is  intensive and requires four sessions a week for 4 months.

It is important for patients with PD to seek speech treatment when problems first develop, but it is never too late.  If you have any of the difficulties mentioned above, ask your physician for a referral to a qualified speech-language pathologist.