There has never been a better time for physiotherapists to equip themselves with neuro-active exercise skills, as they face an increasingly enthusiastic consumer base in line with the rapid rise in the diagnosis of Parkinson’s.

Parkinson’s is the second most common neurodegenerative condition, although it is soon set to surpass Alzheimers disease as the leading neurological disorder, according to Neurological Physiotherapist Melissa McConaghy.

“It is estimated to affect up to 100,000 people in Australia with roughly 32 people diagnosed each day,” she says.

Globally, it is estimated that there are around 6 million people worldwide with Parkinson’s, with figures set to double by 2040.

It is typically a disease of ageing, however up to twenty per cent are diagnosed under 50 years old and ten percent are diagnosed before the age of 40.

“Over the last decade, best practice intervention for Parkinson’s has moved away from a compensatory movement strategy approach in the later stages of the disease to a more modern approach incorporating neuroplastic training principles in the very earliest stages following diagnosis.

“Parkinson’s is a neurodegenerative condition that is primarily known for dopamine deficiency in the brain which is caused by destruction of a particular neuron in the Basal Ganglia.

“This results in a poverty of movement characterised by bradykinesia, rigidity and tremor.

“As a progressive condition, there is no cure, however, broadly speaking it is not a condition that people die of today given the medical management and intervention available now.”

Physiotherapy plays a vital role in helping people achieve their best life possible after diagnosis – to slow the disease progression and in many cases improve their symptoms in the early stages.

“Not only are physios experts in prescribing neuro-active exercise to help people move better, we can provide appropriate education to give people confidence and build self-efficacy - essential tools required for longer-term behaviour change and exercise adherence.”

Ms McConaghy says recent research is providing a compelling argument for the importance of physiotherapists in developing early intervention strategies to support people with Parkinson’s with appropriate exercise prescription, education and long term behaviour change.

“The growth of digital health and technology in this space will also mean that much of this role will be augmented by apps, online channels, mobile health and greater use of virtual reality, activity trackers and digital biofeedback and communications devices.

“In Australia, Parkinson’s is more understood now than ever and with the explosion of literature exploring exercise, neuroplasticity and neuroprotection the role of physiotherapists in the early intervention and management of Parkinson’s is becoming more mainstream in clinical practice than ever before.

“Having said all of that, as with many things, knowing more makes one realise how little one knows and it would seem that we are not much closer to a cure, despite this.”

As a result of the continued new research and development around Parkinson’s treatment and physiotherapy, there is a growing need for qualified Neurological Physiotherapists.

“Physiotherapy is a diverse profession with many streams of expertise – sports, women’s health, paediatrics for example,” says Ms McConaghy.

“Neurological physiotherapy is one such stream where therapists have skills and additional training in treating neurological conditions like stroke, brain injury, multiple sclerosis, motor neuron disease and of course Parkinson’s.

“What differs in the approach of a neurological physiotherapist, among many things, are often the context in which they work, and how and what they do.

“Restoration of functional ability is what we have historically focused on – helping people to walk again, dress independently or maintain capacity with a degenerative condition.

“More recently, there has also been a focus on supporting people to self-manage and promote a better quality of life through ongoing exercise adherence, equipment and environmental set-up, aids and assistive technology and integration with a multidisciplinary team.”

Ms McConaghy herself has been treating people with Parkinson’s as a Neurological Physiotherapist for more than 18 years.

“Although I never met him, my grandfather died from Parkinson’s related complications back in the 1960’s before levodopa medication was widely available in rural Australia.

“It has always interested me, but it was not really until the last five years, and a complete paradigm shift in how we approach treatment, that I really felt I could make a significant difference to people’s quality of life.

“It wasn’t long after I started experimenting with using neuroplastic training techniques in Parkinson’s that I was totally hooked.

“The new approach was very effective and fast acting and over the past five years, we have worked hard to optimise and build out the approach.”

Treating people with Parkinson’s is mostly about learning how to assess patients thoroughly in order to really tailor therapy to their individual needs, says Ms MsConaghy.

“Given that most of the traditional therapy approaches for people with Parkinson’s have derived from interventions delivered as later stage input with a focus on falls prevention and compensations, it is not surprising that therapists who now find themselves treating people in the early stages of the condition, when these approaches are not appropriate, have struggled to apply a tool kit they just don’t have.”

The PD Warrior ‘Neuroplasticity in Parkinson’s’ training courses have specifically evolved to teach therapists how to apply neuroplastic training principles in the newly diagnosed Parkinson’s population.

“Neuroplasticity itself is not a new concept, it has been used for well over two decades in stroke and brain injury rehab for example, but it is still relatively new to physiotherapists treating people with Parkinson’s.

“Training therapists how to assess impairments in the early stages of Parkinson’s and apply neuroplastic training principles has been very effective and improved the outcomes of patients and their overall quality of life dramatically.”

The courses are taught in 8 countries around the world over roughly 35 courses a year. The level 1 and 3 courses can be conducted entirely online and the level 2 is a one day practical workshop. The learning objectives and outcomes can be found at www.pdwarrior.com/professionals. 

“If therapists are treating people in the early stages of Parkinson’s, up to stage 3 Hoehn and Yahr, then it is recommended that the approach to therapy consider including neuroplastic training principles with a focus on long-term behaviour change to ensure that patients achieve the best results in therapy and in their daily lives.”