Management of individuals with Parkinson's disease: rationale and case studies

In this article, we present a systematic approach to physical therapy management of individuals with Parkinson's disease. This approach is based on a model that relates knowledge of the underlying pathology of the disease to impairments and disability. We discuss use of the model to evaluate, interpret, and treat impairments and disabilities of the patient with Parkinson's disease. We emphasize the relative influence of impairments that arise directly from the neuroanatomical pathology and those that arise indirectly through subsequent musculoskeletal alterations. We illustrate the use of the model in setting goals and in developing a treatment program. Two case studies are presented to illustrate the application of this approach to specific patient care. These case studies suggest the efficacy of physical therapy initiated early in the disease process. The first case study illustrates improvements of balance, gait, and functional movement made by an individual who was not yet receiving medication for Parkinson's disease. The second case study illustrates improvements of balance, gait, and functional movement made by an individual who was already receiving medication for the disease. These case studies illustrate the dramatic improvements that can be achieved in the patient with Parkinson's disease.