Health and wellness
Parkinson’s Disease: A Rehabilitation Story
Dr Anjali Agarwal is a consultant physiotherapist and lifestyle counselor who works with several elderly patients suffering from Parkinson’s Disease. Here she writes a first person account of her rehabilitation work with a patient aged 75 years.
This is a story of my patient, let’s call her Mrs X. She is 75 years old, lives with her husband and is completely dependent on her family that includes son and daughter in law. She has been suffering from Parkinson’s Disease since the year 2010. As her physiotherapist, I have been observing her situation improve over the past two months. This article is a chronicle of the efforts involved to bring about that improvement.
Being financially dependent on the son made Mrs X quite aware of the fact that she would have to spend a lot on her rehabilitation process. According to my study, the elderly lady had been postponing her rehabilitation for almost three years. In fact, I was surprised by her unwillingness to do any exercise.
Since she liked having visitors, left on her own she would be depressed, feel rejected by the family and would have suicidal thoughts, which made her feel quite isolated and worthless.
Given her age, she had multiple ailments and one of the things that troubled her was an extremely painful and swollen knee. Parkinson’s Disease would freeze her knees during the early hours in the morning and her entire schedule, starting from having her breakfast to going to the washroom and having her medications would become a daunting task to complete.
Her husband, himself a post bypass patient, tried his level best to become her carer. There was also a female help who would feed her, assist her to the washroom and help with other basic requirements.
However, being totally bedridden made Mrs X lose confidence to bear any weight on her legs and she would shout in pain and surrender before completing her exercise routine. Each day was a challenge for both me and her. But her caring husband would inspire her day in and day out to continue with the rehabilitation process.
My plan of rehabilitation for Mrs X involved helping her to get independent and also feel valued and respected by her family members, who often felt that she should be like many of the other elderly people who help around the household.My involvement with her as a health care professional wasn’t just limited to her rehabilitation but also involved ensuring that the situational stress in the house did not leave her psycho-social issues unanswered.
For her physical rehabilitation within the home setting, I started with:
1) Strengthening exercises for her quads and hams, straight leg raises and a bit of stretching. A Parkinson’s patient would require stretching exercises on a daily basis.
2) Sit to stand exercises on a sturdy chair, with commands of up and down.
3) Balance Training and fall prevention exercises: We helped the lady get a walker with a seat and wheels that made her quite confident to walk around the house and helped her painful knee.
4) Balance on an exercise ball: She was hesitant initially to even sit on the ball but day in and day out there was a marked spike in her confidence levels and eventually, she exercised balancing on the 55 cm exercise ball and her worry that she would fall got answered.
5) Pain Management: She had painful knees and had severe osteoarthritis. I used Transcutaneous electrical nerve stimulator (TENS), which would help to block her pain.
6) Bridges, Spinal extensions: Lying on the bed the whole day made her lose a lot of strength with regards to her abdominal and spinal ex tensor muscles, I would make her do spinal bridges and static spinal along with pelvic tilts which helped her get some mobility around the trunk region.
7) Calf stretches: She would drag her feet while walking which resulted in some shortening of the tendoachilles and made her peroneal muscles very weak. We worked on doing calf stretching and and peroneal muscle stretching as well.
8) Gait Training: The simple quick fix solution to her freezing problem was taught to her. The command which I generally verbalized loud to her was, Heel, Strike, Heel, Heel and made her walk with bigger steps on to the square marking on the floor. She was educated to understand that if an occasion arises where she feels she is losing balance because of the freezing, she should stop and try imagining putting her heel on a stair step or a book. The key word would be Lift Up Heel.
9) Cognitive skills: I would give her a shirt to button and unbutton and a zipped bag to open and lock. I also gave her a mixture of rice and dal to separate in different boxes.
10) Facial exercise: I asked her to smile as often as possible and to chew her food slowly.
11) Posture Care: Mrs X would stoop forward and that made her prone to falls. She was advised to stand straight, focusing on squeezing her shoulder blades. Though initially she found this real hard, with practice she showed drastic improvement.
12) Relaxation exercises: Her Breathing exercises included Abdominal breathing, Diaphragmatic breathing and Progressive Muscular Relaxation. I asked her to do them whenever she thought she was getting negative thoughts.
13) Lifestyle Modification: Inclusion of a walking aid like rollator walker, feeding and eating aids with bigger grip and more stable cutlery, plates and glasses helped her feel more independent. Dressing and washing herself after the correct guidelines of having her medications on proper timings helped her a lot.
Mrs X’s real challenge to date has been her inability to go out of the house or just to go to a temple. She feels isolated more so because she feels like nobody would respect her special needs and limitations. Thankfully, her husband plays an important role as a carer and he is considerably focused towards her Rehabilitation.
Her family, especially son and daughter in law were given counseling to understand the situation around Parkinson’s. They have now understood the lady’s predicament and are accepting her situation gradually.
My reason behind writing this article is to tell everyone how getting help from a professional is of paramount importance. It can become too difficult for the family, carer or the patient herself/himself to cope with Parkinson’s Disease symptoms all alone without adequate guidance and support.
Comments
Subha Jayaprakash
30 Aug, 2020
HI, my mom is 67 years old and she has suffered from stroke 10 months back, during that time, they diagnosed. parkinson's disease. It was very confusing to differentiate on the symptoms. Also she is getting depresseddd and not willing to do physio. am also finding that when she open and close her hand, she could not stop imeeddiately - she. does 3 or 4 times and stops. she is getting angry and shouting at all of us. and later she says i shouldnt have shouted. Recently, she is saying she gets bitter taste while swallowing and reducing her intake and hesitate to take medicines. Am scheduling regular video call with our neurologist, he says give physio continuously and adjust the dose of tablet (syndopa). But it was too hard to see her like this and very confusing on what is should do or how to convince her to do exercise or take medicines. Kindly advice.
Silver Talkies
23 Jul, 2019
Hi Akriti, Kindly look through the support centre list of Parkinsons Disease and Movement Disorder Society. You can also call them to find leads. http://www.parkinsonssocietyindia.com/support-for-you/locate-a-support-center/ Good luck, Silver Talkies Team
Akriti Jain
22 Jul, 2019
Dear Doctor, My Father in law is a Parkinson's patient since past 6years now. While hes on medication, we dont see any improvements. Hes become not only asocial, stopped going out of the house etc. but his overall health is detiriorating. There is a physiotherapist who comes home but I wish he can be part of a community/ group where people are doing some activities where it will be a change as well as meet people. Can you recommend any such place/ service in Delhi ? Many thanks.
Shuvra
29 Sep, 2018
My husband is suffering from parkinson and many other serious ailments. Kindly let me know a good rehab in Bangalore
Silver Talkies
17 May, 2018
Dear Kavita, You can try to call Parkinsons Disease & Movement Disorder Society or locate a support centre here: http://www.parkinsonssocietyindia.com/support-for-you/locate-a-support-center/ Regards, Silver Talkies Team
Kavita Mitter
17 May, 2018
Would be grateful if you could suggest a similar facility/ physiotherapist in Delhi.
Silver Talkies
22 Feb, 2018
Dear reader, Sorry to hear that. We have asked PDMDS regarding your query and they should get back soon. Silver Talkies
Ms.Noni@Gmail.Com
21 Feb, 2018
Dear Doctor, Could you please suggest a physiotherapist in Delhi. My father has been recently diagnosed with Parkinsonism. Best regards
Divya Narayanappa
29 Jan, 2018
Hello Doctor very interesting to know we do have blessed​people like you who assures relief for Parkinson sufferers,I have a sister who is suffering from Parkinson for the past 10 yes please guide me if anyone is available in Mysore
Ajit Rao
26 Nov, 2017
Could you please suggest rehabilitation centre in Hyderabad for my sister who underwent DBS. Her problem is over movemnet because of medication and she is habituated to medicine.
Nagaraj.D.S.
14 Aug, 2017
I am an 80year old man in Bangalore with reasonably good health. I am suffering from Parkinson's disease for a few years, & inspite of treatment from a popular Neurologist, it has become worse. My body balance is very bad and movements awkward. Loosing finger control & difficulty in normal activities. Can you suggest any physio therapist, specialised in Parkinson's sufferers' rehabilitation in Bangalore.. I will be waiting for your response. Thanks. D.S.Nagaraj.
Silver Talkies
31 May, 2016
Dear reader, We shall find out and let you know as soon as we can. Meanwhile, one of the best resources regarding Parkinson's Support Groups anywhere in the country is the Parkinson’s Disease & Movement Disorder Society in Mumbai, who will be able to guide you further. Here are their details: mail@parkinsonssocietyindia.com Address: Parkinson’s Disease & Movement Disorder Society 6, Jasville, 1st Floor, Opp. Liberty Cinema, Marine Lines, Mumbai – 400020. Tel: 022- 22007667/ 22068787 / 4747 Silver Talkies Team
Kkb
30 May, 2016
My father is 71 yrs old. He is suffering from parkinsonism since last 3 yrs. His condition is detoriating day by day. My mother also keeps unwell. Can you please suggest a rehabilitation centre in Delhi.
Kothandararaman
19 Feb, 2016
Good booster for senior citizens Forward to mythilyramachandran,rohi
Kamlesh Kapoor
25 Jan, 2016
I am looking for rehab center for my father who is suffering from Dementia, and he is aged 74 years. I am looking for assisted living with rehab facilty for them in Hyderabad. Looking forward for your urgent support. Regards Kamlesh
Silver Talkies
15 Jan, 2016
Dear Mrunalini, We shall try to find out and let you know.
Dr Anjali Agarwal
13 Dec, 2015
Dear Mr Rao, Really sad to hear about your wife. Have u tried Physiotherapy with a specialist in this area. I see you are based in Hyderabad. You are most welcome to bring your wife to consult me at the clinic. most of my parkinsons patient's have shown considerable positive results with the kind of protocol I follow for them. Thanks Dr Anjali Agarwal consultant Physiotherapist.
Silver Talkies
13 Dec, 2015
Dear Mr Krishna Rao, We have forwarded your query to our expert and shall revert soon. Thank you Silver Talkies.
Craig
24 Feb, 2015
Please check out my new post on my personal blog about mmy life with parkinsons *** CURL error: 'Connection timed out after 15000 milliseconds' or disabled allow_url_fopen in php.ini. Antispam service cleantalk.org ***
Lakshmi
14 Oct, 2014
My dad is 66 yrs and has been detected with parkinson's plus syndrome. He lives in neredmet secunderabad. Can you suggest anyone nearby that area who could provide support. Thanks in advance. Lakshmi. *** Antispam disabled. Check access key in CleanTalk plugin options. Request number 36641d55a1edb873033e608822caab89. Antispam service cleantalk.org. ***
Silver Talkies
25 Aug, 2014
Dear Kritika, We have forwarded your query to our Parkinson's experts and shall revert soon. Thank you, Team Silver Talkies
Kritika
25 Aug, 2014
Hi, Thanks for sharing such helpful tips, my dad is 72 and has been living with Parkinsons for over 6 years now. He lives in Secunderabad and I was wondering if you could suggest any support groups around there? Thanks in advance, Kritika
Admin
29 Apr, 2014
Dear Pankej, We shall check and revert. Regards, Team Silver Talkies
Pankej Juneja
28 Apr, 2014
Thanks for this great article. Is any thing like this available in New Delhi? Thanks Pankej
Silvertalkies
29 Nov, 2013
Dear Nehal, We will look into this and get back to you shortly.
Nehal Vora
29 Nov, 2013
Hi, Can you pl suggest any rehabilitation center/care in Delhi and pref Mumbai as well? My father has undergone DBS a few years back and is in urgent need for self assurance. I am also reachable on 9711994387. Thanks. Nehal Vora
Wyatt Hunter
29 Oct, 2013
My husband is 54 and has had Parkinson’s for around 3-4 years. It is a debilitating disease that only gets worse and needs some serious funding to find out 1 because the cure is out there. What causes it and 2. some better treatment for it which multivitamincare .org have the guaranteed cure for PD. He takes over 8 weeks treatment from Multivitamin care formula that finally cure him,as there is no-one available to help unless you have $4,000.00 per week to pay for a Nurse, but with this herbal system you can get rid of your Parkinson effectively ,he had tremors for several years and was gradually becoming worse before we found PD supplement from Multivitamincare that was able to get rid of my husband disease and alleviate all symptoms within the short period of his usage.,they have the best medication for PD.
Anonoymous
27 Oct, 2013
[...] A Parkinson’s patient’s rehabilitation story [...]
Silvertalkies
19 Jul, 2013
Dear Sahana, We will do our research and keep you posted here about Parkinson's professionals in Bangalore
Sahana
19 Jul, 2013
Please recommend a similar professional in Bangalore. Thank you.
Nasira Hameduddin
11 Aug, 2012
Dear doctor It is nice to hear of your work with Parkinson's patients. My parents live in Hyderabad but are under the care of an US doctor who consults with them every month. The doctor has been insisting on music therapy for some time. Can you please provide it since research shows it is very beneficial for persons with movement disorders. Or is there someone else you know. Currently my dad goes to Apollo life twice a day, but the management there isn't very keen on our request.
B.Srinivasan
12 May, 2012
Is there any centre at Coimbatore for Tamilnadu. I read an Article that Dr.Anbuchelvan of KMCH, Coimbatore is at it B.Srinvasan
Silver Talkies
05 Apr, 2012
Dear Mr Narayan, We do hope you receive a reply from PDMDS. We are also getting in touch with them to find out about few more Parkinson's related queries and can hopefully get back to you soon. The Elderly Physio Care Clinic in Chennai has done some fall prevention related work with Parkinson's patients and you could check with them to see if they could be of further help. You can reach them on 9884130430 & 9940234934 or on http://www.elderlyphysiocare.in. Alternatively, you can also check at Dr VS Natarajan's Clinic. The contact details are: Adhiparasakth Clinic, 044-26412030/26267282. We do hope this helps. Silver Talkies Team
Narayanan
04 Apr, 2012
Hello, My father aged close to 80 has been diagnosed with Parkinson's disorder for at least 10 years. As of now the most troubling issue is the loss of balance. Just today he lost his balance four times. We are in consultation with a neurologist. But he says there are no medicines for freezing and loss of balance with Parkinson's disorder. While we are facing with other issues like trembling, poor gait, constipation, these issues are in tolerable level. I am looking for some kind of solutions, either permanent or temporary or even some sort of solution which could reduce the issue of falling and make him independent. It could be a moral consultation or physiotherapy or any alternative or traditional medication etc. Do you think any such facility is available in Chennai? I can be reached over phone on 9444991270 if you want. Thanks in advance for any info you could provide. Regards, Narayanan PS: I just wrote the above lines to mail@parkinsonssocietyindia.com as well - FYI
Silver Talkies
27 Mar, 2012
Dear Mr Rao, We shall forward your query to Dr Agarwal. Please give us few days to hear back. Regards, Silver Talkies team
Krishna Rao
26 Mar, 2012
Dr. Anjali Agarwal, I am yet to find a suitable physiotherapist. I could not bring my wife to Kondapur on the appointed date as she was unable to make movements. Is there any clinic nearby Somajiguda or can you make a home visit? Krishna Rao 9810223863
Silver Talkies
20 Mar, 2012
Dear Kamlesh, Please look up the following links of support groups. We do not have information yet on one in Hyderabad but contacting ARDSI could help. https://silvertalkies.com/dementia-support-groups-india/ http://ardsi.org/NationalofficecareCenters.aspx We shall try to find more resources and mail you. Best of luck
Mrunalini
23 Feb, 2012
i am looking for rehab centre for my grandmom in hyderabad.plz sugest best/
Krishna Rao
16 Feb, 2012
My wife is facing similar issues even after DBS this year. Its traumatic for her and also me. Her age is 48. Pl. give your no. Krishna Rao hyderabad 9810223863
Silvertalkies
07 Jan, 2012
Dear Nehal, You can contact the Parkinson's Disease & Movement Disorder Society in Mumbai, who will be able to guide you further. Here are their details: mail@parkinsonssocietyindia.com Address: Parkinson's Disease & Movement Disorder Society 6, Jasville, 1st Floor, Opp. Liberty Cinema, Marine Lines, Mumbai - 400020. Tel: 022- 22007667/ 22068787 / 4747
Silvertalkies
06 Jan, 2012
Dear Sahana, You can get in touch with Ameeta Patel at 22341224 or 23332668
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