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.