Jennifer Marie J. Yang, MD

What is Parkinson’s disease? I do not want to reinvent the wheel, so I’m going to direct you to this very good explanation from the Mayo Clinic and the Parkinson’s Foundation.

How does rehabilitation help? While rehabilitation cannot make Parkinson’s Disease go away, it can help by improving function and enhancing quality of life. To recap: function is how you get through all your activities during the day. See this previous blog post titled “Rehabilitation Medicine” for more detail. In this post, we’ll go through some common symptoms and signs that can get in the way of function.

Tremors can affect your walking and balance, causing you to fall. More commonly, they can affect the ability to hold or grasp objects, making it difficult to pick up utensils for eating, using zippers and buttons, and putting on your shoes among other things.

Difficulty starting movement, the loss of voluntary movement (the medical term is akinesia), slow movements (bradykinesia) and problems with coordination (ataxia) can also occur. This also affects walking and balance, and a reduced ability to keep from falling or break a fall. Losing your balance while walking, getting out of a chair or off the toilet, or while dressing can also happen.

Fatigue and decreased endurance – getting tired easily while doing activities – is also possible. While it can be related to Parkinson’s disease itself and the increased physical and mental effort you have due to Parkinson’s disease, fatigue may also be due to a decreased level of fitness – meaning your heart and lungs are not in optimal condition, thus making you feel tired all the time.

People with Parkinson’s disease can also have swallowing difficulties because of weak and non-coordinated muscles that help you eat and swallow. This may make getting enough nutrition and hydration (i.e., food and water) difficult. These same muscles also help you form words and speak, so some people with Parkinson’s disease can also have slowed, soft speech (hypophonia).

Toileting – which includes the act of going to the toilet, and control of urination and bowel movements – can also be affected. Physically, getting on and off the toilet and losing your balance while doing so is possible. Some people may have urinary retention (unable to urinate) or constipation. Others may have poor control and the inability to sense the need to urinate or have a bowel movement.

Cognitively, Parkinson’s disease can affect a person’s memory, decision making, concentration, attention span and other functions of the brain. Psychiatric changes may include depression, hallucinations and behavioral changes. However, sometimes it may be hard to tease out whether these symptoms are due to the disease itself, or side effects of the medications used to treat Parkinson’s disease.

Finally, Parkinson’s disease can also affect autonomic function. “Autonomic” refers to all the body functions that we do not consciously think of or control. Examples include breathing, blood pressure and sweating or perspiration. In my experience, low blood pressure has been the most common problem.

For more information about Parkinson’s disease, you can also listen to our panel discussion from April 2021, sponsored by Singapore’s Nanyang Academy of Fine Arts and World Dance Alliance-Singapore. I participated in a panel about Parkinson’s Disease along with neurologist/movement disorders specialist Dr. Roland Dominic Jamora and dance therapist/founder of Sayaw PD Mr. Novy Bereber in April 2021. Many thanks to Dr. Filomar Tariao for organizing and moderating the discussion.

In the next blog post, I will tackle how physical activity (exercise and dance) can help Parkinson’s disease.

Key References:

• Abbruzzese, Giovanni, et al. “Rehabilitation for Parkinson’s disease: Current outlook and future challenges.” Parkinsonism & related disorders 22 (2016): S60-S64. •Earhart, Gammon M. “Dance as therapy for individuals with Parkinson disease.” European journal of physical and rehabilitation medicine 45.2 (2009): 231.
• Hackney, Madeleine E., and Crystal G. Bennett. “Dance therapy for individuals with Parkinson’s disease: improving quality of life.” Research and Reviews in Parkinsonism 4 (2014): 17-25. •Heiberger, Lisa, et al. “Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease.” Frontiers in aging neuroscience 3 (2011): 14.
• McGill, Ashley, Sara Houston, and Raymond YW Lee. “Dance for Parkinson’s: a new framework for research on its physical, mental, emotional, and social benefits.” Complementary Therapies in Medicine 22.3 (2014): 426-432.
• Sharp, Kathryn, and Jonathan Hewitt. “Dance as an intervention for people with Parkinson’s disease: a systematic review and meta-analysis.” Neuroscience & Biobehavioral Reviews 47 (2014): 445-456.
• van der Kolk, Nicolien M., and Laurie A. King. “Effects of exercise on mobility in people with Parkinson’s disease.” Movement Disorders 28.11 (2013): 1587-1596.