We follow an integrated, multidisciplinary approach to treating Parkinson’s Disease, using evidence-based physiotherapy interventions. The process includes a comprehensive evaluation of the individual’s symptoms, physical abilities, daily requirements, and personal goals, leading to a highly individualized treatment plan.

1.Initial Assessment: Upon the first visit, a comprehensive assessment is conducted to understand the individual’s current condition and the effects of the disease, medical history, and their personal objectives from therapy. This includes evaluating motor symptoms such as tremors, rigidity, and bradykinesia, as well as non-motor symptoms like cognitive changes, sleep disorders, and mood disturbances. The patient’s mobility, balance, strength, flexibility, endurance, gait, posture, and speech are also evaluated.

2.Developing a Customized Treatment Plan: Based on the initial assessment, a personalized treatment plan is designed to address the patient’s unique needs. This typically includes a blend of various physiotherapy interventions to target motor and non-motor symptoms, enhance physical function, and improve quality of life.

3.Implementation of Therapeutic Interventions: The implementation phase involves carrying out the designed treatment plan. This can include:

• • • Exercise Therapy: A blend of strengthening, flexibility, aerobic, and balance exercises tailored to the patient’s physical capabilities and goals. Amplitude training and reinforcement of common patterns may also be incorporated into the therapy.
      
    • Gait Training: To address challenges such as freezing, shuffling, and festination, strategies like visual and auditory cues, rhythmic counting, and gait cycle training are implemented.
    • Postural Training: Counters postural instability and decreases fall risk through postural exercises and balance training.
      
    • Respiratory Muscle Strength Training: To manage decreased respiratory muscles, dysphagia, ineffective coughing, speech disorders, and cardiorespiratory dysfunction, with a prolonged positive impact on respiratory muscle strength, swallowing function, and cardiovascular autonomic function.
    • Dual-Task Training: This involves training the patient to perform a cognitive task and a motor task simultaneously, enhancing their ability to multitask, improving their gait velocity, step length, and decreased freezing of gait.
    • Neuroplasticity Training: High-intensity, repetitive exercises that promote neuroplasticity and motor learning are incorporated.
    • Speech and Swallowing Therapy: If required, collaboration is made with speech and language therapists for interventions addressing voice, speech, and swallowing difficulties.

4.Progress Monitoring and Plan Modification: Regular follow-ups and assessments are conducted to monitor the patient’s progress. The progress is measured by evaluating

• • • • Condition status
      • Quality/safety of walking
      • Posture
      • Functional performance
      • Fitness and endurance
      • Dexterity and writing
      • Cognition
      • Quality of life
      • Balance, falls risk and confidence to move
      • Respiratory function
        

The treatment plan is modified based on progress, emerging symptoms, and changes in the patient’s condition or goals.

5. Patient Education and Home Program: Education about Parkinson’s, its progression, and self-management strategies are integral to our treatment plan. A home exercise program is provided, along with guidance on its proper execution, to continue the benefits of therapy at home and encourage long-term management of symptoms.

Our ultimate goal at In Step Physical Therapy is to enhance the quality of life for individuals with Parkinson’s, helping them maintain their independence and active lifestyle for as long as possible.