Parkinsons Disease

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When it comes to staving off Parkinson's disease's progression, movement is the best medicine.

A long-term degenerative disease that affects mobility, speech and motor skills, Parkinson's is the fastest-growing neurologic disorder worldwide and set to outpace dementia. Parkinson's disease afflicts 1 million people in the United States and 6.9 million people globally. That figure is projected to reach pandemic status and double to 14.2 million people by 2040. The good news is the earlier Parkinson's is detected, the better chance patients have of managing it. Currently, there is no cure. 

Many clinics in the Ivy Rehab Network offer a multidisciplinary approach to care. Patients can participate in physical therapy, occupational therapy, speech therapy, an aquatic exercise class, a land-based exercise class or attend a monthly support group.

Age and genetics, especially for early onset Parkinson's, do play a role in Parkinson's disease, but a growing body of research shows environmental factors may be a bigger cause for concern. This includes chemical exposure, geographic region, and living in rural versus urban areas. Parkinson's usually presents between 50 and 65 years old, but early onset can start in a person's 40s.

"The closer you are to the source, the greater the likelihood you are to get it," he said of the chemical exposure. "Vietnam vets have Parkinson's at an alarmingly higher rate, they think due to Agent Orange."

The pathophysiology of Parkinson's disease involves the failure of certain brain cells' "garbage removal" system. This leads to the death of cells that create dopamine in the brain. Dopamine helps with smooth, purposeful movements. It is a crucial neurotransmitter for movement, emotions, and sensations of pleasure.

Getting a Diagnosis

As Parkinson's progresses, the brain slowly loses dopamine supplies. There are no visible signs until someone has 70 to 80 percent of dopamine loss. That is why it can be tricky to diagnose. Parkinson's is not detectable by an MRI, body scan or blood test. In addition, 40 percent of people with Parkinson's disease don't see a neurologist.

Diagnosis comes down to various signs and symptoms related to motor function, including slow movement, small movement, rigidity, tremors, postural instability, or freezing of gait. On the non-motor side, signs may include mood disorders, low blood pressure, cognitive changes, sleep difficulties, loss of sense of smell, pain, fatigue and impulse control disorders.  

People often report losing their balance, tripping more, or having difficulty picking their feet up to walk. They may struggle to write, button a shirt, or get in and out of the car. For example, a 72-year-old who golfs regularly and suddenly struggles to get out of a chair should talk to their doctor. 

How Physical Therapy Can Help Parkinson's Disease

After a Parkinson's diagnosis, there are pharmaceutical and surgical options to help increase dopamine production. Patients also benefit from physical, speech and occupational therapies, and high-intensity exercise, which can stave off Parkinson's progression.

A physician's referral is not needed to start PT, and an evaluation looks at strength, balance, range of motion, gait, and functional mobility. It establishes where you are at currently, how PT can help get you to where you want to go, and if you are safe for exercise.

LSVT Programs for Parkinson's Disease

LSVT BIG and LSVT LOUD are the most researched and proven treatment methods. LSVT BIG is an exercise approach specific to combating the motor impairment of Parkinson's disease and focuses on amplitude, or bigness, and high-intensity exercise. 

"The things that have been proven most effective are large exaggerated movements, cycling, boxing, tai chi, dancing," he said. "A lot of people have never been a regular exerciser so I say 'find something you like or something you don't hate and do that.'"

LSVT treatment protocol calls for 16 one-hour treatment sessions, four times per week for four weeks. That is not always feasible so Keenoy says to start with 10 to 15 minutes of daily exercise.

Some patients show improvement with one to four sessions per week, ranging from four to 12 weeks. Therapists focus on teaching people how to apply the treatment principals to getting out of a chair, putting on their shoes, or other functional and recreational activities. 

Beyond Physical Therapy for PD

Speech therapy and LSVT LOUD can help patients maintain their voice quality, volume and address any swallowing difficulties, as well as breathing exercises to help enhance voice volume. Occupational therapy helps with daily living tasks such as dressing, eating, and driving.

If you have recently been diagnosed with Parkinson's Disease, or are worried it has been undiagnosed, contact your nearest Ivy Rehab Network clinic for an evaluation. Ivy's friendly and skilled therapists offer a variety of therapy options to help Parkinson's patients manage the disease and continue their favorite activities.


It's OK if you don't have a prescription.

It's OK if you don't have a prescription from your doctor.

Even if you don't have a prescription from your doctor, call one of our physical therapy clinics or use this form to book your appointment today. Learn more about direct access here.


Our clinics that offer parkinson's disease:

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