PARKINSON’S DISEASE CARE IN INDIA: THE VITAL ROLE OF REHABILITATION

Introduction: The Growing Challenge Few are Talking About

Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, cognition, and daily functioning. In a review by de Lau and Breteler (2006) [1], it was reported that an estimated 10 million people in the world (i.e., approximately 0.3% of the world population) and 1% of those above 60 years are affected with PD.

There are very few population-based studies determining the exact incidence and prevalence of PD in India.

In a door-to-door survey done in Bangalore district in South Karnataka in 2004, the prevalence rate of Parkinsonism was found to be 33 per 100,000 (crude prevalence) and 76 per 100,000 (age adjusted). Rural population had a higher prevalence compared to the urban population (41 vs 14).

From a survey in Kolkata in 2006, the prevalence of Parkinsonism was found to be 45.82 per 100,000. In Kashmir, the prevalence was 14.1 per 100,000, while the age-adjusted prevalence was 134 per 100,000. A survey in the Parsi community in Mumbai, a small stable community, showed a prevalence of 192 per 100,000, which was higher compared to the rest of the population.

Till recently, PD was considered to be a geriatric disease. However, in the past few decades it has been well established that several genetic and familial forms of PD can occur. Early-onset PD (EOPD), with onset of motor symptoms at 40 years, constitutes approximately 5–10% of patients. EOPD can be further divided into young-onset PD (YOPD; age at onset 20–40 years) and juvenile PD (JP; age of onset <20 years) [2].

Parkinson’s Disease Unmasked: What Really Happens to the Body and Mind

Parkinson’s disease primarily affects the nervous system, leading to symptoms such as tremors, muscle stiffness, slowed movement (bradykinesia), and balance issues.

As the disease progresses, individuals may also experience cognitive decline, depression, and difficulties in performing everyday tasks.

A delay in diagnosis, lack of awareness, and inadequate rehabilitation services are some of the challenges of Parkinson’s care. Most individuals and their families are unaware of the early signs of the disease, mistaking symptoms for normal aging. Additionally, access to specialized care is limited, especially in rural areas, making home-based and community rehabilitation approaches even more important.

Occupational Therapy: Small Changes that Transform Daily Life

Occupational therapy provides practical solutions to improve functional abilities, focusing on mobility, coordination, independence, and assisting patients in adapting to challenges related to dressing, eating, bathing, and other activities of daily living (ADL).

Key Interventions include:

• Using adaptive utensils, button hooks, and grab bars to maintain independence.
• Hand exercises, weighted utensils, and task-specific training to improve dexterity.
• Home safety modifications such as non-slip flooring, grab bars, and strategic furniture placement.
• Movement-based activities like rhythmic exercises, walking programs, and seated stretches to improve flexibility, balance, and mobility.

The condition can also cause memory issues, anxiety, and depression. Memory aids and structured routines are incorporated to enhance cognitive function. Leisure activities such as gardening, pet therapy, and movie watching are believed to increase dopamine levels, improving symptoms and emotional well-being.

Therapists also train individuals on energy conservation techniques to prevent fatigue. Family caregivers play a crucial role and receive training on safe transfers, communication strategies, and self-care to manage stress and prevent burnout.

Physiotherapy Power: How Movement Becomes Medicine

Core Physiotherapy Interventions

• Aerobic and resistance training: Improves cardiovascular health, muscle strength, and reduces both motor and non-motor symptoms.
• Balance and gait training: Techniques like tai chi, dance, and treadmill exercises enhance mobility and reduce fall risk.
• LSVT BIG therapy: Encourages larger, more purposeful movements.
• Flexibility exercises: Reduce stiffness in hips and legs.
• Technology-assisted interventions: Includes exergaming and Nordic walking for better coordination and balance.

Long-Term Support and Recommendations
Physiotherapy lasting at least six months can provide sustained movement improvement and reduce dependence on medication. The American Physical Therapy Association (APTA) recommends aerobic, resistance, balance, and flexibility exercises, aiming for 150 minutes of moderate-to-vigorous exercise weekly.

Home-based therapies can overcome challenges like access issues and compliance problems, making physiotherapy an essential part of PD care.

Speech Therapy Secrets: Why Speaking with Intention Changes Everything

Speech therapists address the neuromuscular deficits caused by PD, such as rigidity, reduced range of motion, and slowness in laryngeal muscles. These deficits impair speech clarity and make communication challenging.

One key speech characteristic is that quick conversational speech often becomes unintelligible. However, when speaking intentionally, patients can achieve better loudness, clarity, and articulation.

Following the model of intention, therapists encourage patients to speak with an accent, change pitch, or speak louder [3]. This conscious change disrupts automatic motor patterns and improves clarity.

The Mind Matters: Why Psychologists are Game-Changers in Parkinson’s Care

While PD is known for its motor symptoms, its non-motor symptoms—depression, anxiety, cognitive decline, and social withdrawal—are often overlooked.

• Depression: Affects up to 35% of patients [4].
• Sleep disorders: Common in PD [5].
• Cognitive impairment: Around 40% experience mild impairment, with some progressing to dementia [6].

Psychological Interventions include:

• Psychoeducation for patients and caregivers.
• Cognitive Behaviour Therapy (CBT) for depression and anxiety.
• Mindfulness-based stress reduction (MBSR) for stress management.
• Dance and movement therapy to improve executive functions, mood, and motor symptoms [7].
• Cognitive rehabilitation for better daily functioning.

Caregiver mental health is also supported, as caregiver burnout can impact patient care.

The Future of Parkinson’s Care: Building a Better Support System

A multidisciplinary approach is crucial for PD care. This involves:

• Integrating rehabilitation into healthcare systems.
• Offering specialized courses in PD care.
• Public education on early signs and rehabilitation benefits.
• Creating PD support networks and therapy groups for emotional and social support.