[Amy Bullen]

Assessment is where the therapist can understand the client’s main functional problems and goals, motor and non-motor symptoms, relevant medical history, level of understanding of role of exercise in disease, readiness for therapy, and where a targeted treatment plan can be developed.

[Amy Bullen]

Effective coaching is about supporting the person to be motivated and responsible for their own exercise adherence, for initial and long term behaviour change. Motivation can help build their confidence, sense of satisfaction and achievement, using intrinsic or extrinsic factors. While the coaching model promotes more autonomy, some people may require a slightly more traditional approach from the therapist. The three main techniques for effective coaching include engagement, driving self-efficacy and behaviour change.

[Amy Bullen]

It is unknown as to what causes the dopamine deficiency in the substantia nigra pars compacta cells in basal ganglia/midbrain of people with IPD. Diagnosis usually occurs between 55-65years of age (in which up to 60% of cells can already have perished), but symptoms can be present up to 20years prior.

There are stages of progression of the disease: Braak Stages 1-2 (autonomic disturbances), 3-4 (sleep and motor disturbances), 5-6 (emotional and cognitive impairment) which correlate with progressive brain disease and infiltration of Lewy bodies.

Clinical Diagnosis of IPD based on presence of primary motor impairments and non-motor symptoms, exclusion of other neurological conditions and response to medication.

Primary motor impairments include: hypo/bradykinesia, tremor, rigidity, weakness, akinesia

The types of IPD are: bradykinesia (target amplitude, scale, symmetry), tremor dominant (target forced use, motor output, high effort), agility impaired (target weight shift, agility, falls prevention, dynamic balance)

Non motor impairments, such as depression, apathy, anxiety, cognitive impairment, autonomic system dysfunction can greatly affect quality of life.

Secondary impairments like changes to mood, sedentary behaviours, and falls can also have a large impact.

Medications don’t have an effect on disease progression, only on symptoms, and are thought to support neurorestoration only. However, if clients can move better, there is more potential for a training effect. Therefore, it is important for medications and exercise to work in partnership for optimising outcomes.

[Amy Bullen]

There are 7 core principles – specificity, high effort (intensity), frequency, powerful, complex, meaningful, fun, all of which are designed to slow, halt or reverse the progression of IPD, through their roles in neuroplasticity (rewiring of the brain), neuroprotection (slow decline of dopamine producing cells) and neurorestoration (normalise brain electrical activity).

You should aim to categorise patients into one of the three different groups of IPD (bradykinesia, tremor dominant, agility impaired, or a combination), along with identifying functional goals and barriers, so that an individualised approach can be tailored based on the 7 core principles framework.

[Amy Bullen]

PD Warrior is a program for people with Idiopathic Parkinson’s Disease, preferably newly diagnosed or in the early stages of the disease, that aims to provide neauroactive exercise (neuroplasticity, neuroprotection and neurorestoration), education to empower the individual to take control of their lifestyle, and to drive a supportive “warrior” community.