· Pharmacological treatment:
Levodopa has been the most widely used treatment for over 30 years. Since motor symptoms are produced by the absence of dopamine in substantia nigra, the administration of L-DOPA temporarily diminished the motor symptoms.
Dopamine agonists: bromocriptine, pergolide, apomorphine, etc.
MAO-B inhibitors: selegiline and rasagiline increase the level of dopamine in the basal ganglia by blocking its metabolism.
Other drugs such as amantadine and anticholinergics may be useful as treatment of motor symptoms.
· Surgery: Surgery for PD can be divided into two main groups: lesional and deep brain stimulation (DBS). DBS is the most commonly used surgical treatment.
The review version of the European Physiotherapy Guideline divides physiotherapy intervention for Parkinson’s into exercise and movement strategy training.
Exercise: Exercise has been proven to maintain health and wee-being in Parkinson’s and now importantly it is shown to play a big role in addressing secondary prevention (focusing on strength, endurance, flexibility, functional practice and balance.
Physical activity, in particular, aerobic exercise might slow down the motor skill degeneration and depression.
Quality of life may be increased when performing strength training against an external resistance (cycle ergometer, weight machines, therapeutic putty, elastic and, weight cuffs).
Executing dual task, e.g. talking while walking, is commonly difficult in patients with Parkinson’s. Training such patients with Motor-Cognitive Dual-Task training, improves dual-task ability and might improve gait, balance and cognition.
Movement Strategy Training:
Strategies (physical or attentional cues and combined strategies) can help overcome some of the resultant problems, hence have become an increasingly utilized method of intervention for people with Parkinson's.
The European Guidelines provides a section that describes the use of motor learning, expectations if practiced and executed as a strategy to train improvements in movement. It takes the form of cued functional and dual task training. Compensatory strategy training uses external cues, self-instruction and attention.
· Visual cueing: a focus point to step over and initiate gait; strips of tape on the floor to initiate or continue walking through areas that cause slowing or freezing.
· Auditory cueing: continue 1-2-3 to initiate walking; stepping to the beat of metronome or specific music at a specified cadence to continue the rhythm of walk.
· Attention: Thinking about taking a big step; making a wider arc turn. This is applicable in case of correcting a bad habit- such as walking with stuff hip or hip hiking.
· Proprioceptive cueing: rocking from side to side ready to initiate a step; taking one step backwards as a cue ready to then walk forwards.