Ask an Expert: Physiotherapy

Nina Bloomfield currently works for Fraser Health in pulmonary rehabilitation as well as part time in private practice focusing on neurological physiotherapy. In 2014, she led PSBC’s PWR pilot project in Burnaby, BC. Throughout Nina’s 30 years of experience as a physiotherapist, her interest in PD has led her to work with both individuals and groups teaching exercises to enhance movement and maintain functional mobility.

What is physiotherapy? Isn’t it just for people who are injured?

Physiotherapy is treatment performed by a registered physiotherapist aimed at enhancing or restoring movement and function. Trained in movement science, physiotherapists are experts in assessing and treating movement. Therapists often specialize in specific areas including orthopedics and sports injury, respiratory health, neurology, women’s health and pediatrics or geriatrics. A common misconception is that physiotherapists can only help after an injury or mobility issue has arisen, but they can also work with you on preventative measures for potential movement problems.

What Parkinson’s symptoms can physiotherapy help?

We all have unique bodies and movement patterns but a diagnosis of Parkinson’s can bring additional movement problems such as rigidity, slowness of movement, balance and posture issues, as well as general de-conditioning from lack of exercise. A physiotherapist can make general recommendations and educate you on the kinds of exercises that are important to address and prevent common physical issues from PD. In addition, an individual assessment will address your unique concerns to ensure that you are functioning optimally.

Can physiotherapy help even if I have “freezing of gait” or balance and posture issues?

Absolutely. A physiotherapist can educate you and recommend specific exercises that allow you to better understand and manage your challenges.

Can I do physiotherapy if I’m in a wheelchair or use an assistive aid such as a cane or a walker?

The human body has great capacity to adapt and change. Regardless of your level of ability and use of assistive devices, exercises and new movement strategies can be used to improve your function. Sometimes a carepartner can be shown how to assist you in your exercises and mobility.

Do you need a referral from your doctor to see a physiotherapist?

Physiotherapists in BC are direct care professionals and do not require a doctors referral. If you are seeing a physiotherapist in the public system, such as in a hospital out patient department or through home care in some settings doctors referral may be helpful or needed.

What is LSVT® LOUD? What is PWR!? Are there specific exercise programs for people with Parkinson’s?

There has been a significant increase in research exploring the effect of exercise for Parkinson’s symptoms over the past few years. Exercise in general has been shown to have a positive effect.

LSVT® was one of the first exercise programs specifically designed, studied and proven to help people with Parkinson’s – in particular those who have bradykinesia, or slowness of movement. Dr. Becky Farley, a physiotherapist from Arizona, developed the research and exercise program for LSVT® but then went on to develop the Parkinson’s Wellness Recovery Program, or PWR!.

PWR! is aimed to help with a variety of issues at all levels of Parkinson’s and uses whole body movements. It is offered in both group and individual settings and can be tailored to specific needs. For more information about PWR! see www.PWR4life.org.

Are there physiotherapy exercises that I can do at home if I’m in a remote area of BC and cannot access a physiotherapist easily?

More research is showing the importance of exercise for Parkinson’s disease – specifically exercises such as tai chi, yoga, dancing and treadmill training. The difference between general non-specific exercise and physiotherapy exercises is simply that physiotherapy exercises follow an assessment and the prescription of exercise is specific to you. Becky Farley has written a book called, “A PWR! Guide to a Parkinson-specific Exercise Program” that can be used as a guide to begin exercises. Combining general exercise with exercise designed for people with Parkinson’s is an excellent way to stay active and address symptoms when a physiotherapist is not available.

If I’m too tired or in too much pain, how can I do physiotherapy?

Fatigue and pain are a common cause of a vicious cycle of inactivity. A physiotherapist can advise you on how to gradually build up an exercise program to help reverse this cycle. It is also important to be sure that your general health and wellness is addressed including optimal medication, good nutrition, sufficient rest and participating in social activities you enjoy. The important thing to remember is that every bit of activity and exercise counts.

Why should I go to physiotherapy?

Exercise is now considered an important part of treat ment of Parkinson’s disease and should be started as soon as possible. A physiotherapist can help direct you in starting an exercise routine, or make sure that the exercises you are doing address your unique situation.

It is best to see a physiotherapist who has a special interest in treating people with neurological conditions. Many private clinics specialize in sports and orthopedics, but there are more clinics that now specialize in neurology. UBC’s Pacific Parkinson’s Research Centre has a physiotherapist you can consult with if you are being seen there. Some hospital outpatient physiotherapy clinics have specific neurology physiotherapists. If you are home bound, a home care physiotherapist may be able to see you in your home through home health services.

How often should I see a physiotherapist?

This will depend on your needs, goals and the resources and services available. What is most important is that you are provided with the tools, education, movement strategies and exercises that you can follow on your own on a regular basis. A routine will help you get the best results.

Are there any specific questions I should ask the physiotherapist when I visit them?

You will want to know about what kinds of exercises or other treatment that can be offered to help to improve your mobility and address any specific concerns you have related to your physical function.

How much does physiotherapy cost?

Physiotherapy services offered in public health settings such as hospitals, home health and the UBC Movement Disorder Clinic have no fee. Private physiotherapy costs will vary and it is best to contact the therapist or clinic directly. The Physiotherapy Association of BC has a website with a ‘find a physio’ feature where you can search for services in your community. If you have extended health benefits some or all of the costs may be covered. Otherwise, physiotherapy is a medical expense that may be applied to your tax return.

This content was published in the Spring 2015 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.