The ability to move. The neuromuscu-lar symptoms of Parkinson’s disease such as bradykinEsia and gait DISTURBANCES progressively impair movement and mobility, with a significant and direct effect on independence. Mobility can be unassisted or assisted. supportive THERAPIES such as PHYSICAL THERAPY and OCCUPATIONAL therapy can help to maintain mobility for as long as possible through structured exercises and techniques that preserve balance, coordination, and muscle strength. These may include the following:
• Regular walking with intentional effort focused on aspects of gait such as body position, arm swing, and stride length.
• Gentle strength (resistance) exercises with light weights, to maintain muscle mass and strength. Resistance activities such as strength training and walking also help maintain bone density and strength, which are particularly important in women who are past menopause and in older men as well.
• Activities that practice movements to minimize gait freezing and other gait disturbances, such as concentrating on lifting each foot completely from the walking surface with each step. Other strategies to overcome freezing include marching, clapping out a cadence, or using a ribbon or other object for the person with Parkinson’s to step over. Removing clutter and increasing open space often helps to reduce freezing in the home.
• Range of motion exercises to help to keep joints and the muscles that support them moving freely.
• Activities that practice hand-to-eye coordination, muscular coordination, and balance, such as catching and throwing a ball.
In the mid to late stages of Parkinson’s, continued neuromuscular degeneration results in increased difficulty with motor skills and balance. As lev-odopa and other anti-parkinson’s medications become less effective, symptoms become less predictable. MOBILITY aids such as walking sticks and walkers can provide stability, reducing the risk of falls. In late Parkinson’s, mobility may require a wheelchair. activities of daily living (ADL) measures and assessment tools such as the Parkinson’s impact scale can help to determine a person’s level of mobility.
Some aspects of mobility are psychosocial as much as they are physical. One of the toughest challenges for people with neurodegenerative diseases such as Parkinson’s is the progressive loss of independence. For many people one of the first activities relinquished is driving; stopping driving significantly curtails independent mobility in ways that extend well beyond functional ability. Many communities have low-cost public transportation alternatives for seniors and people with mobility limitations that can accommodate mobility aids including wheelchairs. The Americans with disabilities act (ADA) has established widespread access to public facilities for people with mobility impairments. Although accepting the transition to assisted mobility can be emotionally difficult for the person with Parkinson’s before a crisis such as a major fall demands it helps to extend independence. Innovation and creativity in dealing with mobility challenges are helpful, too, to adjustment to the changes that Parkinson’s imposes.