Abstract
The first evidence-based guidelines for physiotherapy in Parkinson’s disease (PD), developed according to international standards of guideline development, were published in 2004 by the Royal Dutch Society for Physical Therapy. In 2007 the Association of Physiotherapists in Parkinson’s Disease Europe produced a DVD in English and Dutch based on these guidelines, featuring practical illustrations and real patient video clips to promote research-based physiotherapy in PD in Europe. The guidelines identify six core areas of physiotherapy practice: physical capacity and prevention of inactivity; transfers; gait; posture; reaching and grasping; and balance and falls. They focus on axial symptoms, where drug response is on the whole not satisfactory. The aims of treatment vary according to disease stage: early or maintenance phase (Hoehn and Yahr [H&Y] stages 1–2), midor complex phase (H&Y 3–4) and late or palliative phase (H&Y 5). In the early stage the emphasis is in prevention of inactivity, physical conditioning and maintenance of joint mobility. In the middle stage the emphasis is on transfers, balance, posture, gait and upper limb function. In the late stage the emphasis is on mobilisation with aids and prevention of chest infection, contractures and pressure sores. The guidelines recommend the use of cognitive strategies for transfers by subdividing a complex movement and concentrating on the execution of each part. The guidelines also recommend the use of visual, auditory, proprioceptive and cognitive cues to manage problems of gait, and exercises for balance. The relevant problems for each patient are identified during physiotherapy assessment, and the appropriate treatment strategy requires the creative application of the guidelines. The European Parkinson’s Disease Association collected coping strategies invented by people with Parkinson’s disease, and compiled them in a DVD, which was launched at the III International Forum on Advanced Parkinson’s Disease in Seville 2008.