Management of Bradyinesia in Parkinson’s Disease -Guidance
Bradyinesia refers to slow movement or slowness in carrying out an activity in Parkinson’s.
Management of Bradykinesia
Bradykinesia generally responds well to medication, especially in the early stages of the illness.
But as with any other symptom of PD, degree of Bradykinesia is different for each one with PD: thus the treatment is also very individual.
Exercises to improve quality of movement and increase muscle tone can help with everyday activities.
Occupational therapist can advice a few changes in routine to make the activities fater and more efficient.
Some tips for PwPS to deal with Bradykinesia:
1. Continue your usual daily activities and don’t reduce physical mobility as long as you are able to do so.
2. Engage in daily exercise that have been recommended to keep your muscles strong and flexible.
3. Adjust your daily routine to make it easier to continue on your own.
4. Follow the advice from occupational therapist to make life easier by using helpful devices such as Velcro instead of buttons, elastic waistbands, height-adjusting beds and raised seat cushions, which make it easier to get out of a chair. These techniques will help you do things faster and easier.
5. Maintain a positive attitude – Don’t let the frustration of slowing down hamper your confidence and independence. Manage your time wisely and give yourself nough time to complete your tasks on your own.
6. PwPs find Bradykinesia quite frustrating and disabling at times, but if you try to do the activity faster, you might make more mistakes or it will be clumsy.
Thus it is advised to take your own time to finish the activity at your own pace rather than doing it in hurry.
As Bradykinesia affects the speed and amplitude of movements, focusing on improving the quality of movements by focusing on big, complete, fast and strong movement help in PD.
Push and Pull Exercise:
Due to bradykinsia, actions such as quickly reaching out to the objects, pushing or pulling them with force, etc. Get affected. So let’s work on the same action in following exercise!
1. Push & Pull -Forward
When you are pushing a heavy carton forwards, we use both our hands also along with the force generated by the simultaneous movement of the trunk.
2. Sit erect in the middle of the chair, with both the feet kept apart.
3. Now take your trunk forward with both your arms forward as if you are pushing A heavy box with force forward and say “push”
4. Now from that position imagine that your have to pull a very heavy carton towards yourself. So now make a fist and draw both the arms backward by making a fist in such a way that elbows make 90 degrees angle with the shoulders and say “pull”
5. Repeat this for 10 times
6. Perform 2 sets of this exercise (1st set with normal speed and perform 2nd set faster)
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2. Push and Pull – Upwards
Now imagine you are pushing a carton somewhere on top,
1) Take the arms up by straightening the elbows and opening your hands and say “push”
2) From this position, get both the arms towards the body with elbows bent to 90 degrees. and say “pull”
3) Repeat the same exercise for 10 times
4. Perform 2 sets of this exercise (1st set with normal speed and perform 2 nd set faster.
Push and Pull -Side ways
1) Sit erect with the back straight.
2) Now imagine that you have to push the heavy objects present near you by the side.
3) Spread the fingers and straighten the elbows so that both the arms are at the sides and say “push”
4) Now from that position, get both the arms close to the body by making a fist and elbows bent to 90 degrees and say” pull”
5) Repeat the same for 10 times.
6) Perform 2 sets of this exercise (1st set with normal speed and perform 2 nd set faster)
Forearm twist (Pronation and Supination exercise)
1.) Sit on the chair with back straight.
2) Keep the right elbow in line with the shoulder bent to 90 degrees.
3) Hold the right arm with your left arm just above the elbow joint.
4) Turn th arm and palm once facing towards the floor.
5) Repeat the same for 10 counts
6) Now keep the left elbow in line with the shoulder bent to 90 degrees.
7) Hold the left arm just above the elbow joint with your right hand.
8) Turn arm and plam once facing towards the ceiling and then towards the floor.
9) Repeat the same for 10 counts.
10) Perform 2 sets of this exercise (1st set with normal speed and perform 2nd set faster)
Twist and Claps: Trunk Mobility
This exercise will improve the mobility of the trunk as well as the arms simultaneously.
1) start this exercise by instructing them to sit upright with feet kept wide apart and both arms spread wide apart.
2) Swiftly ask the patients to twist from the abdominal area and clap over the right hand with their left hand
3) Similarly swiftly ask them to twist from the abdominal area, open the arms wide apart and clap over the left hand.
4) Repeat it in Quick succession on the right and left side alternatively.
5) Repeat this exercise for 10 times.
6) perform 2 sets of this exercise (1 set with normal speed and perform 2 nd set faster)
You must have noticed that you take more time to get up from siting position to standing.
Also you would have faced difficulties in rising from the chair, bed, etc. This happens due to bradykinesia and rigidity in PD rocking in the chair is one of the strategies that can be used to effectively come to standing position.
As you repeat this action in quick successions, it will help you generate momentum that will prepare you for standing up easily.
1) Sit with the back erect in the middle of the chair.
2) Clasp both the hands, keep your elbows straight and lean forward as if grabbing an object from the front.
3) Then rock backwards in such a way that you touch the backrest of the chair.
4) Repeat this action for 10 counts in quick successions.
5) Perform 2 sets of this exercise (1st set with normal speed and perform 2 nd set faster)
Sit to Stand Exercise
1) Sit erect with both the feet shoulder width apart.
2) Come to the edge of the chair.
3) Place your feet behind your knees, place them shoulder width apart.
4) Hold your arm rest / chair, lean forwards, rock in the chair to get the momentum and shift your weight on your legs.
(Hands can be crossed across the chest or maintained at 90 degrees at shoulder level or hands can be placed on the thighs )
5) Get up in 5 counts, hold the standing position for 5 counts and sit down in 5 counts (3 repetitions)
6) Get up in 4 counts, hold the standing position for 4 counts and sit down in 4 counts (3 repetitions)
7) Now get up in 3 counts, hold the standing position for 3 counts and sit down in 3 counts (3 repetitions)
Hip abduction and adduction
This exercise is useful in improving the strength of the hip muscles
1) Sit erect on the chair and hold the chair by your side
2) Raise both the feet up with the knees kept straight.
3) Now get both the feet closer and far away.
4) Repeat this exercise for 15 counts.
5) Perform 2 sets of this exercise (1 st set with normal speed forward with the knee straight so that the right heel is in contact with the floor.
(Movement should be quick and complete the full range of movement)
Starting Position – Sit with the back straight and feet on the ground.
On the count of (1) straighten the right leg forward with the knee straight so that the right heel is in contact with the floor.
On the count of (2) straighten the left leg forward with the knee straight so that the left heel is in contact with the floor.
On the count of (3) bend the right knee and get it towards yourself such that now the toes of the right leg are in contact with the floor.
On the count of (4) bend the left knee and get it towards your self such that both the toes are touching the floor.