Balance, posture and gait issues are some of the most troublesome and difficult to treat Parkinson's symptoms. While tremor and muscle rigidity can be treated with dopamine replacement therapy, these medications are less useful when it comes to how you walk and maintain your balance.
Dr. Chris Hass of the University of Florida says patients can better control their balance, posture and gait symptoms through motor therapies, exercise and physical therapy.
“It concerns me that in many cases we wait to treat gait and balance until the patient has fallen versus seeing a physical therapist well in advance of falling,” says Dr. Hass, “so it’s important to almost 'pre-hab' the system. “
I waited for 2 years to get into the movement disorder neuro who has now left, and he never once mentioned physical therapy, exercise, vocal therapy, sleep neuro, balance, gait etc. etc. Just simply did the same diagnostic tests the 3 times I visited with him and wrote prescriptions. I tracked these down myself.
Pre-hab the system, if only. Glad I was tech savvy enough to check it out. I'm still learning every day.
Ditto the UK despite referral to Physio being recommended by the official NICE guidelines. I have to go through the so-called PD savvy clinic - can't self refer to the normal NHS provision. I have twice resorted to requesting this referral (My PD nurse forgot both times and had to be reminded) I got a lengthy assessment but the hip problems which lead me to request referral were not addressed at all which only dawned on me when I got home. Any sense that we might engage in Pre-hab related to my PD was totally absent.
There are one or two multi-disciplinary PD clinics but none near where I live.
Neither my neuro nor my PD nurse have ever initiated any discussion about exercise in the six years I have been dx. with PD.
Some useful discussion on this and other PD topics at
Yes, despite all the 'support' services in the UK for PWP, there's very little 'pre-hab' or preventative stuff that I have encountered. I'm grateful for our healthcare system, particularly when I read how many PWP can't get their insurance to pay for Aziclet in the States, whereas it was prescribed for me straight off the bat. Swings and roundabouts, I guess. I'm fortunate in that I have some financial resource, so can pay for gym membership, yoga classes and some private physio where I need it. I find this site very helpful for 'tips'. My stiff hand has responded rather well to the camphor oil massage someone here suggested. No healthcare professional has suggested how beneficial exercise is in managing PD yet I find it vital.
I take sinemet (CARBIDOPA/LEVODOPA) and it relieves my stiffness and the pain in my right hand. It returns to almost normal. Hand writing also is 95% of normal.
Yes, here in the States, Insurance doesn’t pay for many things, and certain preventative medicines etc. Aids for mobility, exercise/gym/physiology classes are all hard to get any financial support for. We have a broken healthcare system that is not amenable for fixed income elderly people, who have to pay high insurance premiums and high pharmacy costs for medicines.
I have been diagnosed for 11 year, am now 74 years. Looking back to the first few years, biggest thing I had going for myself was that that I was involved with Tai Chi, which I continued to practice at a studio I belonged to. Knowing it and its associated Mindfulness, has made a world of difference in balance issues. Five years ago, was lucky to find LSVT BIG. Takes on Movement Issues head on. Learning "free walking" will provide stunning benefits later. Should your symptoms evolve to where you experience feneistration of freezing. Look to the MOVE IT, program developed by Kevin Lockette PT. Shows the way to resolve gait problems.
Looking back, to when I was diagnosed, was the failure of the value of LSVT BIG and MOVE IT to have been brought to my attention, and the resulting loss of opportunity
to be better now, only if I could have learned them in the beginning!.
Hi Roy, I first encountered the PIGD PD type in one of your posts. After reading the NIH links that you included, I thought I recognized myself (80; diagnosed with DaTscan in Oct. 2018; early balance and gait issues on left side). My movement Neuro swatted away the idea when I brought it up without explaining why he thought not. But watching Dr.Hu from Oxford now erases any consolation I had from my doctor's dismissive diagnosis. Time, do you think, for a second opinion, or do only the bravest, most credentialed like Dr. Hu even venture opinions about PIGD?
It may be nice to know. Second opinion, I think you already know.
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Mild dyskinesia, severe dyskinesia and Freezing of Gait (FOG) 
Parkinson's and Mitohormesis - presentation by Dr. Matthew CL Phillips
advanced suggestions that dont cost $ for pwp. Poor posture.
Parkinson's disease and Medical Devices
