Table 1 Physiological constraints in Parkinson’s disease that affect balance and exercise
Constraint | Impact on balance and mobility | Exercise principles | Exercise examples |
|---|---|---|---|
Rigidity | Flexed posture ↓Trunk rotation ↓Range of motion | ↑Axial rotation ↑Reciprocal movements ↑Upright posture ↑Limits of stability ↑Big steps | Kayaking Shoulder roll |
Bradykinesia | Small and slow movements ↓Base of support | ↑Size of APA ↑Base of support | Clock lunges Speed skater |
Impaired Sensory Integration | ↓Kinesthetic awareness Overutilization of vision Instability on unstable surfaces | ↓Use of visual and proprioceptive input ↑Kinesthetic awareness | Cone tap standing on foam and wearing sunglasses |
Reduced Executive Function and Attention | ↓ Performance with dual tasks ↓Ability for complex sequencing of actions | ↑Performance with dual task (cognitive or motor) | Boxing with cognitive dual task Tai Chi |
Freezing | ↓APA ↓Visuospatial skills ↓Mobility with divided attention | ↑Weight shifting ↓Use of visual and auditory cues Layer exercises with dual task | Footwork drills: progressing to wearing sunglasses and adding dual task |
Inflexible Program Selection: task planning and sequencing | ↓Performance on functional transfers: sit-to-stand, rolling, floor transfers ↓Ability to quickly change strategy | ↑Performance of sequencing components of transfers ↑Ability to quickly change strategies | Floor exercises including rolling and getting on/off the floor |