Parkinson's Disease

Parkinson's reduces the automatic scaling of movement. Steps shorten, handwriting shrinks, the voice quietens, the arms stop swinging. The person is not choosing to move less — the internal system that sets the size of a movement is under-producing.

The important part is that the capacity is usually still there. When someone is asked to take deliberately huge steps, they often can. What has failed is the automatic setting, not the muscle. That single fact is what most of this programme is built on.

Most rehabilitation improves function without touching the disease. Parkinson's may be the exception. In a randomised trial of treadmill exercise in early Parkinson's, participants training at 80 to 85 per cent of maximum heart rate remained stable on motor scores over six months while the control group declined 4.

A definitive phase 3 trial is still running, so the honest statement is that a signal exists rather than that the case is closed. But it is a strong enough signal to change how a programme should be designed: towards effort, not towards comfort.

The practical consequence matters. Many people with Parkinson's are told, usually kindly, to take it easy. If the intensity finding holds, that advice is not merely unhelpful — it is the opposite of the treatment.

Because the problem is under-scaled movement, the training deliberately over-scales it: exaggerated steps, exaggerated reach, exaggerated turns, repeated at high effort until the larger movement starts to feel normal rather than theatrical.

Standardised amplitude programmes of this type improve step length and movement size, and patients frequently report that the effect carries into daily tasks. It feels absurd at first. That is expected and it is explained beforehand.

Freezing of gait — the feet stopping as though stuck, typically at doorways, when turning, or under time pressure — is one of the most disabling and most frightening symptoms. It is also one of the most treatable with a technique rather than a drug.

The internal rhythm that paces walking is impaired; an external rhythm can substitute for it. A metronome, a counted beat, lines on the floor, a laser projected in front of the foot, or a tap on the leg all restore stepping in many people. Trials of auditory, visual and tactile cueing show improved gait and fewer freezing episodes.

Cueing is taught as a skill the patient owns rather than as equipment they depend on, because the doorway that causes the freeze is at home, not here.

Falls in Parkinson's often happen while doing something else — carrying a cup, talking, thinking about the next room. Automatic walking has become non-automatic, so it competes with any second task for attention.

Training therefore includes dual-task practice under supervision, and, just as importantly, teaching when not to dual-task: stopping to talk, putting the cup down, doing one thing at a time in the situations where a fall would be costly.

This programme does not manage your Parkinson's medication. Levodopa timing and dose, and decisions about deep brain stimulation or infusion therapy, belong to your neurologist. We work around your medication schedule — therapy is timed to your best 'on' periods rather than to our timetable.

We also do not claim to reverse the condition. What the evidence supports is better function, fewer falls, larger movement, and possibly a slower rate of motor decline with sustained high-intensity exercise. That is a substantial claim already, and it does not need inflating.

Gains from amplitude and intensity training fade without maintenance, and the underlying condition continues. Blocks are usually planned every twelve to eighteen months, with a daily home programme in between.

The home programme is therefore designed to be sustainable rather than impressive — something that survives a bad week, because the weeks it has to survive are the point.

Three to six weeks, three to five hours a day. High-effort aerobic training at prescribed intensity, large-amplitude movement training, cued gait practice, balance and dual-task work, and speech and swallowing assessment where voice or swallowing is affected.

Therapy is scheduled around medication timing. The discharge document is written for your neurologist, and the home programme is written for you.