The Movement Disorder Specialists include neurologists and geriatricians who have additional training in Parkinson’s disease and other movement disorders. They provide expert care for the diagnosis of PD and other movement disorders, prescribe and adjust medications, advise on the suitability of deep brain stimulation and other surgery and discuss drug trials.
A physiotherapist has specialised training in the assessment and rehabilitation of movement after injury, disease or health disorders. A physiotherapist specialised in movement disorders has the skills to assess the impact of the movement disorder on mobility, walking, balance, strength, fitness and function. They are trained to prescribe tailored exercise programs to improve motor symptoms such as balance and walking problems and minimise disability and optimise quality of life.
Based on the assessment, a physiotherapist can tailor an exercise program to meet your needs. Even if you have just been diagnosed with PD, a physiotherapist can advise you on how to remain physically active and suggest exercises that can help you move well and minimise the physical effects of PD.
A physiotherapist can develop a home program for you that you do on your own but with regular reviews to adjust it as needed.
A physiotherapist can work with your local gym instructor to ensure that your gym program is suitable for you.
If you need adaptive equipment, such as a walking aid, a physiotherapist can determine which one best suits your needs.
An occupational therapist is trained in the assessment and treatment of changes to a person’s function due to injury, disease or a health disorder. An occupational therapist specialised in movement disorders has the skills and knowledge to assist with managing the many functional challenges due to movement disorder, such as PD.
An occupational therapist aims to improve the person’s quality of life and optimise independence.
If you are having trouble with your writing, with using eating utensils, with washing and dressing yourself, getting into and out of bed, an occupational therapist can advise you on ways to make these daily tasks easier and safe to perform by using practical strategies and equipment.
They are able to determine which equipment and modifications for the home can improve safety and ease of moving, such as a shower chair, grabs rails, and ramps to replace steps.
If your doctor has suggested that you need a driving assessment, a specialist occupational therapist will be required to complete this assessment.
Occupational therapists have a good understanding of the effects of cognitive changes on everyday tasks. They are therefore well suited to advise you on strategies to address your difficulties, such as managing your medications using the best dispenser for you, use of a suitable alarm or reminder device to ensure you take your medications on time.
An occupational therapist will work with a physiotherapist on developing strategies to lessen your risk of falling, such as the use of a walking aid, removing obstacles in your home, and possible use of a wheelchair for improving access to the community.
They can also support your participation in leisure activities through the use of adaptive equipment.
A speech pathologist is trained in the assessment and treatment of speech, language eating, swallowing and drooling problems. A speech pathologist specialised in movement disorders has the skills and knowledge to assist with managing the many changes to voice and swallowing due to PD or other movement disorders.
A speech pathologist will first determine why you are having problems then suggest how therapy may help you. Any suggested strategies will be tailored to your specific needs.
Regardless of how long you have had PD, a speech pathologist will be able to assist you. Seeing a speech pathologist while your symptoms are mild is important as they will be able to suggest strategies to improve them before they have a significant impact on your function. Acting early can also prevent or delay the development of other problems.
If your PD is advanced and you have severe communication problems, a speech pathologist can advise on communication aids, such as voice amplifiers, electronic communication devices and computer software programs.
If you have severe eating and swallowing difficulties, your speech pathologist may discuss alternative methods of food preparation, such as thickened drinks and pureed food, or other ways to take in nutrients, such as having a feeding tube inserted into your stomach.
Your speech pathologist will work closely with a dietitian when planning ways to ensure you get adequate nutritional intake.
A dietitian can help plan a healthy, well-balanced diet for the person with a movement disorder.
For most people with PD, or another movement disorder, it is important to ensure adequate protein intake and to avoid weight loss.
A dietitian will assess your current food intake, determine if your weight is suitable for you and plan your short and long term nutritional goals. If you are losing weight, it is important to identify what may be causing this, such as loss of appetite, excessive dyskinesia, swallowing difficulties, etc. It is less common to gain weight, however this may be a problem in people who have deep brain stimulation.
Your dietitian will advise you on ways to address any nutritional problems you have. Oral nutrition supplements may also be suggested by your dietitian to improve your overall nutritional intake. If eating and swallowing problems are contributing to your poor food intake, your dietitian will work with your speech pathologist to develop ways to improve this. When protein is interacting with your PD medications and causing you to go ‘off’ or slow down after meal time, speak to your dietitian who will be able to advise you on ways to manage this. Do not avoid protein foods as they are important for growth and repair of your body and essential for your overall health, especially muscle health. Seek advice first.
A social worker has the expertise to assist with social and emotional needs.
A social worker specialised in movement disorders understands the impact the disorder, such as PD, has on the person, their caregiver/partner and family. Social workers aim to understand each person or family’s unique situation and goals and tailor all interventions to the individual.
Parkinson’s disease is almost a lifelong disorder and your needs and those of your caregiver and family will change over this time. A PD specialist social worker understands the symptoms of PD and how these symptoms affect your daily life. Social workers with expert knowledge on the impact of PD on the person’s wellbeing, on the stress PD puts on the caregiver and family are well placed to support you at whatever stage of your journey.
They can talk to you about emotional and personal matters and help you manage your reactions to having PD or other aspects of your life that you are finding difficult.
Sometimes people with Parkinson’s and their families talk with a social worker only once, for a specific issue, for information about a service, or at a point of transition or crisis. Others meet with social workers at periodic intervals, as specific needs emerge during the course of the disease.
A social worker may advise the person directly or refer them to other service providers for more detailed information and personal advice, for example when seeking advice regarding benefits and entitlements.
Social workers can help patients and families:
A neuropsychologist is a psychologist who specializes in understanding the relationship between the physical brain and behaviour. Disorders within the brain and nervous system can alter behaviour and cognitive function. The most common reason a person will see a neuropsychologist is for them to conduct a range of memory and cognitive tests to help clarify the degree of any cognitive difficulties they may have.
It is a normal for anyone with PD to have cognitive problems, such as being slow in processing information. However disorders such as dementia may cause similar problems. A neuropsychologist is able to identify those cognitive problems that are due to your PD and those that may be due to another disorder, such as dementia.
A nurse specialised in movement disorders understands the impact a movement disorder, such as PD, can have on you, your caregiver and family. The nurse helps you as the person living with PD and your family understand your PD symptoms and how PD medications can control them. The nurse works closely with your movement disorder medical specialist and can act as a ‘bridge’, answering queries or referring you to other professionals within the multidisciplinary team.
Nurses who have been specially trained in Parkinson’s disease may be closely involved in several aspects of your care, such as determining if your PD medications are optimal for you, observation of your symptoms to determine if they are due to side effects of your PD medications and referring you to another team member if appropriate.
If you are on Duodopa therapy, the Parkinson’s disease nurse can assist you with education on using the pump and caring for the tube (PEG). They can help with troubleshooting when there are sudden changes, such as the Duodopa suddenly not working.
The nurse working for the MDC can offer support by phone or face to face and can help monitor your responses to changes to your PD medications and feedback to your neurologist or general doctor any concerns caused by the changes.