Every patient with PD should be educated on neuroprotection and neuroplasticity, and the earlier they are educated, the better. In treating those diagnosed with a progressive disorder, you want to empower them on how they can change their brain and maximize the benefits of their exercise program. The intensity, difficulty, complexity and specificity of exercises need to be explained and incorporated in their exercise routines. Although they may consider themselves “active,” their intensity may not be at a sufficient level to promote the most benefits. An easy way to access the intensity of their walking is to count their steps per minute and use a metronome to maintain their speed and/or increase it (100 steps/min would be considered moderate intensity). Your role as a physical therapist is to increase the intensity level of practice beyond their self-selected energy expenditure. Many of my patients reports therapists do not work them hard enough and give in to their complaints. Make sure you always try to motivate and work your patient to their fullest ability; help them understand they are capable of moving more than they think.
Besides the intensity of exercise, the quality of movement maintained during repetitive movements is very important. One of the main movement problems due to basal ganglia disorder is the failure to automatically maintain an appropriate amplitude and timing of sequential movements. Training should include awareness of complete muscle activation, attention to effort and amplitude of movement. Use auditory cues (music or metronome while walking on a treadmill), visual or tactile cues (touching a target to maintain range of motion during calf raises) will immediately enhance the size and timing of their movement and therefore maximize overall performance.
You should become aware of your patient’s goals and interests (i.e. sports, hiking, dancing) and incorporate task specific exercises to help improve outcomes and compliance. For example, if your patient plays tennis, incorporate the racket in your session during reaching and stepping exercises.