3.4 Parkinson's Disease, MS, ALS, & GBS

Parkinson's Disease (PD)

Parkinson's disease (PD) is a progressive disorder caused by loss of dopamine-producing neurons. The cardinal motor signs are often remembered as TRAP: Tremor (resting, pill-rolling), Rigidity (cogwheel), Akinesia/bradykinesia (slow, small movement), and Postural instability. Patients also show a stooped posture, shuffling festinating gait, hypokinesia, and freezing episodes.

Hoehn and Yahr Staging

PTA Interventions

• LSVT BIG (Lee Silverman Voice Treatment BIG) principles train large-amplitude, high-effort movement to counteract hypokinesia; the PTA cues the patient to move "big."
• External cueing bypasses the impaired internal movement drive: visual lines on the floor to step over, an auditory metronome or music for cadence, and rhythmic counting to initiate and sustain gait.
• Strategies for freezing: stop, reset posture, shift weight side to side, then step to a cue rather than pushing forward.
• Emphasize posture extension, trunk rotation, reciprocal arm swing, balance, and fall prevention. Schedule sessions during peak "on" medication time when possible.

Multiple Sclerosis (MS)

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, often following a relapsing-remitting course. Symptoms vary widely: fatigue, weakness, spasticity, sensory loss, ataxia, visual changes, and bowel/bladder dysfunction.

Key PTA Precautions

• Fatigue management is central. Fatigue is one of the most disabling MS symptoms. The PTA uses energy conservation, activity pacing, frequent rest breaks, and submaximal exercise; the goal is consistent function, not exhaustion.
• Uhthoff's phenomenon: a rise in body temperature transiently worsens MS symptoms. The PTA keeps the patient cool — cooler treatment environments, cooling garments, hydration, exercising during cooler times of day, and avoiding hot modalities or overheating.
• Train balance, gait, and strength at submaximal intensities; avoid overwork weakness.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, is a progressive degeneration of both upper and lower motor neurons, producing a mix of spasticity and flaccid weakness with atrophy and fasciculations. It is relentlessly progressive.

Key PTA Precautions

• Monitor respiratory status closely. Respiratory muscle weakness is the leading cause of death; watch for shortness of breath, weak cough, and reduced endurance, and report changes promptly.
• Avoid fatiguing, high-intensity exercise — overwork can worsen weakness in already-failing muscles. Use gentle, submaximal activity.
• Focus on function, energy conservation, contracture prevention (PROM and stretching), safe mobility, caregiver training, and timely equipment (assistive devices, wheelchair, orthotics) as the disease progresses.

Guillain-Barre Syndrome (GBS)

Guillain-Barre syndrome (GBS) is an acute, immune-mediated polyneuropathy, often after an infection. It classically produces a rapid, ascending, symmetrical paralysis beginning in the legs and moving upward, with risk to the respiratory muscles in severe cases. Unlike ALS, GBS is usually followed by gradual recovery over weeks to months in a descending pattern.

Key PTA Precaution

• During the recovery phase, overexertion can worsen outcomes. The PTA uses submaximal, non-fatiguing exercise, frequent rest, and gradual progression as strength returns. Acutely, monitor respiratory status and vital signs; later, prevent contractures and overwork while progressively rebuilding endurance and function within the plan of care.

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