Parkinson’s Rehabilitation

Support for movement, balance and everyday independence

Parkinson’s can affect the way you walk, balance, turn, stand up and complete everyday movements. Some people also experience stiffness, reduced strength, slower movement or periods where starting a movement becomes difficult.

Parkinson’s rehabilitation focuses on maintaining movement and physical ability for as long as possible while addressing the difficulties that are most relevant to you.

Treatment is adapted to your symptoms, stage of Parkinson’s, general health and daily routine rather than following the same programme for everyone.

What is Parkinson’s rehabilitation?

Parkinson’s rehabilitation uses physiotherapy and structured exercise to help manage changes in movement associated with the condition.

Physiotherapy does not cure Parkinson’s or stop every change caused by the condition. Instead, rehabilitation focuses on maintaining mobility, improving physical capacity and developing practical strategies for movements that have become more difficult.

Treatment may involve:

• Walking practice
• Balance exercises
• Strengthening
• Flexibility and mobility exercises
• Posture work
• Strategies for freezing
• Practising everyday movements
• General cardiovascular exercise
• Falls prevention
• Advice for family members or carers

The programme can change over time as your needs and abilities change.

When Parkinson’s physiotherapy may help

An assessment may be useful if you are experiencing:

• Slower walking
• Shorter or shuffling steps
• Difficulty starting to walk
• Freezing of gait
• Difficulty turning
• Reduced balance
• Falls or near falls
• Difficulty getting up from a chair
• Problems getting in or out of bed
• Reduced arm swing while walking
• Stiffness
• Reduced strength
• Changes in posture
• Difficulty using stairs
• Reduced confidence outdoors
• Fatigue during physical activity
• Difficulty keeping up with your usual exercise
• Reduced independence with everyday movement

Physiotherapy may also be useful earlier in the condition to establish an appropriate exercise routine before significant mobility difficulties develop.

What happens during your first appointment?

Your first appointment begins with a discussion about how Parkinson’s currently affects your movement and everyday routine.

The physiotherapist may ask about:

• When you were diagnosed
• Your current Parkinson’s symptoms
• Medication and how movement changes during the day
• Walking difficulties
• Freezing episodes
• Falls or near falls
• Balance
• Stiffness
• Fatigue
• Current exercise
• Work and hobbies
• Mobility aids you currently use
• Other medical conditions
• Activities that have become more difficult
• What you would most like to improve or maintain

The physical assessment may include:

• Walking
• Turning
• Standing balance
• Getting up from a chair
• Strength
• Joint movement and flexibility
• Posture
• Stepping
• Coordination
• Getting on and off the floor where appropriate
• Movements that are particularly difficult for you

The aim is to understand both your current physical ability and the situations where movement becomes more challenging.

What rehabilitation may include

Treatment is based on the difficulties identified during the assessment.

Walking practice

Walking may change as Parkinson’s progresses.

You may notice:

• Shorter steps
• Reduced walking speed
• Less arm swing
• Difficulty turning
• A tendency to shuffle
• Difficulty starting to walk
• Increased effort when walking

Physiotherapy may include practising larger, more deliberate steps and working on rhythm, posture and arm movement.

Walking exercises can be progressed towards the environments you normally use, including your home, outdoors or busier public spaces.

Balance exercises

Changes in balance can increase the risk of falls and may make people less confident when moving independently.

Exercises may work on:

• Standing balance
• Stepping
• Changing direction
• Reaching
• Moving around obstacles
• Uneven surfaces
• Recovering balance after a small disturbance
• Walking while changing direction

The level of challenge will depend on your current ability and falls risk.

Strengthening

Maintaining muscle strength can make everyday movement easier.

Exercises may focus on:

• Legs and hips
• Calves
• Trunk and core muscles
• Back muscles
• Shoulders and arms
• General whole-body strength

Strengthening can help with activities such as standing from a chair, climbing stairs, walking and maintaining an upright posture.

Mobility and flexibility

Stiffness can make movement feel slower or more restricted.

Mobility exercises may focus on:

• Trunk rotation
• Shoulder movement
• Hip movement
• Ankle movement
• Reaching
• Turning
• Larger whole-body movements

The aim is to maintain useful movement for everyday activities rather than simply increasing flexibility.

Home exercise programme

You may receive exercises to practise between appointments.

The programme can be kept manageable and adjusted as your ability changes. Regular physical activity is generally more useful than relying only on exercises completed during physiotherapy appointments.

Walking with Parkinson’s

Walking changes are common in Parkinson’s, but the pattern differs between individuals.

Some people begin taking shorter steps. Others find that walking becomes faster and more difficult to control, or that their feet seem temporarily stuck to the floor.

Rehabilitation may work on:

• Increasing step length
• Starting and stopping
• Changing direction
• Walking around obstacles
• Arm swing
• Walking speed
• Outdoor mobility
• Turning safely
• Managing doorways and narrow spaces

The aim is to make walking more practical and confident within your normal environment.

Freezing of gait

Freezing describes a temporary difficulty starting or continuing movement even though you intend to move.

It may feel as though your feet are stuck to the floor.

Freezing can occur:

• When starting to walk
• When turning
• When approaching a doorway
• In narrow spaces
• In crowded environments
• When trying to move quickly
• When attention is divided between several tasks

Different strategies work for different people.

Physiotherapy may introduce external cues such as rhythm, counting, visual markers or deliberate stepping strategies to help restart movement.

Rather than repeatedly trying harder to move during a freezing episode, learning a specific strategy can sometimes make the situation easier to manage.

Cueing strategies

Parkinson’s can affect movements that previously happened automatically.

External cues can sometimes help provide another way of initiating or maintaining movement.

Examples may include:

• Counting steps
• Walking to a rhythm
• Stepping over a visual target
• Using deliberate larger movements
• Breaking a movement into separate stages
• Saying an instruction aloud before moving

A cue that works well for one person may not work for another.

During rehabilitation, different strategies can be explored and then practised in situations where movement usually becomes difficult.

Turning

Turning can become particularly challenging for some people with Parkinson’s.

You may take several very small steps, feel less stable or experience freezing when changing direction.

Rehabilitation may involve practising:

• Wider turns
• Deliberate stepping
• Turning in stages
• Moving the feet rather than twisting through the body
• Turning around furniture
• Turning in narrow spaces

These strategies can then be practised in situations that reflect your home or community environment.

Getting up from a chair

Standing from a chair may become slower or require several attempts.

Physiotherapy can look at:

• Foot position
• Moving the body forwards
• Using momentum appropriately
• Leg strength
• Chair height
• Repeated practice

Strengthening the legs can also form part of treatment if weakness is contributing to the difficulty.

The aim is to make the movement more reliable rather than depending entirely on someone else pulling you to standing.

Moving in bed

Parkinson’s can make rolling and changing position in bed more difficult.

You may experience difficulty:

• Rolling from side to side
• Moving towards the edge of the bed
• Sitting up
• Getting your legs into or out of bed
• Turning under the covers

Rehabilitation may involve practising these movements in separate stages and identifying strategies that make them easier to initiate.

Family members or carers may also be shown safer ways to assist where appropriate.

Posture

Parkinson’s can gradually affect posture, and some people develop a more forward-flexed position.

This may influence:

• Walking
• Balance
• Looking ahead
• Reaching
• Breathing during activity
• Comfort when sitting or standing

Physiotherapy may include exercises aimed at maintaining trunk movement, upper-body strength and awareness of a more upright position.

The goal is not to hold one rigid posture throughout the day, but to maintain the ability to move through different positions.

Balance and falls

Falls can occur for several reasons in Parkinson’s, including changes in balance, freezing, turning, reduced step length or difficulty responding quickly when balance is lost.

A falls assessment may consider:

• When falls happen
• Where they occur
• Turning
• Walking speed
• Footwear
• Strength
• Balance
• Freezing
• Mobility aids
• Home or outdoor environments

Treatment may include strength and balance exercises alongside practical movement strategies.

Where falls are occurring frequently, other healthcare professionals may also need to be involved.

Getting up from the floor

For people who are able to practise safely, learning how to get up from the floor can be useful.

The physiotherapist may break the movement into manageable stages and practise:

• Rolling
• Moving onto hands and knees where appropriate
• Using furniture for support
• Moving into kneeling
• Standing safely

Not everyone should practise floor transfers independently, particularly where falls risk, osteoporosis, previous injury or another medical condition makes this unsafe.

Strength and physical conditioning

Parkinson’s itself can make movement more difficult, but reduced activity can add another problem.

If you gradually become less active, muscle strength and cardiovascular fitness may decline.

This can make:

• Walking
• Stairs
• Standing
• Household activities
• Shopping
• Exercise

more tiring than they need to be.

A rehabilitation programme may therefore include both Parkinson’s-specific movement practice and general strengthening and cardiovascular exercise.

Exercise and Parkinson’s

Physical activity can form an important part of managing Parkinson’s.

The most appropriate exercise depends on your symptoms, fitness, balance and interests.

Activities may include:

• Walking
• Strength training
• Cycling
• Swimming
• Exercise classes
• Dance
• Balance exercises
• Gym training
• Mobility exercises

The programme does not need to remain gentle indefinitely simply because you have Parkinson’s.

Where appropriate, exercise can be challenging enough to improve strength and fitness while remaining safe for your current ability.

Returning to or maintaining the gym

If you already exercise regularly, physiotherapy can help identify ways to adapt your training as movement changes.

Gym exercises may include:

• Squats or sit-to-stands
• Leg strengthening
• Pulling and pushing exercises
• Calf exercises
• Trunk rotation
• Cardiovascular training
• Balance work

Exercises can be adjusted for safety without unnecessarily removing physical challenge.

If balance is reduced, additional support or supervision may initially be appropriate.

Fatigue and Parkinson’s

Fatigue can affect physical activity and may not always improve simply by resting.

On some days you may have enough energy for a full programme, while on others normal activities may feel considerably harder.

Rehabilitation may involve planning activity around your energy levels and identifying a manageable balance between exercise, daily tasks and recovery.

The aim is not to stop whenever fatigue appears, but also not to repeatedly exercise to the point where normal daily activity becomes difficult.

Medication and movement

Parkinson’s medication can affect how easily you move at different times of the day.

Some people notice periods when medication is working well and movement feels easier, as well as periods when symptoms become more noticeable before the next dose.

Understanding this pattern can be useful when planning:

• Exercise
• Walking
• More demanding activities
• Physiotherapy sessions
• Daily routines

Physiotherapy does not replace medical management of Parkinson’s medication.

If you notice significant changes in how medication is working, new side effects or increasingly difficult “off” periods, these should be discussed with your Parkinson’s nurse, neurologist or medical team rather than changing medication independently.

Dual-task activities

Walking while doing something else can become more difficult for some people with Parkinson’s.

Examples include:

• Walking while talking
• Carrying an object
• Looking for something while walking
• Turning while answering a question
• Moving through a busy environment

Rehabilitation may practise these situations when appropriate.

In other situations, it may be safer to deliberately concentrate on one movement at a time.

Your physiotherapist can help identify where practising divided attention is useful and where simplifying the task is safer.

Mobility aids

Some people with Parkinson’s eventually benefit from a walking stick, walking frame or another mobility aid.

Using an aid is not necessarily a sign that rehabilitation has failed.

The right equipment may allow you to:

• Walk further
• Move more safely
• Reduce falls risk
• Maintain independence
• Continue activities outside the home

However, not every walking aid is suitable for Parkinson’s, particularly when freezing or particular walking patterns are present.

An assessment can help determine whether an aid is appropriate and how it should be used.

Maintaining independence

One of the main aims of Parkinson’s rehabilitation is to support independence for as long as possible.

Treatment may focus on practical movements such as:

• Getting out of bed
• Standing from a chair
• Walking around the home
• Using stairs
• Getting in and out of a car
• Shopping
• Moving outdoors
• Exercising
• Participating in hobbies

The rehabilitation programme can be built around the activities that are most important to your own routine.

Home and community mobility

Movement inside a clinic is not always the same as movement in daily life.

Difficulty may become more noticeable:

• In crowded places
• At doorways
• On uneven ground
• In smaller rooms
• When crossing roads
• When carrying something
• When moving quickly
• When attention is distracted

As rehabilitation progresses, strategies can be practised for the situations that cause the most difficulty.

The aim is for treatment to translate into useful movement outside the clinic.

Support for family members and carers

Family members and carers can play an important role when mobility becomes more difficult.

Where appropriate, they may be shown:

• How to provide safe assistance
• How to respond during freezing
• How to help with transfers
• How much support to provide
• How to encourage active participation rather than completing every movement for the person

This can make everyday movement safer while helping the person with Parkinson’s remain as involved as possible.

Working with other healthcare professionals

Parkinson’s can affect more than movement.

Depending on your symptoms, rehabilitation may involve a wider team including:

• Neurologists
• Parkinson’s nurses
• Occupational therapists
• Speech and language therapists
• Dietitians
• GPs
• Pharmacists
• Other relevant healthcare professionals

Physiotherapy primarily focuses on movement, balance, mobility, strength and physical activity.

Occupational therapy may help with daily tasks and equipment, while speech and language therapy may be involved when speech, communication or swallowing are affected.

Rehabilitation as Parkinson’s changes

Parkinson’s is a progressive condition, so rehabilitation goals may change over time.

Earlier rehabilitation may focus on:

• Establishing regular exercise
• Maintaining fitness
• Improving movement quality
• Keeping physically active

Later rehabilitation may place greater emphasis on:

• Walking strategies
• Freezing
• Falls prevention
• Transfers
• Mobility aids
• Maintaining independence
• Support for carers

Treatment can therefore be reviewed at different stages rather than using one programme indefinitely.

When there is a sudden change

Parkinson’s symptoms generally change over time rather than causing every sudden new problem.

A sudden major change in movement, balance, strength or awareness should not automatically be assumed to be Parkinson’s.

Seek appropriate medical assessment for symptoms such as:

• Sudden weakness or numbness
• New difficulty speaking
• Sudden severe dizziness
• Loss of consciousness
• A significant unexplained change in walking
• New severe confusion
• A serious fall or injury
• Rapid deterioration that is different from your usual symptoms

Changes in medication response, repeated falls or a noticeable deterioration in normal Parkinson’s symptoms should also be discussed with the healthcare team managing your condition.

Treatment based on your goals

Parkinson’s affects everyone differently.

Your rehabilitation goals may include:

• Walking with larger steps
• Turning more confidently
• Managing freezing
• Reducing falls
• Getting out of a chair more easily
• Staying physically active
• Continuing to use stairs
• Returning to the gym
• Walking outdoors
• Maintaining independence at home
• Staying involved in hobbies
• Feeling more confident with movement

Treatment can be developed around these practical goals and adjusted as your needs change.

How long will Parkinson’s rehabilitation take?

There is no single timeline.

Some people may benefit from a period of physiotherapy to address a particular movement problem and establish an exercise programme.

Others may return for further rehabilitation when symptoms or mobility needs change.

Because Parkinson’s is a long-term condition, maintaining regular physical activity outside physiotherapy is an important part of rehabilitation.

The aim is to provide exercises and strategies that can be used independently as much as possible while reviewing them when circumstances change.