Physical Therapy intervention in PD :Part 2.

3.BALANCE TRAINING : 
The balance training program is extremely beneficial for regaining the independence of the patient , to reduce the fear of falling and hence , reducing the fall episodes.
 The training should include a tailor-made simulative method by trying to duplicate the conditions the patient encounters everyday.
 There have to be clear and precise instructions from the therapist like ,"sit erect" or "stand tall"
 -stability tasks
weight shifts , reach-outs, axial rotation of head and trunk , axial rotation combined with functional reaching , etc.
 -seated activities
sitting on therapy ball or an inflatable discs , which is unstable and hence, motivates the patients to maintain balance.
-transitions
 from sit to stand , stand to sit , sit to lying supine and vice versa.
 -challenges
 voluntary movements while trying to balance, reduced lighting, open environment,etc
 Later, progression to dynamic activities can be made .
 Frenkel's exercises can also be used for balance training.

 4.LOCOMOTOR TRAINING: 
The focus of this training revolves around the obvious gait impairments like slow speed, reduced arm swing, stooped posture while walking , etc.
 These flaws can be corrected by firstly improving the dynamic balance and posture , then widening the Base of Support (BOS) , increasing the arm movements and increasing speed.
Proper visual and auditory feedback should be given to encourage the patient.
 Some stretegies include -
 -practice marching in place
 -lift the toes while walking
 -spread the legs to increase the BOS
-use smaller steps while turning
 -while experiencing a freezing episode , lift the toes off the ground


 5 CARDIOPULMONARY TRAINING:
 L-dopa can produce orthostatic hypotension and arrythmia.
Besides, any respiratory dysfunction leads to increased morbidity and mortality rates.
This can be commonly found in patients with PD because of the flexed posture and hence, reduction in lung expansion.
The following methods can be taught-
-deep breathing exercises
 -diaphragmatic breathing
 -maintained trunk extension
-aerobic training