The Importance of Skilled Maintenance Physical Therapy in Parkinson's Patients
The Importance of Skilled Maintenance Physical Therapy in Parkinson’s Patients
Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder characterized by motor symptoms such as bradykinesia, tremor, rigidity, and postural instability. With the global prevalence of Parkinson’s rising—affecting over 10 million people worldwide—managing the condition holistically has become a public health priority [1]. Among various therapeutic strategies, skilled maintenance physical therapy (SMPT) stands out as a powerful intervention to preserve function, prevent secondary complications, and improve the quality of life in people with Parkinson’s.
What is Skilled Maintenance Physical Therapy?
Skilled maintenance physical therapy refers to the delivery of clinical services by licensed physical therapists aimed at maintaining a patient’s current functional abilities and preventing decline, rather than restoring lost function. Unlike restorative rehab (short-term), SMPT is intended for patients with chronic or progressive diseases like Parkinson’s where plateauing or declining function is expected without intervention.
According to the U.S. Centers for Medicare & Medicaid Services (CMS), SMPT is considered a covered service when “the services require the skills of a qualified therapist to perform a maintenance program safely and effectively” [2].
Key Benefits of Skilled Maintenance Physical Therapy in Parkinson’s
1. Preserving Mobility and Motor Function
Motor impairments in PD progressively affect gait, posture, and functional mobility. SMPT involves tailored interventions such as:
Gait training with visual and auditory cueing
Range of motion exercises
Strengthening routines
Postural control techniques
These therapies help patients sustain their functional baseline and delay deterioration [3].
Evidence: A study by Keus et al. (2014) supports the role of physiotherapy in improving physical functioning in PD, especially when interventions are individualized and continuous [4].
2. Preventing Falls and Injuries
Fall risk is significantly higher in people with Parkinson’s due to postural instability and freezing of gait. Recurrent falls can lead to fractures, fear of movement (kinesiophobia), and institutionalization.
SMPT programs often include:
Balance training
Transfer practice (e.g., sit-to-stand)
Home hazard assessments
Use of assistive devices
Evidence: The Parkinson’s Foundation notes that over 60% of people with PD fall annually, and SMPT can reduce fall frequency through targeted risk-reduction strategies [5].
3. Maximizing Neuroplasticity
While Parkinson’s involves the loss of dopaminergic neurons, the brain retains some capacity for neuroplasticity—the ability to form new neural connections through repetition and task-specific practice.
SMPT integrates:
Dual-task training
Task-oriented movement
High-repetition, intensity-appropriate exercises
Evidence: Research indicates that exercise can influence neurotrophic factors (like BDNF), enhancing brain plasticity and motor learning in PD [6].
4. Slowing Functional Decline
As Parkinson’s progresses, many patients lose the ability to perform activities of daily living (ADLs). SMPT emphasizes maintenance of current abilities, including bed mobility, transfers, and safe ambulation, thereby extending independence.
A longitudinal study by Dibble et al. (2010) showed that continuous physical therapy improved mobility and slowed deterioration in PD patients over 6 to 12 months [7].
5. Reducing Caregiver Burden
By helping individuals retain independence, SMPT indirectly reduces the physical and emotional strain on caregivers. Education on safe mobility, fall prevention, and adaptive strategies fosters a more manageable home environment.
Caregivers also benefit from training on:
Proper body mechanics
Safe transfer assistance
Communication during freezing episodes
Evidence: A review in Movement Disorders (2016) concluded that caregiver involvement in physical therapy planning leads to better outcomes and improved satisfaction [8].
6. Providing Patient and Family Education
Therapists play an integral role in educating patients and caregivers about:
Energy conservation
Symptom awareness and response
Equipment recommendations (e.g., walkers, grab bars)
Progression planning
This fosters a proactive care model rather than a reactive one.
When Should Therapy Begin?
Ideally, SMPT should begin soon after diagnosis, even if symptoms are mild. Early intervention helps patients establish a routine and delay functional loss. However, therapy remains beneficial at every stage of Parkinson’s.
Early stage: Focus on fitness, posture, and education
Mid stage: Emphasis on mobility, ADL support, and fall prevention
Late stage: Prioritize safety, caregiver training, and comfort care
Evidence-based guidelines from the European Physiotherapy Guideline for Parkinson’s Disease recommend long-term, consistent therapy throughout the disease continuum [4].
Conclusion
Skilled maintenance physical therapy is a vital and evidence-based intervention in the management of Parkinson’s disease. Beyond exercise, it offers a personalized, goal-oriented approach to preserving mobility, reducing complications, and enhancing patient autonomy. Given its proven benefits, SMPT should be recognized not as optional, but as essential in long-term Parkinson’s care.
References
Parkinson’s Foundation. (2023). Statistics and Facts. https://www.parkinson.org
Centers for Medicare & Medicaid Services. (2013). Jimmo Settlement Agreement FAQs. https://www.cms.gov
Tomlinson CL, Patel S, Meek C, et al. (2012). Physiotherapy intervention in Parkinson’s disease: a systematic review and meta-analysis. BMJ.
Keus SHJ, Munneke M, Graziano M, et al. (2014). European Physiotherapy Guideline for Parkinson’s Disease. KNGF/ParkinsonNet.
Parkinson’s Foundation. (2022). Falls and Parkinson’s. [https://www.parkinson.org]
Petzinger GM, et al. (2015). Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. The Lancet Neurology.
Dibble LE, Addison O, Papa E. (2010). The effects of exercise on balance in persons with Parkinson’s disease: a systematic review across the disability spectrum. Journal of Neurologic Physical Therapy.
Ellis T, Rochester L. (2016). Mobilizing Parkinson’s disease: The future of exercise. Movement Disorders.