Controlled trial of physiotherapy and occupational therapy for Parkinson's disease.
Twenty-four patients with Parkinson's disease attending the neurological clinic were included in a controlled cross-over trial of physiotherapy and occupational therapy. Medication was stable in all cases, and no patient had received physiotherapy or occupational therapy before. Speech, gait, posture and balance, tremor in the worst arm, and rigidity in the worst arm were assessed and graded as normal (0) to severely disabled (4); and the following specified activities were timed: rising from a seat, walking 6 m, turning round, walking back to the chair, and sitting down; number of times the patient could open and close his fist fully in 10 seconds (worst hand); time taken to insert a set of pegs into a peg board; and time taken to insert a sheet of cardboard into an envelope. After initial assessment the patients received either active or inactive treatment. They were then reassessed, and after a three-month gap crossed over to receive the alternative treatment. For each treatment the patients attended hospital eight times in four weeks. During active treatment physiotherapy and occupational therapy were planned according to individual needs. Active physiotherapy was geared to positive treatment using proprioceptive neuromuscular facilitation and Bobath and Peto methods. These were used to improve rotation, balance, and walking, reduce festination, and increase the range of movement where rigidity was a problem. Active occupational therapy was aimed at improving personal independence and functional activities, such as mobility, feeding, dressing, and cooking. During active therapy relatives were invited to observe treatment and encourage the patient's activities at home. Inactive treatment consisted of infrared radiation to the thorax and diversional activities such as table games and crafts, with minimal supervision. Of the 24 patients (18 men, average age 68-9 years; six women, average age 731 years), eight were withdrawn: one during the initial treatment, four during the three-month gap before cross-over, and three during the second course of treatment. One of these eight patients died, four required treatment for other illnesses, and three could not continue for social reasons. Twenty-three patients completed an initial course, and 16 the full cross-over study. Results (table) obtained in each test in the assessment made by the doctor before treatment were compared with those obtained immediately after treatment using the sign test for comparison of grades (assessments 1-5) and Wilcoxon's rank paired test for the timed data (assessment 6-9). In no test was there a significant change after treatment.