Meeting with a physiotherapist can take place in a variety of settings, including your own home, a hospital, Parkinson's clinic, rehabilitation unit, out-patient clinic or a nursing home.
The initial appointment will last between 30 - 45 minutes, although this will vary depending on in which country you live. Further assessment and treatment sessions should take between 30 - 60 minutes, depending on whether it is an individual or a group session.
At the first appointment the physiotherapist will assess your mobility problems, analyse why they occur and will define your individual needs. With your involvement, a treatment plan will be developed and goals of treatment will be set.
The physiotherapist will ask you (and your partner or carer if present) what you consider are your main difficulties regarding mobility. Depending on your obvious level of physical movement, he or she will also ask questions such as:
- do you have difficulty when walking or turning, as if your feet are glued to the floor?
- do you walk unaided or sometimes require an aid, like a stick?
- do you ever fall or are afraid of falling? If this happens, are you able to get up from the floor on your own or with help?
- do you have problems moving from one position to the other, such as getting up from a seat or turning in bed?
- do you have difficulty in reaching and grasping objects?
- do you have pain, for example in your joints or muscles?
- do you take anti-Parkinsonian medication? If so what, and at what time of the day?
- at what time of the day or night do difficulties occur? Is it always the same time, or are they unpredictable?
- do you have involuntary movements (dyskinesias)? If so when?
- do you feel tired or have difficulty concentrating?
- do you feel lonely or sad?
- do you work or drive and what are your hobbies?
- do you have other medical conditions such as arthritis, diabetes or heart problems?
- what is your home environment like? For example, do you have stairs? Do you live alone, or with a partner or carer?
- finally, the physiotherapist will ask what you expect from the treatment?
Once the physiotherapist has an understanding of your particular difficulties and requirements, he or she will then need to establish when you last took your medication before conducting a physical examination.
During the physical examination the physiotherapist will observe how you walk, whether you can change direction whilst walking, and if you can turn or move from one position to the next, including rolling over in bed, sitting and standing up. The physiotherapist will assess your posture when you are sitting, standing and walking and will check if you have problems with tremor and, if so, the ways in which it affects your movement. Your balance will also be tested, normally by performing an unexpected, quick and firm jerk on the shoulders in a backwards direction (don’t worry – you won’t be allowed to fall). Other tests may include timing and counting your steps whilst walking a distance of 10 meters.
After assessment the physiotherapist will work with you to set goals according to your needs and a treatment plan will be established. Generally it will consist of an appropriate exercise programme, as well as coping strategies specific to your requirements, plus advice on ways to improve your daily life activities. When and how often you return to visit the physiotherapist will depend on your individual treatment plan.
