Introduction

A primary motor disorder, such as Parkinson's disease (PD), appears to be an ideal target for physiotherapy intervention. Referral to physiotherapy is recommended in the early stages of the disease (Dobbs et al. 1992) and there is evidence of the clinical effectiveness of physiotherapy at this time (Comella et al. 1994). Unfortunately it is still more common for referral to be delayed until the disease is advanced (Oxtoby 1982), when the opportunity to initiate a preventative treatment strategy has passed.

Physiotherapy has a significant role to play in the short and long-term management of PD. Physiotherapy must be integrated with other therapies. This will maximize the benefits of therapy for the patient and carer by ensuring consistency of approach, reinforcement of treatment aims, and by developing appropriate compensatory strategies (Kauser and Powell 1996).

The pathophysiology of the motor disorder in PD

Due to a deficiency of dopamine in the basal ganglia motor control is impaired in PD. Patients experience this in terms of difficulties with initiating, maintaining, and changing from one sequence of voluntary movement to another. Excess abnormal involuntary movement, such as tremor, may also be present. Balance is often impaired in elderly patients with PD. Clinical examination defines these difficulties in terms of akinesia, bradykinesia, tremor, rigidity and impaired postural reflexes. Impaired integration of normal control may contribute to these problems and a sense of increased effort of movement may result (Lövgreen and Cody 1997).