The Professional’s Guide
to Parkinson’s Disease
dietitian
GP
nurse
occupational therapist
pharmacist
physiotherapist
social worker
speech and language therapist

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Written by…
Ana Aragon Dip COT
Specialist Occupational Therapist for Parkinson's Disease, Bath & North East Somerset PCT
Bhanu Ramaswamy MCSP, Grad Dip Phys
Consultant Physiotherapist in Intermediate Care, Derbyshire County PCT
Dr J Campbell Ferguson MB, ChB, FRCP (Glasgow & Edinburgh)
Retired Consultant Physician, Ayrshire
Catherine Jones MRCSLT
Speech and Language Therapist, West Kent PCT
Charles Tugwell, BPharm, MSc, ACPP, MRPharmS, MCLIP
Clinical Pharmacist, Neurology/Neurosurgery, Senior Directorate Pharmacist, Head & Neck,
The Royal London Hospital, Barts and The London NHS Trust
Dr Chris Taggart MBChB, FRCGP
General Practitioner & Coventry GP Postgraduate Tutor, Tile Hill Primary Care Centre
Fiona Lindop MCSP, Grad Dip Phys
Senior Physiotherapist, Derby Hospitals Foundation Trust
Karen Durrant MCSP, Grad Dip Phys
Superintendent Physiotherapist, Derbyshire County PCT
Karen Green BSc, MSc
Senior Specialist Dietitian (Neurosciences), The National Hospital for Neurology & Neurosurgery
Karen Hyland Dip Diet, PGDip, RD
Team Leader, Nutrition and Dietetics, Barnet PCT
Sarah Barter BSc (Hons), DipSW
Registered Social Worker, General Social Care Council; Community Support Worker, Taunton and Minehead
Stella Gay RGN, BSc (Hons), PGDip Clinical Neuroscience
Parkinson’s Disease Nurse Specialist, East Elmbridge and Mid Surrey PCT
With thanks to…
Alison Forbes RGN
Parkinson’s Disease Nurse Specialist, Kings College, London
Dr Anna Jones PhD, BA, Grad Dip Phys, MCSP
Principal Lecturer/CETL4HealthNE Fellow, School of Health, Community and Education Studies,
Northumbria University, Newcastle upon Tyne
Anna Kissick MSc, MRCSLT
Community Speech & Language Therapist, East Elmbridge and Mid Surrey PCT
Annette Hand MA, Dip HE, RGN
Nurse Consultant – Parkinson's Disease, Northumbria Healthcare NHS Trust
Eric Skinner
Staff Development Officer, Social Services Department, Somerset County Council
Jane Hall MSc, MCSP
Senior Physiotherapist, Elderly Rehabilitation, East Elmbridge and Mid Surrey PCT
Julia Johnson MSc, LRCSLT
Clinical Specialist Speech and Language Therapist, Kings College Hospital Foundation Trust
Liz Scott BA (Hons), RGN
Parkinson’s Disease Nurse Specialist, Buckinghamshire Hospitals NHS Trust

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The Professional’s Guide
to Parkinson’s Disease

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Foreword
There are 120,000 people in the UK with Parkinson’s
The significance of the multidisciplinary team was
disease. This means it is likely that as a health or
highlighted in the 2006 NICE Guideline for Parkinson’s,
social care professional you regularly encounter people
which signals the importance of access to specialist
whose lives are affected by the condition.
diagnosis, regular reviews, Parkinson’s Disease Nurse
Specialists, therapists and palliative care. It is
Expert professional care can make a huge difference
important that commissioners build services in
to the quality of life of those affected. The Parkinson’s
accordance with the Guideline and the PDS is working
Disease Society (PDS) is committed to supporting
with commissioners and health and social care
professionals to deliver care of the highest quality and
professionals to support this process.
have therefore produced this guide for some of the key
groups of professionals working in the field.
One particular area in which PDS and health and
social care professionals are collaborating effectively to
When we started this project we consulted many
improve care is in relation to medicines management
professionals to get their views on whether we should
in hospitals and care homes. The Society’s ‘Get it on
continue to produce information in separate packs
time’ campaign aims to ensure that people with
aimed at different disciplines. The response was
Parkinson’s get their medication on time, every time,
unanimous: all were in favour of bringing information
as the timing of medication is crucial to their wellbeing.
together in one publication so it would be possible to
Hospital stays can be extended if medication is not
cross-reference between sections to get a holistic view
managed properly and the person concerned is likely
of the condition. This reflects the growing recognition
to require a higher level of care, at a significant cost
of the importance of the multidisciplinary approach in
in both time and resources to health services.
the management of Parkinson’s.
Please contact us if you would like a ‘Get it on time’
The guide is written by experts from different
campaign pack to help you make improvements in your
professionals groups and is divided into eight sections,
area of practice.
each tailored to the relevant discipline:
The PDS will continue working to develop close links
dietitian
with professionals, who also play a key role in putting
people in touch with the Society for further support
GP
and advice. Together we must reach every single
nurse
person in the UK living with Parkinson’s, to ensure they
occupational therapist
do not feel alone with their condition and have access
pharmacist
to the highest quality services and support.
physiotherapist
Further resources for professionals are available online
social worker
at www.parkinsons.org.uk/for_professionals.aspx
speech and language therapist
Of course there are many more professionals involved
with people with Parkinson’s and we hope this guide
will be a useful source of information for all of you.

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About the Parkinson’s
Contact us
You can write to us at the following email addreses:
Disease Society
professionals@parkinsons.org.uk
The Parkinson’s Disease Society (PDS) was
campaigns@parkinsons.org.uk
established in 1969 and now has nearly 30,000
enquiries@parkinsons.org.uk
members, over 40,000 supporters and more than 330
branches and support groups throughout the UK.
events@parkinsons.org.uk
membership@parkinsons.org.uk
We provide support and advice to people with
publications@parkinsons.org.uk
Parkinson’s, their carers, families and friends, and to
health and social services professionals involved in
research@parkinsons.org.uk
management and care. Our free Helpline service,
Or you can call our freephone Helpline on 0808 800 0303,
staffed by registered nurses and expert advisers, deals
Monday to Friday, 9am to 8pm (except bank holidays),
with more than 20,000 enquiries a year by telephone,
Saturdays, 10am to 2pm. (The Helpline is a confidential
email and letter.
service. Calls are free from UK landlines and some
We also produce a wealth of information for everyone
mobile networks.)
affected by Parkinson’s. Full details of all the resources
www.parkinsons.org.uk
available can be found on the PDS website.
Research is also a major focus of the PDS’s work.
Around a quarter of our total budget is spent on
supporting projects that aim to identify and improve
treatments, gain a greater understanding of the causes
of the condition and, ultimately, develop a cure, which
will allow people with Parkinson’s to live a life that is
free from the symptoms of the condition.
We also campaign for high-quality health and social
care for all people with Parkinson’s and their carers
at a national and local level. We believe that all people
with Parkinson’s should have easy access to high-
quality healthcare and the help and support they need.

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Contents
1
About Parkinson’s disease
The dietitian’s guide to Parkinson’s disease
7
Introduction
7
Diet and nutrition in Parkinson’s
9
Who is likely to be referred to you?
13
Case study
15
Relevant resources from the PDS
15
References and further reading
The GP’s guide to Parkinson’s disease
19
Introduction
19
Background
20
Pathology
20
Diagnosis
21
Follow-up
21
Motor symptoms
22
Non-motor symptoms (NMS)
24
Treatment
26
Relevant resources from the PDS
26
Useful websites and further reading
The nurse’s guide to Parkinson’s disease
29
Introduction
Bowel and bladder dysfunction
30
Introduction
30
Bowel dysfunction
31
Treatment and management of bowel dysfunction

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31
Bladder dysfunction
32
Treatment and management of bladder dysfunction
33
Conclusion
33
Useful contacts
Communication and swallowing problems
34
Introduction
34
Communication difficulties in Parkinson’s
35
Swallowing difficulties in Parkinson’s (dysphagia)
36
How can a nurse help?
36
Conclusion
Complementary therapies
37
Introduction
37
Points to consider
37
Conclusion
Drug management
38
Introduction
38
What kinds of drug treatments are available?
39
Drugs currently used in Parkinson’s
44
Nursing issues of drug management in Parkinson’s
46
Conclusion
Mobility problems
47
Introduction
47
Mobility problems specific to Parkinson’s
48
Other key issues in the management of mobility in Parkinson’s
50
Conclusion
Neuropsychiatric problems
51
Introduction
51
Mental dysfunction in Parkinson’s
55
Conclusion
Sexual function and intimate relationships
56
Introduction
56
What can be a problem?
57
Other causes of sexual dysfunction
58
How can a nurse help?
59
Conclusion

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60
Relevant resources from the PDS
61
References and further reading
The occupational therapist’s guide to Parkinson’s disease
67
Introduction
68
Assessment
68
Priorities for therapy
70
Communication issues
70
Useful communication strategies
70
Apathy and motivation
71
The benefits and frustrations of aids and equipment
71
Learning and memory
72
Education
73
Attention
73
Intrinsic cues and triggers
74
Extrinsic cues and triggers
74
Visual cues
75
Auditory cues
Interventions for some common functional and daily-living issues associated with
having Parkinson’s
77
Poor medication compliance
77
Mood, motivation and initiative
78
Cognition and perception
78
Visio-spatial problems
79
Hand function
81
Mobility and gait disturbances
83
Methods for reducing the risk of falls
84
Some general strategies for improving gait and balance
85
Transfers
86
Seating
87
Early morning and self-care routines
87
Fatigue
87
Poor saliva control
87
Night-time issues
89
Relevant resources from the PDS
90
References and further reading

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The pharmacist’s guide to Parkinson’s disease
95
Introduction
95
Drug therapy
96
Drug groups
98
Pharmaceutical care issues
100
Relevant resources from the PDS
100
Further reading
The physiotherapist’s guide to Parkinson’s disease
103
Introduction
104
Movement abnormalities in Parkinson’s disease appropriate for physiotherapy
intervention
106
The basal ganglia: implications for physiotherapists
108
The limbic system: implications for physiotherapists
109
Disease progression
Physiotherapy interventions
110
Assessment tools and considerations
111
Posture – including range of joint movement
112
Functional gait – including freezing and indoor and outdoor mobility
113
Balance and falls
114
Transfers
115
Bed mobility
115
Muscle strength and power
116
Pain
116
Condition of feet and footwear
117
Effects of Parkinson’s on functional ability, wellbeing and quality of life
117
Treatment
119
Concepts and projects to inform intervention
121
Required physiotherapy skills for treatment of people with Parkinson’s
121
Cueing and movement strategies
123
Gait
124
Falls
125
Rehabilitation in early onset Parkinson’s
125
Long-term management
126
Outcome measurements

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Document Outline

• profsguidecovers_singlepages.pdf
• prof guide main doc

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