Can physical therapy alleviate my mother’s stiffness at 64?

Question

Hello doctor,

My 64-year-old mother was diagnosed with Parkinson’s disease 18 months ago, and her symptoms have been progressively worsening. Initially, she noticed a tremor in her right hand while applying makeup, but now both hands tremor constantly.

She is unable to hold a cup of coffee without spilling it. Her neurologist started her on Carbidopa-Levodopa 25/100 three times daily, but she experiences severe nausea and dizziness, especially in the mornings.

Her walking has become very slow and shuffling, and she fell twice last month while trying to get to the bathroom at night.

What concerns me the most is that her face has become expressionless, almost like a mask, and her voice has grown so soft that we can barely hear her on the phone.

She was always very active and social, but now she avoids going out because she feels embarrassed by the tremors and drooling.

Parkinson’s disease has also affected her sleep. She acts out her dreams and has kicked my father several times during the night.

Additionally, her blood pressure drops to around 90/60 mmHg when she stands up, which the doctor says may be due to the medication. Can physical therapy help with her stiffness and walking problems?

We are also wondering if there are better medication options that might control her symptoms without causing such severe nausea, as she is losing weight because she is unable to eat properly.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I’m really sorry your mother is going through this. Parkinson’s disease can be very challenging, both physically and emotionally, for patients and families.

The tremor, slow movement, stiffness, loss of facial expression (“masked face”), and soft voice are classic Parkinson’s symptoms. Acting out dreams, called REM (rapid eye movement) sleep behavior disorder, is also common in Parkinson’s disease.

Dizziness and low blood pressure on standing (orthostatic hypotension) are often caused by both the disease and its medications. Nausea from Carbidopa-Levodopa is common, especially when the stomach is empty.

Try giving the medication after a small snack, such as crackers or a banana. Avoid protein-rich meals at the same time, as they can reduce Levodopa absorption.

Sometimes doctors increase the Carbidopa component or switch to extended-release formulations to reduce nausea. If symptoms persist, a neurologist may add a mild anti-nausea drug such as Domperidone (not Metoclopramide, which worsens Parkinson’s).

If Levodopa side effects are difficult, other medication options are available. These include dopamine agonists (Pramipexole, Ropinirole), MAO-B (monoamine oxidase-B) inhibitors (Rasagiline, Selegiline), or COMT (catechol-O-methyltransferase) inhibitors (Entacapone).

To manage low blood pressure, encourage her to stand up slowly and stay well hydrated. Extra salt, if permitted, and compression stockings may also help.

If symptoms persist, the doctor may adjust medication timing or add drugs such as Midodrine or Fludrocortisone. These treatments can significantly improve daily functioning.

Physiotherapy is very useful in Parkinson’s disease. It helps maintain balance, posture, and flexibility while reducing the risk of falls.

Speech therapy can strengthen her voice and improve her facial expression. Occupational therapy teaches safer ways to manage daily activities like dressing, eating, and walking.

Acting out dreams can sometimes be treated with Melatonin or Clonazepam at bedtime. Good sleep hygiene, such as a quiet, dark room and avoiding late caffeine, is also important.

Depression and social withdrawal are common in Parkinson’s disease. Emotional support, reassurance, group therapy, or meeting others with Parkinson’s can make a meaningful difference.

Overall, her symptoms are manageable with medication adjustments, therapy, and supportive care. Please discuss treatment optimization and supportive options with her neurologist to improve her quality of life.

I hope this helps you.

Thanks and regards.