Parkinson’s Disease and Specialist Seating

Parkinson’s disease is a neurodegenerative disorder that affects millions of people worldwide. While the physical symptoms of Parkinson’s disease, such as tremors and slowness of movement, are well known, the impact that the disease can have on posture often goes overlooked. Poor posture in individuals with Parkinson’s disease can lead to a range of complications, including pain, contractures, and altered organ function. Specialist seating can help those with Parkinson’s disease maintain optimal posture, promote well-being, and reduce the risk of secondary complications. In this blog, we cover the various postural challenges that can result from Parkinson’s disease and how CareFlex’s specialist seating can help support individuals living with the condition.

Parkinson’s is the fastest-growing neurological condition in the world.1 The lifetime risk of being diagnosed with Parkinson’s disease is 2.7%; this is equivalent to 1 in every 37 people being diagnosed at some point in their lifetime.2

At CareFlex, we are committed to raising awareness of Parkinson’s disease and increasing knowledge about the importance of postural care. Our Clinical Specialist, Rebecca Dunstall, also wanted to share a poem she has written in honour of those with Parkinson’s disease:

Awareness needs to shine bright,

On a community finding their light.

Some find it difficult to balance; others find it difficult to walk,

Some find just sitting comfortably a struggle; it’s time for us to talk.

Posture isn’t just a fancy clinical word; it’s at the core of our health and well-being.

The ability to eat safely, breathe well, interact, and engage will be ever so freeing.

The challenges are there to be overcome,

Together let us get the mission done.

What is Parkinson’s disease?

Parkinson’s disease is a neurodegenerative disorder of the central nervous system that belongs to a group of conditions called movement disorders, in which parts of the brain become progressively damaged over many years.3

What causes Parkinson’s disease?

Parkinson’s occurs when nerve cells, or neurones, in an area of the brain that controls movement, become impaired and/or die. Normally, these vital neurones produce a brain chemical known as dopamine, which is responsible for transmitting signals between the parts of the brain and nervous system that help control and coordinate body movements.3 Parkinson’s disease can appear when a certain amount of dopamine-producing cells are affected. Individuals with Parkinson’s disease also have problems with producing norepinephrine, which is the main chemical of the sympathetic nervous system. The exact cause of Parkinson’s disease is unknown, but several factors are believed to play a role, including genes, environmental triggers, and Lewy bodies.

What are the signs and symptoms of Parkinson’s disease?

The signs and symptoms of Parkinson’s usually develop gradually and are mild at first. They vary from person to person, but the main one affects physical movement:

  • Tremor–shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed and resting and disappears with voluntary movement and sleep.
  • Bradykinesia (slowness of movement) – where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps. It is associated with difficulties along the whole movement process, from planning to initiation and final execution.
  • Rigidity (muscle stiffness) – stiffness and resistance to movement caused by increased muscle tone, which can make it difficult to move and make facial expressions, and can result in painful muscle cramps (dystonia).
  • Postural instability – typical in the late stages of the disease, resulting in impaired balance and frequent falls.
  • Writing changes – handwriting becomes more difficult, and writing appears small.

Although considered a movement disorder, an individual with Parkinson’s disease can also experience a wide range of other challenges, including:

  • Memory problems
  • Behaviour and mood alterations
  • Cognitive disturbances
  • Alterations in autonomic nervous system function
  • Depression, anxiety, and psychotic symptoms
  • Sleep problems
  • Changes in perception and vision abnormalities
 

What postural challenges can result from Parkinson’s disease?

A stooped or flexed posture alters head position and increases the risk of a fixed kyphosis

  • Leaning to one side results in an increased risk of a fixed scoliosis
  • Neck and back pain impacting comfort levels and engagement in activities of daily living
  • Involuntary movements (tremors) affect postural stability and functional movement
  • Rigidity and abnormal muscle tone affecting postural symmetry
  • Contractures (irreversible changes to joint range of movement)
  • Change in proprioception (postural awareness), increasing the risk of falls
  • Fatigue results in a limited ability to interact with family and friends

What seating is best to support those with Parkinson’s disease?

Providing a chair for Parkinson’s disease, which is appropriately set up for the individual with adequate postural support, is critical for comfort, stability and management of abnormal movement patterns. Support at all body segments is needed, especially as a physical prompt to the head to promote safety and optimum physiological function such as swallow function, breathing and digestion.

Specialist seating can help individuals achieve their optimum quality of life by offering a solution for maximised health and independence. Maintaining good posture and positioning can help to promote well-being whilst protecting the body system and reducing the risk of secondary complications.

How can CareFlex help?

CareFlex specialist seating meets key seating objectives through a range of functions and accessories:

  • Adjustability and flexibility will ensure the correct seat dimensions, including seat depth and seat width, especially as the individual’s needs change.
  • A ramped cushion can encourage pelvic stability at the back of the chair and aim to reduce the risk of sliding down or falling from the chair.
  • A reconfigured waterfall back can comfortably accommodate kyphotic postures, reducing the pressure at the apex of the thoracic spine.
  • An articulating headrest can further support an increased thoracic kyphosis if fixed.
  • For individuals who lean to one side and lack the ability to correct themselves back to an upright sitting posture, the use of a contoured back or lateral supports may be indicated.4
  • For more complex postural needs, where safety within the chair is a concern, tilt-in-space can be considered following a risk assessment. Tilt-in-space can also encourage good energy management.
  • A negative angle leg rest can accommodate a reduced range of movement at the knees should contractures be present.
  • Positioning aids, such as pelvic belts or chest harnesses following a risk assessment, may also be indicated to maximise postural control.
  • WaterCell Technology is at the heart of CareFlex seating; it provides a reliable and dynamic pressure redistributing solution to reduce pressure injury risk when used holistically as part of a 24-hour management programme.

rise and recline chair may be indicated for users who have the ability to stand independently but, at times, require assistance to do so safely. Rise and recline chairs should be comprehensively assessed and reviewed over time as they are not safe or appropriate for all users.

Additionally, verbal prompting at regular intervals to adjust position in the chair may be indicated for those who lack postural awareness. It is also important to consider the environment and ensure any focal points, such as TV, is directly in front of the person.5

As Parkinson’s progresses and an individual’s presentation potentially becomes more complex, the CareFlex tailored seating solutions service can develop bespoke chair adaptations.

As with any postural care approach, the individual’s daily life throughout the full 24 hours should be considered holistically and managed by their multi-disciplinary team. Promoting comfort and maximising independence for an individual with Parkinson’s disease is key. Please do not hesitate to get in touch to discuss any seating needs or book a free no-obligation seating assessment.

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References

1
  1. Parkinson’s UK (2023) World Parkinson’s Day Available from: parkinsons.org.uk/get-involved/world-parkinsons-day
2
  1. National Institute for Health and Care Excellence (2022) Parkinson’s disease: How common is it? Available from: https://cks.nice.org.uk/topics/parkinsons-disease/background-information/prevalence
3
  1. NHS Choices (2016) Parkinson’s diseaseAvailable from: nhs.uk/conditions/parkinsons-disease/
4
  1. Pope PM (2007) Severe and complex neurological disabilities: management of the physical condition London: Elsevier
5
  1. Royal College of Occupational Therapists (2018) Occupational therapy for people with Parkinson’s 2ndeditionAvailable from: rcot.co.uk/occupational-therapy-people-parkinsons