Specific Problems

1. Mobility: Rigidity and slowness of movement are the two most frustrating aspects.

Common difficulties are:



Rising from a chair

Turning in bed - may need regular turning


2. Eating and Drinking

3. Constipation

4. Urinary Incontinence

5. Communication

Parkinson's affects the control of muscle co-ordination and therefore a person's ability to communicate. The symptoms of tremor, stiffness and slowness can also impact upon the person's verbal and non-verbal methods of communicating with others.

Verbal Communication



Non-Verbal Communication

Facial Expression:


Limb Movement:




Parkinson's can cause considerable difficulties in a person's ability to communicate with others. Speech can be affected in volume, tone, inflection and pace. Facial expression may become mask-like and limb movement restricted. Handwriting can become smaller and smaller until it is indiscernible.

These problems however, can be overcome by understanding the complexities of the illness. Concentrate on every movement and one movement only. Regular exercise of everyday movements provides valuable practice and precision. Reduce stress by using relaxation and preparation. Maintain independence and dignity by refusing to allow others to speak for you.

Social Isolation:

There are a number of factors in relation to Parkinson's Disease which can contribute to the social withdrawal of the sufferer. As Parkinson's Disease is a chronic illness, the potential for these factors influencing the individual become greater over a very long period.

  1. Communication Difficulties: As explained previously, there are a number of physical restrictions which can impede the person's ability to communicate with others. The person with Parkinson's must be given time and not rushed when asked to respond. An empathic attitude will reduce stress and greatly facilitate their ability to communicate. People with Parkinson's should have social interaction incorporated into their daily activities programme. Education for others, as well as family members etc, will reduce embarrassment for the person with Parkinson's

  2. Physical Symptoms: The most obvious symptom is tremor. Many people with Parkinson's are extremely embarrassed and attempt to hide the offending limb. Dyskinesias, or abnormal wriggling movements, may also cause distress. In both cases, it is important to reduce the amount of stress the person experiences as this will exacerbate the condition. We encourage people with Parkinson's to minimize the effect of the movement by stabilising the limb. The tremor is reduced if the limb is involved in purposeful movement, so playing with coins etc. is useful. Dyskinesias may be reduced with a reduction in levodopa intake, though this may cause Parkinson's symptoms to return

  3. Decreased Mobility: As the illness progresses this becomes the largest factor in contributing to the individual's social isolation. Their ability to physically walk from their home to other areas decreases as symptoms become more severe and medication less effective. Tasks such as, climbing stairs, using escalators, and generally moving around busy areas such as shopping centres becomes nearly impossible. Regular medication reviews to ensure pharmacological treatment is optimally effective and side effects are kept to a minimum, coupled with the use of external cues and other movement strategies can address the problems of decreased mobility

  4. Decreased Ability to use Transport: As well as a decrease in the person's functional mobility, they will also experience difficulty in using various forms of transport eg. driving a motor vehicle. The decrease in reaction time, ability to navigate, fine motor co-ordination, and general limb mobility make it increasingly difficult for the person to have full control of the motor vehicle. Some people with Parkinson's may require limitations on their licence, or even cancellation. It is advisable to refer people to occupational therapy for a full driving assessment

  5. Cognitive Difficulties: People with Parkinson's may also be experiencing concurrent cognitive impairment, which will impede their ability to follow simple instructions or utilise aids such as cue cards, diaries etc. Difficulty with storing and recalling items from memory is commonly reported and thus the use of a diary or personal messages is recommended. Distraction whilst performing tasks can cause further complications. Encourage the person to break complex tasks into single steps, mentally rehearse each step, concentrate fully on each step and not be distracted by environmental factors

  6. Lethargy: All people with Parkinson's report lethargy to some degree. This should be reduced with effective pharmacological management. Encouraging the person to identify factors which increase/decrease lethargy will help them maintain independence and optimal level of functioning. Other family members should be told about this phenomenon. The person should be encouraged to take regular rest periods to establish stable sleep patterns

  7. Depression: At some stage, up to 90% of people with Parkinson's may experience depression to some degree. Anti-depressant medication may be necessary for more severe cases, for others supportive counselling and education may be appropriate. Depression can result from the grief process at being diagnosed with Parkinson's, loss of mobility, loss of independence, and a loss of general control over one's life. This symptom may also be due to other chemical changes occuring within the brain

  8. Myths about Parkinson's Disease: The greatest factor at present which contributes to the social isolation of people with Parkinson's is their preconceived ideas or myths about the condition. Many people worry that Parkinson's will either kill them, be inherited by their children, make them totally physically incapacitated, or directly result in dementia.

    These of course are all untrue. Education at the time of diagnosis is vital in dispelling myths and enlisting the participation of the person and their family in the ongoing management of Parkinson's Disease. Supportive counselling to allow the individual and their family the opportunity to express emotions such as anger, frustration, fear etc. within a safe environment is extremely therapeutic. 

Most people worry about what others will think and therefore attempt to hide their Parkinson's. Acceptance of the illness and participation in management decisions through education will encourage the person to maintain independence and optimal functioning. As well as individual education, broader public awareness campaigns and specific inservice education sessions for health providers will improve understanding of the illness and how we can lessen the stigma associated with Parkinson's Disease.