From the time he was 5 years old, Trent MacLean has loved physical activity. He and his brother played ice hockey and indoor lacrosse growing up in Canada. So when he was diagnosed with Parkinson's disease 15 years ago, MacLean, now 69, was heartened to discover that exercise may slow progression and reduce some symptoms like hand and foot tremors. He also learned that it might improve his motor skills, which would make typing and buttoning shirts easier.
MacLean started with physical therapy (PT) once or twice a week, which helped correct and improve his posture and balance. His physical therapist monitored his walking for safety, stride, and arm swing and gave him word and number association activities to test his cognitive reaction times. He also got fitted for walking poles. “The walks helped kick-start my day,” says MacLean, who lives in Santa Monica, CA. Now he schedules physical therapy sessions on an as-needed basis, mainly to check on his progress and make sure his form is correct. “I like to walk with good posture,” he says.
Otherwise, he attends to exercise as if it were a full-time job. He takes spin classes, golfs, hikes or cycles, lifts weights, and plays Ping-Pong. When he's not exercising, he's putting his business consulting skills to use promoting the Los Angeles–based nonprofit Ping Pong for Good, which advocates for table tennis in a growing number of facilities from Vancouver to San Diego for people with Parkinson's disease, Alzheimer's disease, multiple sclerosis, stroke, and other neurologic disorders.
MacLean's focus on physical therapy and exercise has paid off. He has been on the same medication dose since his diagnosis (“a badge of honor,” he says). “My tremors can come back if I'm not doing those things, and my movement disorder specialist also recommends naps,” he says. “I need that rest to avoid fatigue.” Improving his posture and balance through physical therapy has helped MacLean exercise safely.
“I just keep working at it. I don't let things get to me. I take my nap. And play Ping-Pong. It activates more parts of the brain than any other activity. Even five to 10 minutes can be beneficial.” He also ensures that he gets enough rest, eats healthy meals, and manages stress.
A Specialized Profession
For many people with neurologic conditions, physical therapy is an integral part of living with a chronic disease or recovering from injury. It can help reduce disability and boost movement. Unlike exercise, which often concentrates on fitness, stamina, and endurance, PT sessions usually focus on specific areas like posture and balance and goals such as improving gait in people with Parkinson's disease or rebuilding muscle strength in stroke survivors.
Physical therapists evaluate patients' level of function, from standing and walking to performing everyday tasks like washing dishes, putting away groceries, and gardening. Once they have a baseline, they can create customized plans to help patients improve in targeted areas.
Since 2016, physical therapists have been required to complete a doctorate in physical therapy (DPT) from an accredited program and pass a state licensing exam. Before then, a master's or undergraduate degree was enough, so people who became physical therapists before 2016 may not have doctorates.
“I recommend physical therapy and exercise to almost all my patients,” says Natalie P. Witek, MD, FAAN, a movement disorders specialist at the Advocate Medical Group clinic at Advocate Lutheran General Hospital in Park Ridge, IL. “Physical therapy helps patients work toward their optimum mobility under professional supervision.”
Ideally, patients will start or continue to exercise once their physical therapy sessions end, says Dr. Witek. “Exercise can help with sleep, anxiety, and mood. And it's one of the few things that can increase brain volume,” she says. “Doing some exercise is better than none, even if you're using stretch resistance bands for a less intense workout.”
Exercise and PT Combo
Facilities that integrate PT and exercise include places like the NeuroBalance Center in Barrington, IL; re+active, a physical therapy and wellness center in Los Angeles; InMotionin Beachwood, OH; and Beat Parkinson's Today in East Hartford, CT. At centers like these, people can participate in person or virtually and pay by the hour or the class for interval training or high-intensity activities designed for people with movement impairments or other limitations. Some places also offer physical therapy with licensed providers.
At the NeuroBalance Center, for instance, classes are modified so participants can exercise safely, says Kelly Snow, DPT, who teaches there. Special equipment is available, including cross-trainer seated machines, elevated rowers with backs and seat belts, and treadmills with harness systems for safety, says Snow, adding that caregivers can attend and participate. Snow worries about people who finish PT and resume exercising at community centers or local gyms that may not have adequate safety measures in place for people with poor balance and limited mobility.
PT at Home
For some people, having a physical therapist come to the home is a safer and more convenient option. Patients may not have transportation, may be too physically unstable, or may not like to travel in bad weather. Doing PT at home is not ideal—sessions may be delayed, rescheduled, or canceled, and traveling therapists don't have access to lots of equipment—but it's better than no PT if it's the only option, says Dr. Witek.
Paying for PT
Insurance companies, including Medicare, stipulate that physical therapy be “medically necessary” before they provide coverage, says Julie Hershberg, DPT, at re+active. The threshold for Medicare patients in 2024 is $2,330 for PT and speech therapy combined. To find out if they can extend their PT sessions, patients should reach out to their primary care physicians or neurologists and ask if they can write another prescription.
“My biggest frustration when I was a physical therapist in a big hospital system was having to cut off services due to insurance not covering them or financial caps, regardless of whether patients met their goals,” says Snow.
Just this year, the American Physical Therapy Association challenged UnitedHealthcare for requiring prior authorization, an involved and lengthy approval process between doctors and insurers, before extending sessions in outpatient clinics and hospitals. The health insurer did not budge and continues to require prior authorization.
For at-home therapy, patients must meet the Centers for Medicare and Medicaid homebound criteria, and all sessions must be conducted at the patients' homes.
To find physical therapists in your area, including board-certified neurologic clinical specialists (physical therapists who have advanced training and certification in working with people who have neurologic conditions such as peripheral neuropathy, brain injuries, and movement disorders), visit ChoosePT.
