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Re strength training.  There is an awful lot more to managing Parkinsons than
strength training.  In fact, the old orthopedic paradigm of "if it doesn't
work, it must need strengthening" which persists in neurological physiotherapy
needs to be rethought.  The problem is one of motor control and a key issue is
early intervention which deals with a modified general exercise program.  This
will improve physical functioning while the Parkinsons person is well
controlled by medication.  Careful monitoring of locomotor function is also
essential during this phase.  The prevention of falls is likely to be a lot
more effective if it is done proactively rather than waiting for deterioration
to occur first.  The obstacle to all of this seems to be ignorance in the
funding industry.  A quick burst of strengthening, pretending that the CNS is
fine, works for musculoskeletal problems but not for Parkinsons.  We need a
new way of thinking about physiotherapy delivery as it applies to Parkinsons.
George Turnbull, Ph.D,  School of Physiotherapy, Dalhousie University,
Halifax, Nova Scotia, Canada.