(646) 355-8777

Herman & Wallace Blog

People with Parkinson disease can MOVE!

Akinesia is a term typically used to describe the movement dysfunction observed in people with Parkinson disease. It is defined as a poverty of movement, an impairment or loss of the power to move, and a slowness in movement initiation. There is an observable loss of facial expression, loss of associated nonverbal communicative movements, loss of arm swing with gait, and overall small amplitude movements throughout all skeletal muscles in the body. The cause of this characteristic profile of movement is due to loss of dopamine production in the brain which causes a lack of cortical stimulation for movement.

If the loss of dopamine production in the brain causes this poverty of movement in all skeletal muscles the body, how does the pelvic floor function in the person with Parkinson disease and what should the pelvic floor rehabilitation professional know about treating the pelvic floor in this population of patients?

Let’s take a closer look referencing a very telling article about Parkinson disease and skeletal muscle function. In the Italian town of L’Aquila, a major devastating 6-point Richter scale earthquake occurred on April 6, 2009. 309 people died and there was destruction and collapse of many historical structures, some greater than 100 years old. The nearby movement disorder clinic had been following 31 Parkinson disease patients in the area, 17 of them higher functioning and the other 14 much lower functioning. In fact, of those 14, 10 of them were affected by severe freezing episodes with severe nighttime akinesia requiring assistance with bed mobility tasks, 1 was completely bedridden and the others with major fluctuations in motor performance. 13 of the 14 patients also had fluctuating cognitive functioning.

This devastating earthquake occurred at 3:30 am. All 14 of these patients were able to escape from their homes during or immediately following the event. Caregivers reported that in the majority of the cases, the person with Parkinson’s disease was the first one to be alerted to the earthquake, the first one to get out of the house, ability to alert relatives to run for safety, physically assisting relatives out of the collapsing buildings, and in some cases independently escaping down 1-2 flights of stairs.

Paradoxical kinesia is thought to be the reason for this all but sudden ability to move normally within the presence of an immediate threat to their life and lives of loved ones. Paradoxical kinesia is defined as “a sudden and brief period of mobility typically seen in response to emotional and physical stress in patient’s with advanced idiopathic Parkinson’s disease.” There are a few mechanisms hypothesized to play a role, such as, adrenaline, dopaminergic reserves activating the flight reaction, and compensatory nearby cerebellar circuitry.

There is no pathological evidence that in Parkinson disease there is any break in the continuity of the motor system. The neurologic pathways are all intact and the ability to produce muscle power is retained however requires a strong base of clinic knowledge of the disease to help these patients activate these intact motor pathways. I look forward to sharing the neurologic basis of these deficits in Parkinson disease and strategies in pelvic floor rehab to do just that!

Erica Vitek, a specialist in treating patients with neurologic dysfunction, is the author and instructor of Neurologic Conditions and Pelvic Floor Rehab, taking place September 14-16, 2018 in Grand Rapids, MI.


Bonanni, L., Thomas, A., Anzellotti, F., Monaco, D., Ciccocioppo, F., Varanese, S., Bifolchetti, S., D’Amico, M.C., Di Iorio, A. & Onofrj, M. (2010). Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms. Neurological sciences, 31(6), 751-756.

"Pelvic rehab is wrong for me"
Complex Regional Pain Syndrome of the Foot Followi...

Upcoming Continuing Education Courses

Mobilization of Visceral Fascia 2: The Reproductive System - Valencia, CA Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Henry Mayo Newhall Memorial Hospital

Mobilization of Visceral Fascia 2: The Reproductive System - Medford, OR Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia 2: The Reproductive System - St. Louis, MO Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Mercy Hospital St. Louis

Mobilization of Visceral Fascia 2: The Reproductive System - Jackson, WY Satellite Location

Mar 5, 2021 - Mar 7, 2021
Location: Four Pines Physical Therapy

Male Pelvic Floor - Satellite Lab Course

Mar 6, 2021 - Mar 7, 2021
Location: Replacement Remote Course

Male Pelvic Floor - St Paul, MN Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Regions Hospital

Male Pelvic Floor - Kenosha, WI Satellite Location

Mar 6, 2021 - Mar 7, 2021
Location: Aurora Health Care

Pelvic Floor Level 2B - Self-Hosted (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Self-Hosted Course

Male Pelvic Floor - Atlanta, GA Satellite Location

Mar 6, 2021 - Mar 7, 2021
Location: JMM Health Solutions LLC

Male Pelvic Floor - Akron, OH Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Summa Health Center

Pelvic Floor Level 2B - Oklahoma City OK Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Oklahoma Physical Therapy

Male Pelvic Floor - Asheville, NC Satellite Location

Mar 6, 2021 - Mar 7, 2021
Location: Cornerstone Physical Therapy

Pelvic Floor Level 2B - Little Rock, AR Satellite Course (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Core Pelvic Physical Therapy

Pelvic Floor Level 2B - Truckee, CA Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Tahoe Forest Center for Health and Sports Performance / Alliance Therapy Partners

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Torrance CA Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2B - Grand Rapids, MI Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 1 - Jonesboro, AR Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Arkansas State University

Pelvic Floor Level 2B - Williamsburg, VA Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Peak Therapy and Sports Rehabilitation

Pelvic Floor Level 2B - Livonia, MI Satellite Course (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Mendelson Kornblum Physical Therapy

Biofeedback for Pelvic Muscle Dysfunction - Tampa, FL Satellite Lab Course (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Optimal Performance and Physical Therapies

Biofeedback for Pelvic Muscle Dysfunction - Denver, CO Satellite Lab Course

Mar 6, 2021 - Mar 7, 2021
Location: Kelsey Mathias OTR/L

Acupressure for Optimal Pelvic Health - Remote Course (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Athens, GA Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Thrive Integrated Medicine

Pelvic Floor Level 2B - Glenwood Springs, CO Satellite Course

Mar 6, 2021 - Mar 7, 2021
Location: Valley View Hospital

Male Pelvic Floor - Self-Hosted (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - LaCrosse, WI Satellite Location (SOLD OUT)

Mar 6, 2021 - Mar 7, 2021
Location: O'Brien Physical Therapy, LLC

Male Pelvic Floor - Brooklyn NY Satellite Location

Mar 6, 2021 - Mar 7, 2021
Location: PT of the City