Progressive supranuclear palsy physiotherapy

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Progressive supranuclear palsy is a rare neurological condition that mainly affects people over the age of 60. It can have a significant impact on an individual’s physical and mental health, independence, and ability to continue doing things they enjoy. For people with progressive supranuclear palsy, physiotherapy can help to maintain function and independence for as long as possible.

Physios may also be involved in training support people and prescribing assistive technologies to help care for someone with progressive supranuclear palsy during the later stages of the condition.

What is progressive supranuclear palsy?

Progressive supranuclear palsy (PSP) is a degenerative neurological condition that affects the brain. It is one of a group of conditions known as Parkinson-plus disorders. Initially, the symptoms can look very similar to Parkinson’s disease.

People with PSP typically experience difficulties with:

  • head and body movements and walking
  • stiffness and postural changes
  • balance and falls (mostly backwards)
  • eye movements and vision
  • speech and swallowing
  • mood and behavior
  • dizziness and headaches
  • thinking and memory
  • disturbed sleep.

As the name suggests, PSP is a progressive disorder. As it gets worse, people with PSP increasingly lose functional abilities. They usually need growing support for daily activities such as moving around, showering, eating, and participating in home and community life.

Falls tend to be the main reason for loss of independence. People with PSP often need a mobility aid such as a walker or wheelchair to help them stay mobile while lowering their falls risk.

Older man who has progressive supranuclear palsy wearing a blue shirt standing next to a physiotherapist.

What causes progressive supranuclear palsy?

The exact cause of progressive supranuclear palsy is not known. It seems to be related to an abnormal buildup of a specific protein within the brain. This leads to progressive damage to some areas of the brain, especially those involved in controlling movement.

Older age, genetic changes and exposure to heavy metals or toxins may be risk factors for the condition.

Diagnosis of progressive supranuclear palsy is based on the symptoms. Doctors will look for the typical features of PSP, including postural instability, falls, and changes in control of eye movement.

There is no cure or surgical/medical treatment for PSPi. Therapeutic supports focus on managing symptoms and helping people with the condition to maintain the best possible quality of life.

Progressive supranuclear palsy physiotherapy management: an overview

Physiotherapy treatment for PSP aims to optimise physical function and independence and relieve any distressing symptoms.

Physiotherapy treatment for PSP may include therapies designed to improve:

  • walking ability and safety
  • transfers – such as getting out of bed and on/off chairs
  • control of head and body movements
  • balance and posture
  • energy levels
  • muscle strength and flexibility
  • pain or discomfort
  • independence
  • quality of life.

Physiotherapy and progressive supranuclear palsy: What the evidence shows.

As a rare condition, there are fewer studies into progressive supranuclear palsy physiotherapy than there are in some other conditions, such as stroke. However, the benefits of physiotherapy for PSP are of increasing interest.

A 2016 systematic reviewii examined results from six studies exploring the effectiveness of allied health therapies for managing the symptoms of progressive supranuclear palsy. Five of these assessed the effectiveness of various physiotherapy rehabilitation programs focusing on gait, balance and physical capability. One study also looked at gaze control. The sixth study looked at non-invasive brain stimulation for PSP symptoms.

The authors concluded these studies provide early evidence supporting the use of physiotherapy rehabilitation programs to improve gait, balance, and gaze control in people with PSP.

A narrative review published in 2018iii looked at results from 12 studies into the effectiveness of rehabilitation programs for people with PSP. Exercises were the main form of rehabilitation used in these studies, while some also used treadmill and robot-assisted walking training. All the studies showed an improvement in gait and balance after rehabilitation, along with a reduction in falls.

More research is needed to confirm these findings. Further research will also help to work out whether there is a type, dosage and frequency of physiotherapy that is most effective for managing the symptoms of PSP.

Progressive supranuclear palsy physiotherapy treatment

Neurological physiotherapists are experienced at managing disorders like PSP. At Active Ability, our NDIS registered physiotherapists assess your needs and develop a personalized treatment plan. They will help you work towards your goals using recognised, evidence-based therapies.

Balance training and falls prevention

Balance problems and falls are very common in people with PSP. Physiotherapy will often include balance training activities. In addition to therapy designed to prevent falls, you might be trained in how to fall, as well as ways to get back up afterwards.

Jenny’s NDIS goals included becoming more active and building her strength and stamina with the support of allied health professionals, along with building confidence and independence by accessing her community.

Gait (walking) training

Mobility problems are another common feature of PSP. Your physiotherapist will assess your mobility, looking for things like a wide-based or unsteady gait. Depending on assessment findings, treatment might aim to improve walking quality, safety or endurance.

For safety, you may need to use a walker. In later stages of the disease, using a wheelchair can be the safest way to maintain mobility.

Functional task training

This involves practice of everyday tasks such as rolling over in bed and getting from sitting to standing. In some cases, your physio might teach you different ways to achieve what you want to, such as safe ways to get around your home.

Woman with progressive supranuclear palsy seated on an exercise ball doing stretches with help from a physiotherapist. A physiotherapist will help you work towards your goals, such as maintaining strength and flexibility.

Strength and flexibility exercises

You might be prescribed exercises to help maintain muscle strength and flexibility. Exercises will be geared towards supporting your functional capacity. For example, you may need to improve your muscle strength to be able to climb stairs or get in and out of the car.

Muscle stiffness is also a feature of PSP. Stretching exercises can help to maintain freedom of movement.

Pain management

Physiotherapists are highly trained in pain. They can look for physical causes of pain, such as muscle stiffness or joint problems. Physios use various techniques to manage pain, such as stretches, exercises, and advice about positioning. They may also use hands-on techniques such as massage to help ease symptoms.

Assistive technologies

Your physio might recommend assistive devices such as a wheelchair, walking frame or other equipment to improve your safety and make life easier at home or work.

Training support people

Formal and informal support people play an important part in helping someone living with PSP to stay safe and continue participating in meaningful activities. Your physiotherapist might train family members and carers to support your loved one with:

  • moving safely around the home and out in the community
  • completing their exercise program
  • using assistive devices
  • managing pain.

Building the capacity of support people may help someone living with PSP to remain at home longer and decrease dependence on healthcare professionals.

Physiotherapy for people with progressive supranuclear palsy

At Active Ability, our NDIS registered physiotherapists have significant experience working with people living with neurological conditions such as PSP. We focus on strategies to maintain functional ability and safety for as long as possible.

Our caring team will listen to your priorities and design a treatment plan tailored to your needs and goals. We also have NDIS registered clinical dietitians and accredited exercise physiologists, so we can provide multidisciplinary support for optimising your wellbeing.

With no waiting list or travel charges, you can get started with physiotherapy when you need to and make the best use of your funding.

To learn more about how we might be able to help you, contact our friendly team on (02) 8678 7874, or via our   contact form.


[i] – Clerici I, Ferrazzoli D, Maestri R, et al. Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments. PLoS One. 2017;12(2):e0170927. Published 2017 Feb 3. doi:10.1371/journal.pone.0170927.

[ii] – Tilley E, McLoughlin J, Koblar SA, et al. Effectiveness of allied health therapy in the symptomatic management of progressive supranuclear palsy: a systematic review. JBI Database System Rev Implement Rep. 2016;14(6):148-195. doi:10.11124/JBISRIR-2016-2002352

[iii] – Intiso D, Bartolo M, Santamato A, Di Rienzo F. The Role of Rehabilitation in Patients With Progressive Supranuclear Palsy: A Narrative Review. PM R. 2018;10(6):636-645. doi:10.1016/j.pmrj.2017.12.011