Parkinson's Disease and Movement Disorders

Expert treatment for Parkinson’s disease in San Diego

Scripps neurologist Dr. Melissa Houser assesses a man for hand tremors related to Parkinson's disease, representing the expert, compassionate care received at Scripps.

Melissa Houser, MD, Neurology, Scripps Clinic

Expert treatment for Parkinson’s disease in San Diego

Movement disorders are a type of nervous system disorder that originate in the brain and central nervous system, which controls motor functions. Scripps neurologists and other physicians work together to provide exceptional care for patients with movement disorders that can hinder quality of life, such as Parkinson’s disease. This collaboration offers patients the best treatment plans for movement disorders and encourages independent living.


In addition, Scripps Clinic doctors participate in a research program with The Scripps Research Institute to investigate Parkinson’s disease and treatment using neuron cell replacement therapy.

About movement disorders

While not all movement disorders can be cured, many can be managed effectively. Scripps offers extensive rehabilitation programs for patients with Parkinson’s disease and other movement disorders.

Types of movement disorders

Common types and symptoms of movement disorders include:


  • Ataxia, which is characterized by poor coordination of the arms or legs due to damage to the nervous system.
  • Chorea (uncontrolled movements) and dyskinesias, which lead to abnormal writhing type of movements of the face, mouth, jaw, neck, trunk or arms/legs. These may be caused by certain medications or due to underlying brain damage.
  • Tourette syndrome, a tic disorder which produces involuntary movements or vocalizations.
  • Dystonia, which is a condition associated with slow and involuntary movement of large muscle groups, often in a twisting manner. It most often affects physical control of the head, neck, arms or torso.
  • Essential tremor, which involves involuntary shaking movements of the arms. In more severe cases, it may affect the head and voice. 
  • Huntington’s disease, which is a genetic condition that leads to degeneration of nerve cells, which can trigger uncontrolled movements (chorea), cognitive issues and often psychiatric or emotional disturbances.
  • Parkinson’s disease, which is caused by the loss of dopamine cells in the brain that help control movement and coordination, leading to involuntary shaking, slowness, stiffness, and difficulty walking and moving.
  • Myoclonus, which is characterized by a brief uncontrollable jerking of a muscle or muscle group followed by relaxation.
  • Restless leg syndrome (RLS), in which patients have a sense of discomfort or restlessness in the legs that is improved with movement.

Diagnosing movement disorders

To diagnose movement disorders, Scripps neurologists perform comprehensive neurological exams and review symptoms and medical histories.


In some cases, the movement disorders specialist also may order appropriate diagnostic tests, including:


About Parkinson’s disease

Parkinson’s disease is one of the most common movement disorders. Parkinson’s disease causes are not known and its onset is progressive, meaning symptoms get worse over time. While no cure is yet available for Parkinson’s disease, its symptoms can be managed with proper diagnosis, treatment and rehabilitation, including physical, occupational and speech therapies.

Parkinson’s disease symptoms

The most common symptoms of Parkinson’s disease include:


  • Tremor or shaking 
  • Stiffness
  • Rigid muscles
  • Difficulty walking or moving normally
  • Speech problems 

Parkinson’s disease stages

Parkinson’s disease symptoms can vary greatly from person to person, depending on the individual and how far the disease has advanced. According to the Parkinson’s Foundation, there are five stages of Parkinson’s disease progression.


Stage One

The person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions are noticeable.


Stage Two

Symptoms begin to worsen. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture are apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.


Stage Three

Loss of balance and slowness of movements mark this stage, and falls are more common. The person is still fully independent, but symptoms significantly impair self-care activities.


Stage Four

Symptoms are severe and limiting. Standing unassisted is possible, but moving may require a walker. The person needs help with activities of daily living and is unable to live alone.


Stage Five

At the most advanced stage, stiffness may make standing or walking impossible, and the person needs a wheelchair or is bedridden. Around-the-clock nursing care is required for all activities. Hallucinations and delusions may be common.

Parkinson’s disease and movement disorder treatment at Scripps

Depending on the type and progression of the movement disorder, the Scripps neurology team will recommend personalized care plans to achieve the best possible outcome. Treatment plans usually include one or more of the following therapies:


  • Medications
  • Physical therapy, occupational therapy and/or speech therapy and rehabilitation
  • Surgical intervention, including: 
  • Deep brain stimulation (DBS)
  • Pallidotomy, a procedure in which a surgeon makes a scar in part of the brain called the globus pallidus, where the tremor-causing brain activity originates
  • Thalamotomy, a procedure in which a surgeon destroys a part of the brain called the thalamus, which controls some involuntary movements
  • Dopamine pump, for continuous infusion of dopamine gel into the intestines

Parkinson’s disease rehabilitation programs at Scripps

Scripps offers an extensive range of rehabilitation programs for people living with Parkinson’s. Our goal is to help individuals relieve symptoms and learn skills to manage some of the physical and neurological problems caused by the disease. 


Scripps rehabilitation therapists are specially trained to care for people with neurological conditions. Many have advanced certifications, including Neuro-Developmental Treatment (NDT) certification, Neurological Clinical Specialist (NCS) certification, and Lee Silverman Voice Treatment (LVST) certification.


We offer a variety of rehabilitation therapy services for Parkinson’s disease, including:


The Parkinson’s Disease and Movement Disorder Center at Scripps Clinic

The Parkinson’s Disease and Movement Disorder Center at Scripps Clinic is home to a team of experts who have dedicated their careers to providing patients with the best therapeutic options, as well as access to rehabilitation services at several locations across San Diego County. 


Scripps Clinic offers patients being treated for Parkinson’s disease and other movement disorders a full spectrum of care and services, including:


  • Integrative medicine
  • Nutritional specialists
  • Supplement pharmacists
  • Exercise physiologists who specialize in Parkinson’s disease rehabilitation 
  • Multiple exercise programs specifically designed for Parkinson’s patients
  • Speech therapists who specialize in voice treatment (LSVT LOUD) 
  • Physical therapists teaching LSVT BIG program

Speech and voice disorder therapy (LSVT LOUD)

Because speech and voice disorders are common in those with Parkinson’s disease, speech language pathologists at several Scripps locations specialize in Lee Silverman Voice Treatment (LSVT) LOUD — an evidence-based training technique that focuses on improving voice quality, articulation and vocal intensity.


LSVT LOUD improves vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a series of exercises. The goal of treatment is to bring the voice to an improved, healthy volume level with no strain, so patients participate in conversations and have greater confidence in social settings.


We also offer a LSVT LOUD maintenance class for people who have completed the initial LSVT LOUD protocol. Visit our page on rehabilitation classes to learn more about the maintenance class. 

Physical therapy (LSVT BIG)

To simultaneously treat the unique movement impairments caused by Parkinson’s disease, physical therapists at several Scripps locations also offer LSVT BIG. Using core movements and other exercises, the training focuses on improving speed, trunk rotation, gait and balance.


Scripps offers the LSVT BIG program on an outpatient basis. A referral from a primary care physician or specialist is required.


We also offer a LSVT BIG maintenance class for people who have completed the initial LSVT BIG protocol. Visit our page on rehabilitation classes to learn more about the maintenance class.

Parkinson’s boot camps and picnic

The Parkinson’s Disease and Movement Disorder Center at Scripps Clinic offers “Parkinson’s Boot Camps” twice a year. These daylong seminars include Parkinson’s education and exercise training. 


Scripps Clinic deep brain stimulation (DBS) experts also participate in semi-annual hosted picnics in San Diego County that bring together DBS patients and those who may be considering DBS as a treatment option.


Check our events page for upcoming boot camps, seminars and other events.

Parkinson’s disease classes and education

Scripps hosts a weekly exercise group for people with Parkinson’s disease or stroke. The free class offers you a safe exercise program that supports the physical activity prescribed by your physician. Participants must be assisted by their caregiver. Learn more or register for the exercise group or rehab class. 

Parkinson’s disease treatment and rehab locations

The following Scripps Health locations in San Diego County offer treatment and outpatient rehabilitation services for people with Parkinson’s disease and other movement disorders, including physical, occupational and speech therapy: