Kendell M. Jno-Finn 9/15/2018 1

Parkinson's Disease

KE NDE LL M. JNO- FINN, PT, DPT, TPI , FMS, FCS

A Team Approach

CONGRATULATIONS!

Kendell M. Jno-Finn 9/15/2018 2

Now What?Advocacy

Engagement

Collaboration◦ This domain is where we will focus most of our time.

◦ Where do you see this today?

◦ What does it look like in 5 years?

◦ What does it look like in 10 years?

Let's Start With A Story...Oren is an established patient diagnosed with Parkinson's Disease (PD) who was discharged after a successful Physical Therapy episode of care.

He lived independently, drove and was independent with instrumental activities of daily living (IADLs)

He was given a home exercise program (HEP) which he understood and committed to being compliant with.

He return to the clinic after a year and must be driven to his appointment.

He is no longer living independently

His mobility, safety and confidence are all decreased

What is the outlook in this scenario?

Kendell M. Jno-Finn 9/15/2018 3

Putting the Puzzle TogetherMicroscopic versus macroscopic management◦Are the presentations typical?

Two dimensions of symptom presentation◦ Is this a movement problem or a psychological problem

Pharmacology conundrum◦Are prescribing criteria clear-cut?

Communication paradox◦Does our current facility models meet the needs of this patient

population?

Digging A Little DeeperFive Stages

Varied age presentations

60,000 new cases each year

PD versus Parkinsonism (Parkinson - plus syndrome)

Parkinsonism◦ More difficult to treat than PD

◦ There are six types

$25 Billion impact

Kendell M. Jno-Finn 9/15/2018 4

I Have a Movement Problem!

Shaking or tremor at rest

Bradykinesia or freezing—being

stuck in place when attempting to walk

Low voice volume or muffled speech

Lack of facial expression

Stiffness or rigidity of the arms, legs or

trunk

Trouble with balance and falls

Stooped posture

Decreased ability to swallow (dysphagia) and drooling Non-

Motor

This Doesn't Sound Like A Movement Problem

Depression Anxiety ConstipationCognitive

decline and dementia

Impulse control

disorders

Orthostatic hypotension

PainHallucinations and psychosis

Sleep disturbances

Sexual dysfunction

Urinary dysfunction

The Pillbox

L-DOPA Dopamine Agonist

MAO-B Inhibitors Anti-Cholinergics

COM-T Inhibitors

Other

• Amantadine

• antiviral (side effects can be helpfu)

Kendell M. Jno-Finn 9/15/2018 5

Surgical Options

Deep Brain Stimulation (DBS)◦ Implanted device

Duopa◦Gel delivery system through a stoma versus pill

◦Delivered directly to the gut

◦MAO excludes this as an option

Proceed With Extreme Caution

Antipsychotics

Pain Medication

Anesthesia

Nausea/ GI Drugs

Antidepressants

Facility Management

Carbidopa-levodopa confusion

1

Timing of carbidopa-levodopa regarding meals and surgery

2

Carbidopa-levodopa dosing intervals

3

Non-Motor Presentations revisited

•Insomnia

•Orthostatic hypotension

•Nausea

•Hallucinations and delusions

•Pain and levodopa

•Dyskinesias

•Anxiety and panic

4

Kendell M. Jno-Finn 9/15/2018 6

Acceptance doesn't mean resignation: it

means understanding that something is what it is and that there's got to be a way through it.

~ Michael J. Fox