Parkinson’s Disease
DefinitionParkinson's disease (PD) is an idiopathic,
slowly progressive, neurodegenerative disorder whereby two or more of the following needs to be present: bradykinesia, rigidity, resting tremor, and loss of postural mechanisms.
PathophysiologyDopamine acts as a messenger between the
substantia nigra and the corpus striatum in the brain - to produce smooth, controlled movements. Most symptoms of Parkinson's disease are caused by a lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra. When dopamine is too low, ineffective communication between the substantia nigra and corpus striatum occur, and movement is impaired. It seems that by the time clinical manifestations occur, approximately 85% of dopaminergic neurons are lost. It is not clear why these dopaminergic cells deteriorate but scientists suspect it is due to a combination of genetic and environmental factors.
Causes & Risk Factors Most people with Parkinson's
disease have idiopathic Parkinson's disease (having no specific known cause). A small proportion of cases, however, can be attributed to known genetic factors. Other factors have been associated with the risk of developing PD, but no causal relationship has been proven.
Age is the largest risk factor (older than 60 years
Men are affected 1.5 to 2 times more than women
Family history of the disorder Head trauma or illness Exposure to environmental toxins
such as pesticides and herbicides
Signs & SymptomsPrimary symptoms of Parkinson's disease are all
associated with voluntary and involuntary motor function and often start on a specific side of the body. The symptoms progress with time
Common symptoms are:Tremors- may first be only occasional, starting in one finger and
spreading over time to involve the whole arm. The tremor is often rhythmic, 4 - 5 cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling
Bradykinesia: Slowness of motion, particularly when initiating any movement
Signs & Symptoms Muscles may become rigid. This symptom often begins in the legs
and neck. Muscle rigidity in the face can produce a mask-like, staring appearance
Postural instability: Impaired or loss of reflexes making it difficult to regulate posture to maintain balance. Postural instability leads to falls.
Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady
Motor abnormalities that limit action in the hand may develop in late stages. Handwriting, for instance, often becomes small
Secondary symptoms of Parkinson's Continued damage to
the brain can lead to secondary symptoms which vary in severity.
These symptoms include:
stress and anxiety confusion, memory
loss, and dementia (common in elderly individuals)
constipationdepression
difficulty swallowing and excessive salivation
diminished sense of smell
increased sweatingmale erectile
dysfunctionskin problemsslowed, quieter
speech, and monotone voice
urinary frequency
Medical Management
Medical ManagementThere is currently no cure for Parkinson's disease.
Treatment is aimed at delaying the onset of motor symptoms thereby extending quality of life
The most effective therapy for Parkinson's disease is levodopa (Sinemet), which is converted to dopamine in the brain
Surgery is an option for individuals with advanced unmanageable symptoms
An alternative approach currently explored is stem cell therapy
General lifestyle changes (rest and exercise), physical therapy
Physiotherapy Problems↓ dynamic balance due to postural instability,
rigidity, tremors due to PDAbnormal gait pattern with regards to step length
(shuffle), initiating and stopping movement, changing direction and coordination due to PD
Poor posture – rigid flexed trunk leading to ↓trunk mobility and ROM
Chest complications due to ↓ chest expansion and ↓ trunk mobility due to poor posture
↓ Bed mobility with regards to rolling and coming up in to sit due to difficulty initiating movement caused by PD
Potential ↓exercise tolerance due to general inactivity due to fear of falls and lack of confidence
Management
ManagementImprove balance b.m.o rhythmical stabilization, weight
shifts and reaching out of BOS, proximal strengthening.
Improve gait b.m.o visual and verbal cues, Frenkel’s exercises (Includes rhythm), appropriate assistive device.
Postural retraining b.m.o postural correction exercises, muscle specific strengthening and mobility, and maintenance exercises.
Improve bed mobility by teaching specific cues and strengthening movement patterns.
Prevent chest complications by ↑ chest expansion and trunk mobility with DBE’s and trunk ROM exercises.
Prevent ↓exercise tolerance b.m.o cardiovascular training and regular activity
Evidence based articleTHE EFFECT OF A HOME PHYSIOTHERAPY
PROGRAM FOR PERSONS WITHPARKINSON’S DISEASEAlice Nieuwboer,1 Willy De Weerdt,1 ReneÂ
Dom,2 Mieke Truyen,3 Luc Janssens4 and Yvo Kamsma5
ReferencesKFS 309 Neurology notes. (2011) http://www.medicalnewstoday.com/info/parkinsons-disease/treatment-for-parkinsons-disease.php www.webmd.com/parkinsons-disease/parkinsons-causeshttp://www.google.co.za/url?url=http://
www.medicinenet.com/script/main/forum.asp%3Farticlekey%3D442&rct=j&sa=X&ei=0E8-T6HFJc2WhQfCmNjABQ&ved=0CIMBEOkFKAEwAw&q=parkinson%27s+disease+causes&usg=AFQjCNGbhT6Iph3uxLwqBt7pF23pFoVzdQ
http://www.medicinenet.com/parkinsons_disease/page1-6.htm(2008)