Physiotherapy for Parkinson Disease

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Parkinson’sDisease

Definition Of Parkinson’s

A disorder of the brain characterized by shaking and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that controls muscle movement.

Definition Of Parkinson’s Disease In More Detail And More Info.

Parkinson’s disease is an age-related neurologic disease that affects movement, balance, speech swallowing, walking, and muscle tone. Parkinson’s disease affect a region of the brain known as the basil ganglia. One-half to one million persons in the United States are affected with this chronic debilitating disease. Parkinson’s disease was the first neurologic disease to be associated with the loss of a specific neurotransmitter, in this case, dopamine. The cardinal manifestations of Parkinson’s disease include: tremor that usually occurs at rest and can affect any part of the body, bradykinesia that is a slowness of movement, akinesia or obsence of certain movements, and increased muscle tone.

Alternative Names

·         Paralysis Agitans

·         Shaking Palsy

History

·         It appears both in female and male

·         Ages 50 - 79

·         This disease is more prominent on the Pacific Island of Guam and Thekii Peninsula of Japan than anywhere else in the world.(they are trying to find out why)

·         Caucasians get Parkinson’s disease just a little bit more than black people.(less pigment is suspected.

·         Parkinson’s disease reduces life expectancy due to increased incidence of infection associated with chronic immobility

Causes, incidence, and risk factors

·         Parkinson's disease was first described in England in 1817 by James Parkinson. The disease affects approximately 2 out of 1,000 people, and most often develops after age 50.

·         It affects both men and women and is one of the most common neurologic disorders of the elderly.

·         The term "parkinsonism" refers to any condition that involves a combination of the types of changes in movement seen in Parkinson's disease, which happens to be the most common condition causing this group of symptoms.

·         Parkinsonism may be caused by other disorders or by external factors Secondary Parkinsonism.

·         Parkinson's disease is caused by progressive deterioration of the nerve cells of the part of the brain that controls muscle movement (the basal ganglia and the extrapyramidal area).

·          Dopamine, which is one of the substances used by cells to transmit impulses (transmitters), is normally produced in this area. Deterioration of this area of the brain reduces the amount of dopamine available to the body.

·          Insufficient dopamine disturbs the balance between dopamine and other transmitters, such as acetylcholine. Without dopamine, the nerve cells cannot properly transmit messages, and this results in the loss of muscle function.

·         The exact reason that the cells of the brain deteriorate is unknown. The disorder may affect one or both sides of the body, with varying degrees of loss of function.

·         In addition to the loss of muscle control, some people with Parkinson's disease become severely depressed.

·          Although early loss of mental capacities is uncommon, with severe Parkinson's the person may exhibit overall mental deterioration (including dementia , hallucinations , and so on). Dementia can also be a side effect of some of the medications used to treat the disorder.

·         Parkinson's disease is rare in children. When present, it appears to be due to decreased sensitivity of the nerves (post-synaptic) to dopamine rather than deterioration of the area of the brain that produces dopamine.

Another Type Of Parkinsonism

Secondary Parkinsonism

·         There are different stages of Parkinson’s but Secondary is one of them.

·         Conditions which do not usually affect the midbrain that involve the substantia nigra

·         ex.-Trauma such as head injuries from boxing can damage the substantia nigra and lead to Parkinson’s Disease (this is what happen to Mohammed Ali).

·         Or trauma, Ischemia (stroke), Hemorrhage (stroke), Neoplasma (cancer), Neurosyphilis, Tuberculosis.

The Clinical Picture

Trap

Tremor (at rest)

Rigidity (cogwheel)

Akinesia

Postural Instability

Tremor

·         An involuntary movement which may affect the head, limbs, or entire body.

·         Most apparent when limb is related and supported

·         Increased with stress

·         Ceased during sleep

·         Decreased with intentional movements

·         ‘Pill rolling tremor’ if most prominent in fingers and hand

·         Most bothersome, yet least disabling of all symptoms

Rigidity

·         Muscular stiffness and increased muscle tone

·         Patients usually unaware of rigidity but troubled with slowness

·         More apparent to doctor than patient

·         Cogwheeling (affect when moving arms)

Bradykinesia/Akinesia

·         Akinesia: inability to move

·         Bradykinesia: slowness of movement

Most Disabling Feature

·         Decrease in:

·         eye blinking

·         facial expression

·         eating and chewing

·         walking speed

Postural Instability

·         Impaired righting ability

·         Toe-first walk develops

·         Decreased arm swing when walking

·         Posture stooped, knees flexed while walking

·         Unsteadiness while turning

·         Falls will occur

Stage 1

·         Mild one sided tremor or rigidity

·         Affected arm in semi flexed position with tremor

·         Patient leans to affected side

·         One sided disease plus axial (waist) involvement

Stage 2

·         Bilateral involvement

·         Early postural changes

·         Slow, shuffling gait

·         Decreased stride length

·         Mild bilateral involvement

·         Recovery on pull test

Stage 3

·         Pronounced gait disturbances

·         Moderate generalization disability

·         Balanced is a major problem

·         Server tremor, rigidity and/or brandykinesia

Stage 4

·         Significant disability

·         Limited ambulation with assistance

Stage 5

·         Loss of ability to function independently

·         Brandykinesia very severe

·         Independent mobility impossible

Treatments

·         There is no known cure for Parkinson's disease. Treatment is aimed at controlling the symptoms. Medications control symptoms primarily by controlling the imbalance between the transmitters.

·         The medications used vary, depending on the case. The type of medication, the dose, and the amount of time between doses, or the combination of medications used may need to be adjusted as symptoms change.

·         Many of the medications can cause severe side effects, so monitoring and follow-up by the health care provider is important.

·         Deprenyl may be started early in the disorder to slow progression of symptoms and reduce the need for other medications.

·          Amantadine and/or anticholinergic medications may be used to reduce early or mild tremors.

·         Levodopa is a medication that the body converts to dopamine. (It may be used to increase the body's supply of dopamine, which may improve movement and balance.)

·         Carbidopa is a medication that reduces the side effects of Levodopa and makes the Levodopa work better.

·         Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, bromocriptine, monoamine oxidase inhibitors, and others.

·         Good general nutrition and health are important, such as exercise, regular rest periods,avoid stress and tiredness because this can make symptoms worse.

·         Physical therapy, speech therapy, and occupational therapy may help promote functioning, positive attitude, and independence.

Complications

·         disability, varying degrees

·         difficulty swallowing/eating

·         difficulty performing daily activities

·         injuries from falls

·         side effects of medications

Additional Information

·         Experimental or less common treatments may be recommended. For example, surgery to destroy tissues responsible for tremors may reduce symptoms in some people. Transplantation of adrenal gland tissue (and fetal brain tissue) to the brain has been attempted, with variable results.

·         Untreated, the disorder progresses to total disability, often accompanied by general deterioration of all brain functions. It may result in an early death if untreated.
 

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