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)