Parkinson’s Disease

INTRODUCTION:-

Parkinson’s disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills and speech.

Parkinson’s disease is a disorder that affects nerve cells, or neurons, in a part of the brain that controls muscle movement.

Inspite of the best medical and surgical treatments for Parkinson’s disease, patients develop significant physical problems. Physiotherapists aim to enable people with Parkinson’s disease to maintain their maximum level of mobility, activity and independence through the monitoring of their condition and the targeting of the appropriate physical treatment. A range of approaches to movement rehabilitation, which with education and support are employed to maximise functional ability, minimize secondary complications and enhance quality of life over the whole course of the disease.

CAUSES

Parkinson’s disease is caused by the progressive impairment or deterioration of neurons (nerve cells) in an area of the brain known as the substantia nigra. Normally, these neurons produce a vital brain chemical known as dopamine which serves as a chemical messenger allowing communication between the substantia nigra and another area of the brain called the corpus striatum. This communication coordinates smooth and balanced muscle movement. A lack of dopamine results in abnormal nerve functioning, causing a loss in the ability to control body movements.

Characteristic Symptoms of Parkinson’s disease:

Tremors: Involuntary trembling of the limbs

Rigidity: Stiffness of the muscles

Akinesia: Lack of movement or slowness in initiating and maintaining movement

Postural instability: Characteristic bending or flexion of the body, associated with difficulty in balance and disturbances in gait.

The following are some of the other symptoms:

Primary Symptoms:

  • Bradykinesia – slowness in voluntary movement such as standing up, walking, and sitting down. This happens because of delayed transmission signals from the brain to the muscles.
  • Tremors – often occur in the hands, fingers, forearms, foot, mouth, or chin. Typically, tremors take place when the limbs are at rest as opposed to when there is movement.
  • Rigidity – otherwise known as stiff muscles, often produce muscle pain that is increased during movement.
  • Poor Balance – happens because of the loss of reflexes that help posture. This causes unsteady balance which oftentimes leads to a fall.
  • Parkinson’s Gait – a common walk of somebody with Parkinson’s disease. It includes shuffling, head down, shoulders drooped, lack of arm swing, and leaning backwards or forwards unnaturally. Initiating walking is difficult and freezing mid-stride is common.

Secondary Symptoms:

  • Constipation
  • Difficulty swallowing; saliva and food that get caught in the mouth or in the back of the throat may cause choking, coughing, or drooling
  • Sialorrhoea-excessive salivation
  • Excessive sweating
  • Loss of bowel and/or bladder control
  • Loss of intellectual capacity
  • Psychosocial: anxiety, depression, isolation
  • Scaling, dry skin on the face or scalp
  • Slow response to questions
  • Small cramped handwriting
  • Soft, whispery voice

Diagnosis:

  • Diagnosis is based on a neurological examination, including evaluation of symptoms and their severity.
  • When symptoms are significant, a trial test of drugs (primarily levodopa [L-dopa]) may be used to further diagnose the presence of PD. If a patient fails to benefit from levodopa, a diagnosis of Parkinson’s disease may be questionable.
  • Computed tomography (CT) or magnetic resonance imaging (MRI) scans of the brain may be used to help rule out other diseases with symptoms that resemble PD.
  • Laboratory testing of the blood of patients with the symptoms typical of Parkinson’s only rarely uncovers any abnormality.

PHYSIOLINE’S Management:

Specialised Physiotherapy management at Physioline is- to help improve gait, balance and flexibility, improve aerobic activity and movement initiation, increase independence, and provide advice to prevent fall prevention and other safety information.
Avoid Zimmer frames (flow of movement is interrupted) unless fitted with wheels and handbrake.

Occupational therapy – give advice and help maintaining all aspects relating to activities of daily living, both at work and at home; with the aim of maintaining work and family relationships; encouraging self care where appropriate, assessing any safety issues, making cognitive assessments and arranging any appropriate interventions.

Speech and language therapy – improving loudness and intelligibility of speech where possible, ensuring methods of communication are available as disease progresses, and to help with swallowing (reducing risk of aspiration).

Surgery and deep brain stimulation – Treating Parkinson’s disease with surgery was once a common practice, but after the discovery of levodopa, surgery was restricted to only a few cases.

Deep brain stimulation is presently the most used surgical means of treatment, but other surgical therapies that have shown promise include surgical lesion of the subthalamic nucleus and of the internal segment of the globus pallidus, a procedure known as pallidotomy.

Prognosis:

The progression of symptoms in PD may take 20 years or more. In some people, however, the disease progresses more quickly. There is no way to predict what course the disease will take for an individual person.

PD is not considered to be a fatal disease by itself, but it progresses with time. The average life expectancy of a PD patient is generally lower than for people who do not have the disease. In the late stages of the disease, PD may cause complications such as choking, pneumonia, and falls that can lead to death.

DETAILED TREATMENT:- Kindly contact Physioline for the detailed assessment and treatment program which is individualised according to every patient.