Parkinson’s Disease

April 10, 2017 | By | Reply READ MORE...

– Dr. Purti Degwekar

What is Parkinson’s disease?

Parkinson's Disease

Parkinson’s disease (PD) is the second most common neuro-degenerative disorder and the most common movement disorder. It is characterized by a progressive loss of muscle control, which later leads to difficulty in walking, talking (speech) and other activities of daily living.

What are the changes that happen in the brain?

  • In Parkinson’s disease, there is a progressive deterioration of motor function due to loss of dopamine-producing brain cells.
  • Normally, certain nerve cells (neurons) in the brain make a chemical called dopamine, which helps to control movement. In people with PD, these neurons slowly degenerate and lose their ability to produce dopamine. As a result, the symptoms of PD develop gradually and tend to become more severe over time.
  • Although it is well known that lack of dopamine causes the motor symptoms of Parkinson’s disease, it is not clear why the dopamine-producing brain cells deteriorate.

What are the symptoms to look for?

Primary motor symptoms include:

  • Tremor – usually begins in a single hand (the first symptom for 70% of individuals with Parkinson’s disease)
  • Slowness of motion – people with Parkinson’s disease usually see that they have difficulty initiating movements or that performing movements takes longer
  • Stiffness or rigidity of muscles – individuals with Parkinson’s disease often find they have problems with normal activities, for example standing up from a chair or getting out of bed
  • Postural instability – results in impaired balance and falling
  • Gait and posture disturbances:
    • Shuffling gait
    • Decreased swinging of the arms
    • Stooped, or forward-flexed posture
    • Gait freezing – happens in tight, cluttered spaces, doorways or when initiating gait

Secondary motor symptoms include:

  • Impaired gross motor coordination
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
    mask-like face

Non-motor symptoms include:

  • Constipation
  • Bladder problems
  • Sexual problems
  • Cognitive issues like anxiety, depression, dementia, apathy, hallucinations and sleep disorders

Symptoms typically start on one side of the body and spread to the other side over a few years. As symptoms worsen, a person may become dependent in performing normal daily tasks

What causes Parkinson’s disease?

The exact cause of PD is not yet known. Some of the probable causes are listed below:

  • Idiopathic (most common cause) – means that it arises sporadically with no known cause
  • Environmental factors – exposure to heavy metals, pesticides and other toxins
  • Genetic factors – certain genes like SNCA, PARK 2 and 7 are found in early onset Parkinson’s disease
  • Hereditary factors – family history of the disease

How is it diagnosed?

Diagnosis of Parkinson’s Disease is done by the physician or neurologist clinically, on the basis of the medical history and neurological examination.

There is no medical test that will clearly identify the disease, but brain scans are sometimes used to rule out disorders that could give rise to similar symptoms. Patients may be given levodopa and resulting relief of motor impairment tends to confirm the diagnosis.

Computed Tomography (CT) and conventional magnetic resonance imaging (MRI) brain scans of people with PD usually appear normal. Dopaminergic function in the basal ganglia can be measured with different PET and SPECT radioactive tracers.

Management

There is no cure for Parkinson’s disease, but medications, surgery, and multi-disciplinary management can provide relief from the symptoms. When only mild symptoms can be found individuals may decide, along with their GP/consultant, to delay medications until their symptoms increase and instead depend on a healthy lifestyle, focusing on exercise, relaxation and diet.

1. Medical Management­

Commonly used medicines are:

  • Levodopa
  • Dopamine agonists
  • COMT inhibitors
  • MAO-B inhibitors
  • Glutamate antagonists
  • Anticholinergics
  • Surgical Management

Studies in the past few decades have led to great improvements in surgical techniques, so that surgery is again being used in people with advanced PD for whom drug therapy is no longer sufficient.

2. Surgical Management­

Surgical treatment is available for some people with Parkinson’s disease, determined by symptoms. This includes:

  • Deep brain stimulation
  • Pallidotomy

3. Physiotherapy

  • The objective of the physical therapist is to improve the quality of life by maintaining or increasing the patient’s independence, safety and well-being. This is achieved through prevention of inactivity and falls, improving functional activity and decreasing limitations in activities.
  • Independence is increased with balance, stretching and strengthening exercises and provision of walking aids and equipment.
  • Physiotherapists assess how a person performs activities for example; walking, going up and down stairs, getting away from a chair and becoming in and out of bed.
  • Physiotherapists teach patients, their loved ones and carers, special strategies how do deal with the common signs of Parkinson’s. Family and carers usually see the practical handling techniques particularly helpful, with regards to helping individuals up out of bed, walking and overcoming freezing.

Physiotherapy goals for patients with PD are:

  • To improve muscle flexibility and joints’ range of motion – A variety of stretching exercises including PNF patterns are given depending on the structures which are tight.

Parkinson's Disease

  • To improve muscle strength – Strengthening of global muscles as well as stabilizer muscles is very important for maintenance of good posture and balance.

Parkinson's Disease

  • To improve balance and co-ordination – Various exercises in standing and seated position are given with the use of gym ball and foam pad to improve motor planning and balance reactions. A lot of constant auditory, visual and tactile cueing is required for these patients.
  • To improve gait – Gait training is very important for the patient’s safety and independence in the performance of activities and for prevention of falls.

Gait training is done with the help of auditory and visual cues. A metronome (a device that marks time at a selected rate by giving a regular tick) may be used for stimulating rhythmical stepping pattern.

Assistive devices such as a stick or rolling walker maybe needed for patients with moderate to severe Parkinson’s disease.

Parkinson's Disease

Body-weight supported treadmill training (BWSTT)

Parkinson's Disease

Rolling walker

Body-weight supported treadmill training (BWSTT) has been found to be very effective in improving gait, speed of walking, and balance in these patients.

We at PhysioRehab work towards making a tailor-made program for the treatment of patients manifesting different stages of Parkinson’s Disease to make them as independent as possible in their daily life.

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