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    Parkinson's Disease

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    Arko dutta
    This document discusses Parkinson's disease (PD), including its history, signs and symptoms, pathophysiology, assessment, and physical therapy management. PD is a chronic, progressive disorder of the central nervous system affecting the basal ganglia. It is clinically defined by bradykinesia, rigidity, and resting tremor. Physical therapy for PD focuses on improving range of motion, balance, coordination, gait, functional independence, endurance, and respiratory function through exercises and adaptive equipment.

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    Parkinson's Disease

    Uploaded by

    Arko dutta
    31 views25 pages
    This document discusses Parkinson's disease (PD), including its history, signs and symptoms, pathophysiology, assessment, and physical therapy management. PD is a chronic, progressive disorder of the central nervous system affecting the basal ganglia. It is clinically defined by bradykinesia, rigidity, and resting tremor. Physical therapy for PD focuses on improving range of motion, balance, coordination, gait, functional independence, endurance, and respiratory function through exercises and adaptive equipment.

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    Neurological condition, causes Physiotherapy management

    Original Title

    Parkinson’s Disease (1)

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    This document discusses Parkinson's disease (PD), including its history, signs and symptoms, pathophysiology, assessment, and physical therapy management. PD is a chronic, progressive disorder of the central nervous system affecting the basal ganglia. It is clinically defined by bradykinesia, rigidity, and resting tremor. Physical therapy for PD focuses on improving range of motion, balance, coordination, gait, functional independence, endurance, and respiratory function through exercises and adaptive equipment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views25 pages

    Parkinson's Disease

    Uploaded by

    Arko dutta
    This document discusses Parkinson's disease (PD), including its history, signs and symptoms, pathophysiology, assessment, and physical therapy management. PD is a chronic, progressive disorder of the central nervous system affecting the basal ganglia. It is clinically defined by bradykinesia, rigidity, and resting tremor. Physical therapy for PD focuses on improving range of motion, balance, coordination, gait, functional independence, endurance, and respiratory function through exercises and adaptive equipment.

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    James Parkinson (1817) described as Paralysis Agitans or, Shaking Palsy

    It is clinically defined as Chronic, Progressive, Disorder of


    the CNS affecting the Basal Ganggion/Extrapyramidal
    System, affecting mainly persons in middle age or older
    with cardinal feature of Bradykinesia, Rigidity and
    Resting Tremor.
    EPIDEMIOLOGY
    Incidence : 1 to 2 /1000 of population

    Age of Onset : Majority Cases 50 to 79 years


    10% develop young onset PD where initial
    symptoms starts before 40 yrs

    Gender : Almost equal (M ≥ F)


    ETIOLOGY
     Idiopathic : Unknown Etiology
     Infectious : Epidemics of Encephalitis Lethargica
     Toxic : Industrial poisons & Chemicals (Mn, CS2, CN,
    Methanol, Drug addicts of Synthetic Heroine)
     Metabolic : Wilson’s Disease - Cu, Haller vorden- Spatz
    Disease of - Fe , Ca metabolism – Basal Ganglia
    Calcification in Hypoparathyroidism
     Phamacologic : Antipsychotics (Chlorpramazine,
    Haloperidol, Butyro phenol), Antihypertensives
    (Containing Reserpine like Methyl Dopa), Antiemetics
    (Perinol)
     Structural Damage: Normal pressure hydrocephallus,
    Tumors, Stroke, Punch Drunk Syndrome (In Boxers)
    pathophysiology
    Death / Degeneration of cells in Substantia Nigra is is
    secondary to an Oxidative process. The Oxidation may
    arise from Byproducts of Dopamine catabolism through
    Mono Amine Oxygenase-B

    Major degeneration & loss of Pigmented neurons in Pars


    Compacta of sub. Nigra leading to depletion of
    Dopaminergic Neurons resulting into deficiency of
    Striatal dopamine
    Pathophysiology….contd
    Dopamine Inhibitory
    ACH Excitatory
    Dominance of Excitatory Neurotransmitter ACH

    ❖Tone of muscle 1st affected & Rigidity appears leading to


    slowing down of Vol. movts. known as BRADYKINESIA

    ❖Constant adjustment between tone of agonist &


    antagonist in limb, trunk & facial muscle take place
    continuously. This leads to oscillating tone which presents
    as TREMOR as well as due to disinhibition of Pacemaker
    cells in Thalamus.
    Sign & Symptoms
    ➢ Bradykinesia / Akinesia : Due to Impaired preparatory
    process
    Bradykinesia: Slowing of movements during Execution
    due to Prolong time of execution.
    Akinesia (Freezing): Reduction in spontaneous &
    associated movement with slow Initiation due to Prolong
    Reaction Time (command & the 1st contraction of Muscle)
    ❖Poor performance in functional activity like Turning in
    Bed, Walking, Speaking, Tying Shoe Laces, Writing etc.
    How to Assess:
    ➢ Finger & Foot Tapping Test
    ➢ Grooved Pegboard Test
    ➢ Computerized Tapping Test
    Clinical Feature…..contd
    ➢ RIGIDITY: It is increased resistance to passive movement
    throughout the FROM due to increased tone of both agonist &
    antagonist muscle.
    ➢ Rigidity tends to more prominent in muscle that maintain a
    flexed posture i.e. Flexors of Trunk & Limbs.
    ➢ Rigidity increases with Anger, Tension, Efforts, Stress.
    ➢ Seen more in Proximal muscle & Axial muscle than Distal
    muscle.
    Two Types:
    ❖ COG WHEEL: Tremor is superimposed upon rigidity
    ❖ LEAD PIPE or PLASTIC
    To Measure Rigidity: Based on resistance offered/felt to passive
    movement; Mild, Moderate & Severe
    Clinical Feature…..contd
    ➢ TREMOR: Initial manifestation in 50% of patient, present
    in 70-80%.

    ➢ Resting Tremor may progress to Action or Postural Tremor

    ➢ Pill Rolling type in Thumb & Fingers. There is Rhythmic


    pronation & supination of hand with forward & backward
    movement of thumb over finger. It decreases during effort
    or movement and disappear during sleep.
    Clinical Feature…..contd
    ➢ Impaired Postural Reaction: Because of degeneration of
    Globus Pallidus leading to Impaired Balance or Righting
    reaction.

    ➢ POSTURE: Stooped simian posture, Trunk bent forward


    with Head bowed, Shoulder drooped, arms flexed at Elbow
    with hand in front of body, Hip & Knee flexed.
    ➢ FACIES: Mask like face or Expressionless, Blinking reduced,
    No Facial mevement.
    ➢ Micrographia: With the progression of sentence font size
    gradually decreases.
    Clinical Feature…..contd
    ➢ GAIT: Short Shuffling Gait or, Festinating Gait

    ➢ SPEECH: Monotonus, Slurred with poor articulation &


    Hypophonia (Decreased Volume)
    ➢ REFLEXES: Glabellar Tap Reflex – Diminished or Absent.
    DTR – Normal or Exagerrated
    Plantar Response: Extensor Type
    ➢ DYSPHAGIA: Present in 50% of patient. There is difficulty
    in Swallowing. Drooling present & may can lead to
    Aspiration pneumonia.
    Clinical Feature…..contd
    ➢ ANS Disturbance: Excessive Perspiration, Greasy Skin,
    Increased Salivation & Drooling, Bladder Dysfunction Decreased
    Motility of GI Tract & Constipation, Cardiovascular abnormality
    like Orthostatic Hypotension

    ➢ SENSORY SYMPTOMS : In 40% of patients. Deep Cramp like


    pain in muscle & joints. Numbness, Tingling & abnormal
    temperature sensation.

    ➢ VISUAL DIFFICULTIES: Mild abnormality, Decreased Blinking,


    Blurring of near vision, Rarely Diplopia, Pupillary Abnormality
    with decreased reflex response to light.

    ➢ COGNITIVE DEFICIT: Dementia, Intellectual impairment,


    Bradyphrenia (Slowing of Thought process), Depression &
    Behavioral Changes.
    Secondary Complications
    ➢ Weakness & Muscle atrophy (Disuse)

    ➢ Loss of Flexibility leading to tightness & contractures

    ➢ Deformity – Kyphosis

    ➢ Osteoporosis

    ➢ Cardiopulmonary changes like decreased vital capacity &


    cardiac output.

    ➢ Pressure sore in advance stage

    ➢ Loss of Libido & Impotence


    Assessment
    ➢ C/C

    ➢ H/O present & past medical illness

    ➢ Higher Function Evaluation: Memory, Speech, Vision

    ➢ Sensory Function Evaluation

    ➢ Motor Function Evaluation: Tone (Rigidity), Tremor check


    for symmetry of both side, Motor Control, MMT, ROM, DTR,
    Planter response, Glabellar Tap Reflex

    ➢ Functional Evaluation: Bed Mobility, Balance, Oromotor


    function, Breathing Pattern, Gait, C/T/D
    Hoehn & Yahr Classification
    It is the classification of disability stages of P.D.
    Stage I : Unilateral Involvement with minimal or No
    Functional Impairment
    Stage II: Minimal bilateral or Midline involvement, without
    Impairment of Balance.
    Stage III: Impaired righting reflex with difficulty in rising
    from chair & turning. Some functional activities are
    restricted but patient can live independently and continue
    some form of employment.
    Stage IV: All symptoms present & severe. Standing &
    Walking possible only with assistance.
    Stage V: Confined to bed or Wheel chair bound.
    Physiotherapy Management: GOALS
    ➢ Promote full functional ROM in all joints
    ➢ Prevent contractures & Correct faulty Posture
    ➢ Prevent or Minimize disuse atrophy & muscle
    weakness
    ➢ Improve Balance
    ➢ Improve Coordination
    ➢ Promote functional Gait
    ➢ Maintain or Improve Activity & functional
    Independence
    ➢ Maintain or Improve endurance
    ➢ Maintain or Improve Chest expansion, V.C. & Speech
    ➢ Assist in psychological adjustment to disease & life
    style modification
    Physiotherapy Management:

    ➢ Promote full functional ROM in all joints:

    ✓ Active or Passive full range of motion Exercise


    depending upon condition of patient.

    ✓ Stretching to tight muscle or prone to tight like flexors


    with 15 sec hold 10 repetition once in a day
    Physiotherapy Management:
    ➢ Prevent contractures & Correct faulty Posture:

    ✓ Stretching to tight muscle or prone to tight like flexors with 15


    sec hold 10 repetition once in a day.

    ✓ PNF technique like Contract relax or Hold relax.

    ✓ Focus on Extension exercise

    ✓ Prone lying position for 30 min once in a day which will stretch
    the flexor muscles

    ✓ Correction of Posture by postural care & awareness


    Physiotherapy Management:
    ➢ Prevent or Minimize disuse atrophy & muscle
    weakness:

    ✓ Strengthening exercise focus on endurance training.

    ✓ Free AFROM exercise

    ✓ Task oriented activities

    ✓ Virtual training
    Physiotherapy Management:
    ➢ Improve Balance:

    ✓ External perturbation

    ✓ Swiss ball, Medicine ball, Wobble Board

    ✓ Virtual Balance Board training

    ✓ Force Platform

    ✓ Bio feedback
    Improve Coordination:
    ➢ Coordination Exercise

    ➢ Frankel’s exercise

    ➢ Peg board activities


    Physiotherapy Management:
    ➢ Promote functional Gait: By

    ✓ Lengthening stride & step length & broaden BOS

    ✓ Improve arm swing & trunk movement

    ✓ Improve heel to toe pattern

    ✓ Improve weight transference


    Improve Functional Status &
    Maximize Independence:
    Provide Splints & Orthotic support

    Provide Adaptive Device

    Provide Walking Aids

    Home modification
    Physiotherapy Management:
    ➢ Maintain or Improve Endurance:
    ✓ Aerobic Exercise like:
    ✓ Cycling,
    ✓ static cycling,
    ✓ Brisk walking,
    ✓ Treadmill training,
    ✓ Jogging,
    ✓ Swimming,
    ✓ Upper limb Ergometry exercise
    Maintain or Improve Chest Function:
    ✓ Improve chest expansion

    ✓ Stretching of pectoral muscle

    ✓ Correction of posture

    ✓ Deep breathing exercise

    ✓ Incentive spirometry

    ✓ Force expiratory techniques

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