Parkinson Disease

• Parkinson Disease is a progressive, neurodegenerative disorder involving diminishing basal ganglia function, leading to slowed movements, tremor, rigidity, and other symptoms.
• "Neurodegenerative" refers to the degeneration of neurons, which are the basis for all brain activity.

Etiology

• The cause of Parkinson's is unknown, but it involves the destruction of brain cells in the substantia nigra.
• The substantia nigra controls muscular movements by releasing dopamine (neurotransmitter).
• Dopamine decreases as we age, and in Parkinson's, dopamine supply decreases due to necrosis.
• Muscular movements become weaker and more erratic, affecting walking, writing, reaching, and basic movements.

Primary Symptoms

Bradykinesia

• Impairment of voluntary motor control, resulting in slowness or freezing.
• Presents in standing up, walking, and sitting down, difficulty initiating movements (especially walking), and "freezing episodes" when startled.
• Can result in festinating gait or shuffling gait.

Tremors

• Often occur in hands, fingers, forearms, foot, mouth, or chin.
• Typically occur at rest.

Rigidity

• Muscle stiffness produces muscle pain with movement.

Poor balance

• Loss of reflexes affects posture, often resulting in falls.
• Unsteady balance often results in falls

Secondary Symptoms

• Postural changes include kyphotic, head forward posture
• Breathing difficulties
• Fatigue
• Constipation
• Difficulty swallowing
• Choking, coughing or drooling, speech
• Excessive salivation
• Loss of bowel/bladder control
• Anxiety, depression, isolation
• Slow response to questions
• Soft whispery voice, unable to project

Diagnosis & Medical Treatment

• No specific test for Parkinson's exists.
• A systematic neurological exam includes testing reflexes and observing muscle strength, coordination, balance, and other movement details.
• These tests are necessary to rule out other nerve dysfunction, narrowing of the spinal canal, and determine necessary treatments.
• Commonly used medications for Parkinson's include Levodopa (sinemet) & entacapone (comtan)
• Levodopa & entacapone help improve the effectiveness of levodopa
• Dopamine agonists (mirapex) try to stimulate the body's natural production of dopamine.

Parkinson's and ROM

Special Tests

• Usual ROM and strength testing protocol will be attempted.
• AROM reveals a decrease in ROM if rigidity is present.
• PROM reveals uniform resistance in the flexor and extensor groups acting on affected joints.
• Cogwheel rigidity (intermittent resistance) may be present.
• RROM will not be useful if rigidity present.

Contraindications

• Sensory testing results vary depending on the client's sensory impairment.
• Bradykinesia test reveals movement becomes slower & more difficult when the test is positive
• For light touch, deep pressure, pain/temperature perception, two point discrimination and Proprioception
• Specific orthopedic tests depend on the complaint
• Prolonged vigorous or painful techniques should be avoided as they stimulate the SNS.
• Areas sensitive to touch are avoided.
• Ensure pressure and hydro are modified in area of altered sensation
• Positioning, techniques, and hydro are modified if hypertension is present.
• Hypotension is a threat due to autonomic dysfunction (watch during position changes).
• Do not hold down tremors.

Treatment Goals

• Maintain proper alignment.
• Decrease SNS firing.
• Decrease edema if present.
• Maintain tissue health.
• Decrease pain.
• Address postural changes and muscle imbalances
• Limit contractures.
• Reduce constipation.
• Address diaphragm muscles
• Maintain thoracic mobility
• Encourage whole body integration.

Home Care

• Encourage relaxation with diaphragmatic breathing.
• Regular, moderate exercise can improve motor control.
• Encourage continuation with ADLs.
• Maintain functional ability by moving joints through simple ROM, and balance activity
• Provide exercises like Sidelying do retraction/protraction, trunk rotation exercises