Parkinson's Disease

• Parkinson's Disease

What is it?

• Parkinson's is a progressive, neurodegenerative disorder.
• It involves diminishing basal ganglia function.
• Parkinson's results in slowed movements, tremor, rigidity, and other symptoms.
• "Neurodegenerative" refers to the degeneration of neurons, which are the basis for all brain activity.
• The basal ganglia section of the brain is responsible for executing smooth movements.
• The cerebral cortex is responsible for deciding on body movement.

Etiology

• The cause of Parkinson's is unknown.
• Destruction of brain cells occurs in the substantia nigra.
• The substantia nigra controls muscular movements by releasing dopamine, which is a neurotransmitter.
• Dopamine decreases as we age.
• Dopamine supply decreases due to necrosis in Parkinson's patients.
• Muscular movements become weaker and more erratic, impacting walking, writing, reaching, and basic movements.
• Healthy substantia nigra neurons produce "Healthy Dopamine Production".
• Substantia nigra neurons affected by Parkinson's cause cell degeneration and decreased dopamine production.

Primary Symptoms

• Bradykinesia is the impairment of voluntary motor control causing slowness or freezing.
• Bradykinesia presents in standing up, walking, and sitting down, causing difficulty in initiating movements, especially walking, and “freezing episodes” once walking has begun and something startles them.
• Festinating gait or shuffling gait is another primary symptom.
• Tremors often occur in hands, fingers, forearms, foot, mouth, or chin and typically occur at rest
• Rigidity is muscle stiffness that produces muscle pain with movement
• Poor balance often results in falls due to the loss of reflexes that help posture causing unsteady balance

Secondary Symptoms

• Postural changes
• 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

Diagnosis & Medical Treatment

• There is no specific test for Parkinson's.
• A systematic neurological exam will include testing reflexes and observing muscle strength, coordination, balance, and other movement details.
• Testing is necessary to rule out other nerve dysfunctions or narrowing of the spinal canal.
• Commonly used medications include Levodopa (Sinemet) and Entacapone (Comtan), which helps improve the effectiveness of levodopa.
• Dopamine agonists (Mirapex) stimulate the body's natural production of dopamine.

Parkinson's and ROM

• Usual ROM and strength testing protocol is attempted.
• AF ROM should reveal a decrease in ROM if rigidity is present.
• PROM will reveal uniform resistance in the flexor and extensor groups acting on affected joints.
• ROM may reveal cogwheel rigidity showing intermittent resistance
• R ROM will not be useful if rigidity is present

Special Tests

• Sensory testing results vary depending on the sensory impairment
• Testing includes light touch, deep pressure, pain/temperature perception, two-point discrimination, and proprioception.
• Perform specific orthopaedic tests depending on the complaint.
• For the Bradykinesia Test, a positive result is movement that becomes slower & more difficult.

Contraindications

• Prolonged, vigorous, or painful techniques should be avoided, preventing stimulation of the SNS.
• Avoid areas sensitive to touch.
• Modify pressure and hydro in areas of altered sensation.
• Modify positioning, techniques, and hydro if hypertension is present.
• Hypotension is a threat due to autonomic dysfunction, so watching during position changes.
• Do not hold down tremors.

Treatment Goals

• Maintain proper alignment.
• Decreased 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 of ADLs.
• Maintain functional ability by moving joints through simple ROM and balance activities.
• Sidelying retraction/protraction and trunk rotation exercises.