Parkinson_disease_06112023.pdf

Parkinson’s disease HESC3592 Neuromuscular Rehabilitation Dr Paulo Henrique Silva Pelicioni PhD, MSC, PostGrad Cert, BPT Lecturer School of Health Sciences Epidemiology • 2nd Most prevalent neurodegenerative disease worldwide (and in Australia) • Over 200,000 of the Australian population • 2/3 of...

Parkinson’s disease HESC3592 Neuromuscular Rehabilitation Dr Paulo Henrique Silva Pelicioni PhD, MSC, PostGrad Cert, BPT Lecturer School of Health Sciences Epidemiology • 2nd Most prevalent neurodegenerative disease worldwide (and in Australia) • Over 200,000 of the Australian population • 2/3 of people diagnosed with PD are men • 18% of people with PD are 65 years older and younger (early-onset PD), and 10% are diagnosed younger than 45 years old • Globally, the number of people with PD will duplicate by 2040, reaching 17.5M of the World population - increased longevity - industrial by-products - reduction in smoking Epidemiology Parkinson’s disease What is Parkinson’s disease? • Neurodegenerative and progressive disorder • Death and depletion of dopaminergic neurons in substantia nigra pars compacta Parkinson’s disease Parkinson’s disease “Healthy” person Parkinson’s person Parkinson’s disease Signs and symptoms Parkinson’s disease • Heterogenous • Progressive • Motor symptoms • Non-motor symptoms • Motor complications Signs and symptoms Motor symptoms Non-motor symptoms • Bradykinesia • Resting tremor • Rigidity • Postural instability • Gait disorders • Anxiety • Depression • Cognitive impairment • Sleep disorders • Apathy • Autonomic dysfunction Signs and symptoms Signs and symptoms Hoehn and Yahr stages 1. 2. 3. 4. Unilateral motor impairment Bilateral motor and axial impairment Bilateral disease with impaired postural control Moderate/ severe disease. Might still walk or stand unassisted 5. Wheelchair bound or bedridden Signs and symptoms Presence of impairments with PD progression • More common presence of cognitive impairment • Freezing of gait • Falls • Physical dependence • Weakness • Issues associated with ageing become exacerbated Main medications for Parkinson’s Symptomatic treatment – not disease-modifying • Dopamine replacement • Dopamine agonists • COMT inhibitors • Anticholinergics – for tremors, mostly • MAO type B inhibitors – prolong dopamine effect Too much PD medication causes dyskinesia • Amantadine – helps with severe dyskinesias Main medications for Parkinson’s Main medications for Parkinson’s Main medications for Parkinson’s Main medications for Parkinson’s The role of an exercise physiologist • To examine a client with PD • To plan and deliver an exercise programme to attenuate PD symptoms • To plan and deliver an exercise program to tackle co-morbidities • To be part of a multi-disciplinary team Parkinson’s assessments Parkinson’s assessments Parkinson’s assessments Parkinson’s assessments Parkinson’s assessments • Part I – non-motor experiences of daily living • Part II – motor experiences of daily living • Part III – motor examination • Part IV – motor complications Exercise for Parkinson’s disease Primary outcomes • MDS-UPDRS part III (motor examination) • PDQ-39 (quality of life) Exercise on motor examination Exercise on quality of life Exercise for Parkinson’s disease Secondary outcomes • TUG (functional mobility) • Freezing of gait (FOG-Q and NFOG-Q) Exercise for Parkinson’s disease Exercise for Parkinson’s disease Exercise on quality of life Exercise on quality of life Only on TUG Exercise for Parkinson’s disease Adverse events (considerations) • Falls • Pain Virtual reality for Parkinson’s disease Outcomes • Gait • Balance • Quality of life • Adverse events Virtual reality for Parkinson’s disease Virtual reality for Parkinson’s disease Virtual reality for Parkinson’s disease Virtual reality for Parkinson’s disease Freezing of gait (FoG) • One of the most disabling PD symptoms • Its occurrence increases with disease progression (usually Hoehn and Yahr 3 and above) • FoG usually occurs during turning, gait initiation and narrow pathways • Severe FoG can happen during normal walking • Increased the risk of falling substantially Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Freezing of gait (FoG) Types of visual cueing • Stripes taped on the floor/ cones • Laser shoes/ belt • Holographic cueing • Floor pattern Falls prevention • 45% - 68% of people with PD fall in each year • 50% - 86% of people with PD fall (2+) in each year • Its occurrence increases with disease progression (Hoehn and Yahr 3 and above) • People with PD PIGD are more likely to fall due to - FoG - Balance-related circumstances (e.g., trips/ slips) - At home Falls prevention Primary outcome • Rate of falls (falls/month) Falls prevention Falls prevention Falls prevention Falls prevention Falls prevention Falls prevention Primary outcome • Number of people who fell at least once Falls prevention Falls prevention Cognitive impairment in Parkinson’s Cognitive impairment in Parkinson’s • Impaired visual-spatial processing • Poor attentional processing • Poor short-term memory • Executive dysfunction • Deficient information processing • Difficulties with dual-tasking Altogether, they can increase the risk of falling Cognitive impairment in Parkinson’s Tests A. CSRT B. iCSRT C. SST Cognitive impairment in Parkinson’s DLPFC Broca’s Cognitive impairment in Parkinson’s DLPFC PMC SMA Broca’s Cognitive impairment in Parkinson’s Reduced cortical activity during inhibitory complex stepping tasks may reflect a “slow-down” phenomenon in people with PD. Fronto-striatal circuit damage Cognitive impairment in Parkinson’s Cognitive impairment in Parkinson’s Cognitive impairment in Parkinson’s Outcomes • Global cognition • Executive functioning • Attention • Verbal memory • Visual processing • ADLs and QoL Cognitive impairment in Parkinson’s Outcome • Attention Cognitive impairment in Parkinson’s Outcome • Verbal Memory Cognitive impairment in Parkinson’s Cognitive impairment in Parkinson’s Training groups • Locomotor • Multimodal • Cognitive maintenance in cognitive levels reduced physical stress maintenance in cognitive levels Locomotor & multimodal groups Delay in the progressive course of PD on non-motor symptoms Patients trained what really matters? Exercise considerations • Higher disease severity (e.g., increase falls risk) • Dyskinesia (e.g., too uncontrolled can hurt themselves) • Tremor (e.g., affecting gripping) • Not in “off” stage • Cognitive impairment (e.g., levels of understanding) • Freezing of gait • Orthostatic hypotension • Co-morbidities • Pain during execution [email protected]