1. Parkinson's disease ♦ Is a neurodegenerative disorder ♦ Develops around age 50 * incidence rises with age * affects 1-2% of population > age 65 ♦ Higher incidence in men (62%) compared to women (38%)

2. Early Signs and Symptoms  Cardinal Characteristics  Resting tremor  Bradykinesia  Rigidity  Postural instability  Other  Micrographia  Masked face  Slowing of ADLs  Stooped, shuffling gait  Decreased arm swing when walking

3. Additional Signs and Symptoms  Difficulty arising from a chair  Difficulty turning in bed  Hypophonic speech  Sialorrhea  Loss of the sense of smell  Foot dystonia

4. Criteria for Diagnosis  At least two of three: rest tremor, bradykinesia, rigidity  Absence of a secondary cause—drugs, metabolic, etc.  Definitive diagnosis can only be made by autopsy

5. Pathophysiology  : Deficiency of the brain chemical dopamine occurs in the basal ganglia.  Degeneration of nigrostriatal pathway (Substantia Nigra to corpus striatum.

6. Drug Classes in PD  Dopaminergic agents  Levodopa  Dopamine agonists  Anticholinergics  Amantadine

7. Surgical Treatments for Parkinson’s Disease  Ablative  thalamotomy  pallidotomy  Electrical stimulation  VIM thalamus, globus pallidus internus, sub-thalamic nucleus  Transplant  human fetal, genetically engineered transplants

8. Treatment Plan  Maintain or increase ROM in all joints  Efforts to improve postural control and standing balance  Prevent disuse atrophy and muscle weakness  Improve motor function and mobility

9. Physical Therapy: Goal Maintain or increase activity level Decrease rigidity and bradykinesia Facilitate movement and flexibility; optimize gait Maximize gross motor coordination and balance Maximize independence, safety, function

10. Rehabilitation Hoehn and Yahr Rating scale Divided into five stages  Stage 0 = no visible disease;  Stage I = disease that involves only one side of the body;  Stage II = disease that involves both sides of the body. but does not impair balance:  Stage III = disease that impairs balance or walking;  Stage IV = disease that markedly impairs balance or walking: and  Stage V = disease that results in complete immobility.

11. Cardiopulmonary Impairment  The patient's flexed posture can lead to kyphosis, cause a reduction in pulmonary capacity, and produce a restrictive lung disease pattern.  Breathing exercises, postural reeducation, and trunk exercises may be helpful.  Institution of a general conditioning program can increase the patient's endurance.  If pulmonary function progressively worsens, assisted coughing techniques, incentive spirometry, and respiratory therapy intervention may be required.

12. Physical Therapy  Static and dynamic postural controls emphazing whole body movements sitting and standing  Stationary bike training to help reciprocal movements  Exercise: walking(1+mile/day),swimming,golf,dancing  Use of assistive devices, mobility aids, orthotics  Family training and home program  Proper and energy conservation techniques  After 6 mths benefit of therapy if not coninued will be gone

13. Aerobic activities such as:  Using a treadmill  Using a stationary bike or rowing machine  Walking  Swimming

14. MAKE GOOD POSTURE A HABIT  Stand against a wall and be sure your lower back and shoulder BLADES are touching the wall

15. MAKE GOOD POSTURE A HABIT  lie flat on your back, with just enough support to keep your head and neck from tipping back for 5 minutes.

16. FLEXIBILITY OR STRETCHING

18. STRENGTHENING EXERCISES

20. Alzheimer's Disease  Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, symptoms first appear after age 60.