1. Neurology and Rehabilitation Target Day24-11-04 Parkinson’s Disease Dr Bruce Covell Amanda Horlor Linda Lloyd

2. Programme 1)Introduction 2)Set Objectives 3)Pathology 4)Group Work-4 Groups: DiagnosisMaintenanceComplexPalliative 5)Feedback from Groups 6)Drugs 7)Parkinson’s Plus Syndrome M.S.A. P.S.P. C.B.G.D. 8)Discussion and Handouts

3. Service Description The West Herts Adult Rehabilitation Service is an interdisciplinary rehabilitation service for people with complex needs within west Hertfordshire. Our main focus is for people with neurological conditions. The service is based primarily between two sites: Jackets Field Rehab Unit in Abbots Langley and Holywell Rehab Unit at St.Albans City Hospital. Both sites offer an outpatients service and in addition, Holywell Unit offers six inpatient beds for 24 hour rehab programmes.

4. The Approach The Adult Rehab Service provides an empowering and enabling environment, which aims to maximise independence and incorporates a range of therapies that can be tailored to each individuals needs. These needs can be addressed by: Assessment Assessment Intervention advice Intervention advice Specialist teaching Specialist teaching Inpatient rehab Inpatient rehab Outpatient programme with one professional or a team Outpatient programme with one professional or a team Sign posting to other agencies Sign posting to other agencies Specialist equipment, assessment and supply Specialist equipment, assessment and supply Liaison and joint planning with Community Health and Adult Care Services. Liaison and joint planning with Community Health and Adult Care Services. Liaison and joint planning with Acute Hospital Services Liaison and joint planning with Acute Hospital Services

5. Parkinson’s disease is a slowly progressive disorder that affects movement, muscle control and balance. Part of the disease process develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantia nigra. Nerve cells in the substantia nigra send out fibres to tissue located in both sides of the brain. There the cells release essential neurotransmitters that help movement and coordination.

7. Basal ganglia dysfunction as seen in Parkinson’s disease leads to: Impaired performance of well-learnt motor skills and movement sequences. Difficulty performing two or more well- learnt tasks simultaneously. Difficulty shifting motor and cognitive set. Increased time needed for mental processing.

8. The role of the basal ganglia in the performance of ADL’s Pre-movement planning and preparation. Initiation of movement Sequencing and timing of sub-movements. Shifting set.

9. Parkinson’s disease. Main Symptoms Tremor Bradykinesia Rigidity

10. Other Symptoms Postural instability Fatigue Speech impairment Pain Muscle cramps/dystonias Postural hypotension Constipation and bladder problems Anxiety and depression Dementia (mild – moderate)

11. Introduction to Parkinson’s Disease Group Holywell Rehabilitation Unit St.Albans City Hospital PROGRAMME Friday Mornings 11.00 – 12.30 27 th June 2003 11.00 – 12.30 Linda Lloyd Physiotherapist (introduction and video) 4 th July 2003 11.00 – 11.45 Sarah Holmes Citizens’ Advice Bureau 11.45 – 12.30 Merce Boixet Clinical psychologist 11 th July 2003 11.00 – 11.45 Pnina Phillips Pharmacist 11.45 – 12.30 Amanda Horlor Parkinson’s Community Support Worker 18 th July 2003 11.00 – 11.45 Sarah Biggerstaff Community Occupational Therapist 11.45 – 12.30 Helen Spiers Dental Hygienist 25 th July 2003 11.00 – 11.45 Pamela Radley Dietician 11.45 – 12.30 Jane Bradshaw Speech and Language Therapist

12. Exercise Group for people with Parkinsons Disease.

13. The benefits of PD Information and Exercise Groups 1.Reduction in future referrals. 2.Fitter PD patients. 3.A well informed patient. 4.An empowered and enabled patient. 5.An opportunity to share experiences. 6.A happy patient (Reduction of depression and stress levels). 7.Reduction in future complications. 8.Fewer falls.

14. Parkinson’s disease pathways Diagnosis Maintenance Complex Palliative

15. Drugs Amantadine Selegeline Anticholinergic Dopamine Agonists Levodopa – Sinemet & Madopar Apomorphine

16. Parkinson’s Plus Syndrome M.S.AMultiple System Atrophy Shy Drager Syndrome. P.S.P.Progressive Supranuclear Palsy. C.B.G.D.Corticobasal Ganglionic Degeneration.