1. Parkinson’s Disease

2. Definition Parkinson's disease (PD) is an idiopathic, slowly progressive, neurodegenerative disorder whereby two or more of the following needs to be present: bradykinesia, rigidity, resting tremor, and loss of postural mechanisms.

3. Pathophysiology Dopamine acts as a messenger between the substantia nigra and the corpus striatum in the brain - to produce smooth, controlled movements. Most symptoms of Parkinson's disease are caused by a lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra. When dopamine is too low, ineffective communication between the substantia nigra and corpus striatum occur, and movement is impaired. It seems that by the time clinical manifestations occur, approximately 85% of dopaminergic neurons are lost. It is not clear why these dopaminergic cells deteriorate but scientists suspect it is due to a combination of genetic and environmental factors.

4. Causes & Risk Factors Most people with Parkinson's disease have idiopathic Parkinson's disease (having no specific known cause). A small proportion of cases, however, can be attributed to known genetic factors. Other factors have been associated with the risk of developing PD, but no causal relationship has been proven. Age is the largest risk factor (older than 60 years Men are affected 1.5 to 2 times more than women Family history of the disorder Head trauma or illness Exposure to environmental toxins such as pesticides and herbicides

5. Signs & Symptoms Primary symptoms of Parkinson's disease are all associated with voluntary and involuntary motor function and often start on a specific side of the body. The symptoms progress with time Common symptoms are: Tremors- may first be only occasional, starting in one finger and spreading over time to involve the whole arm. The tremor is often rhythmic, 4 - 5 cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling Bradykinesia: Slowness of motion, particularly when initiating any movement

6. Signs & Symptoms Muscles may become rigid. This symptom often begins in the legs and neck. Muscle rigidity in the face can produce a mask-like, staring appearance Postural instability: Impaired or loss of reflexes making it difficult to regulate posture to maintain balance. Postural instability leads to falls. Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady Motor abnormalities that limit action in the hand may develop in late stages. Handwriting, for instance, often becomes small

7. Secondary symptoms of Parkinson's Continued damage to the brain can lead to secondary symptoms which vary in severity. These symptoms include: stress and anxiety confusion, memory loss, and dementia (common in elderly individuals) constipation depression difficulty swallowing and excessive salivation diminished sense of smell increased sweating male erectile dysfunction skin problems slowed, quieter speech, and monotone voice urinary frequency

8. Medical Management

9. There is currently no cure for Parkinson's disease. Treatment is aimed at delaying the onset of motor symptoms thereby extending quality of life The most effective therapy for Parkinson's disease is levodopa (Sinemet), which is converted to dopamine in the brain Surgery is an option for individuals with advanced unmanageable symptoms An alternative approach currently explored is stem cell therapy General lifestyle changes (rest and exercise), physical therapy

10. Physiotherapy Problems ↓ dynamic balance due to postural instability, rigidity, tremors due to PD Abnormal gait pattern with regards to step length (shuffle), initiating and stopping movement, changing direction and coordination due to PD Poor posture – rigid flexed trunk leading to ↓ trunk mobility and ROM Chest complications due to ↓ chest expansion and ↓ trunk mobility due to poor posture ↓ Bed mobility with regards to rolling and coming up in to sit due to difficulty initiating movement caused by PD Potential ↓ exercise tolerance due to general inactivity due to fear of falls and lack of confidence

11. Management

12. Improve balance b.m.o rhythmical stabilization, weight shifts and reaching out of BOS, proximal strengthening. Improve gait b.m.o visual and verbal cues, Frenkel’s exercises (Includes rhythm), appropriate assistive device. Postural retraining b.m.o postural correction exercises, muscle specific strengthening and mobility, and maintenance exercises. Improve bed mobility by teaching specific cues and strengthening movement patterns. Prevent chest complications by ↑ chest expansion and trunk mobility with DBE’s and trunk ROM exercises. Prevent ↓ exercise tolerance b.m.o cardiovascular training and regular activity

13. Evidence based article THE EFFECT OF A HOME PHYSIOTHERAPY PROGRAM FOR PERSONS WITH PARKINSON’S DISEASE Alice Nieuwboer,1 Willy De Weerdt,1 Rene Dom,2 Mieke Truyen,3 Luc Janssens4 and Yvo Kamsma5

14. References KFS 309 Neurology notes. (2011) http://www.medicalnewstoday.com/info/parkinsons-disease/treatment-for- parkinsons-disease.php www.webmd.com/parkinsons-disease/parkinsons-causes http://www.google.co.za/url?url=http://www.medicinenet.com/script/mai n/forum.asp%3Farticlekey%3D442&rct=j&sa=X&ei=0E8- T6HFJc2WhQfCmNjABQ&ved=0CIMBEOkFKAEwAw&q=parkinson%27 s+disease+causes&usg=AFQjCNGbhT6Iph3uxLwqBt7pF23pFoVzdQ http://www.medicinenet.com/parkinsons_disease/page1-6.htm (2008)