PARKINSON’S DISEASE

PARKINSON’S DISEASE Parkinson’s Disease is a chronic progressive degenerative disease of the nervous system. Deficiency of the brain chemical dopamine occurs in the basal ganglia. Patient typically exhibit classic clinical signs of Rigidity, Bradykinesia, RestingTremor and Impaired Postural Reflexes.

Cardinal Manifestations CLINICAL FEATURES Cardinal Manifestations RIGIDITY Rigidity is defined as Resistance to Passive motion that is not Velocity Dependent. BRADYKINESIA It refers to Slowness and difficulty in maintaining movements. TREMOR Resting tremor or Pill rolling tremor. POSTURAL INSTABILITY Frequent Falls results due to Progressive loss of Balance Reactions.

Indirect Impairments Fatigue Edema – In Feet & Ankle Masked Face Postural Deformities – Kyphosis, Scoliosis Osteoporosis Swallowing Difficulties Micrographia – Abnormally small hand writing Visual Abnormalities Sensory disturbances

FESTINATING GAIT Due to Abnormal Stoop Posture, Gait is characterized by a progressive increase in Speed & Shortening of the Step The Patient takes Multiple Short Steps to catch up the Centre of the Mass & Avoid Falling And Eventually break into a Run Turning & Changing Directions are difficult

Hand Writing – Micrographia Abnormally small hand writing seen in Parkinson’s Disease

HOEHN AND YAHR CLASSIFICATION OF DISABILITY STAGE CHARACTER OF DISABILITY 1 Minimal or Absent; Unilateral if present 2 Minimal Bilateral or Midline involvment Balance not Impaired 3 Impaired Righting Reflexes, Unsteadiness When turning or rising from chair. Some activities are restricted, but patient can live Independently and continue some form of Employment. 4 All symptoms are present and severe. Standing and walking possible only with Assistance. 5 Confined to bed or Wheelchair.

DIAGNOSIS Myerson's sign A Diagnosis can be made if At least 2 of the 4 Cardinal Features are Present Hand Writing Samples, Speech & Physical Examinations are Performed Glabellar reflex It is elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign – seen in Parkinson’s disease.  Myerson's sign

CT & MRI Atrophy of Substantia Niagra is noted. Mostly Help Full in Ruling Out Other CNS Pathologies

Medical Management ANTICHOLINERGIC DRUGS Trihexyphenidyl Bentropin DOPAMINERGIC DRUGS Levadopa Carbidopa Sinemet SURGICAL MANAGEMENT Pallidotomy Thalamotomy Deep Brain stimulation

Physiotherapy Management Relaxation exercises ROM exercises & Stretching Facial exercises Respiratory Management Breathing exercises Airway clearance techniques Balance training Sitting balance Sit to stand transition Standing balance Kitchen sink exercises Gait training Aerobic exercises – Walking is beneficial

GAIT TRAINING Goals Activities 1)Weight Transference, Pelvic & Trunk Movts 2) Increase Stride Length & Base of Support 3) Reciprocal Arm Swing 4) Rhythm 5) To Promote Normal Heel Toe Progression Activities - Static Marching, Stepping Forward & Backward & wt Bearing - Floor Markings ( Visual – Cues) - Wand - Oral Counts ( Auditory - Cues) - A Wedge is placed inside the shoe

GAIT TRAINING OTHER ACTIVITIES Starting & Stopping Walking Sideways Walking Across Obstacles Turning Around Regular Walking Exercises to Prolong Functional Independence