1. PARKINSON’S
DISEASE

2. 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.

3. 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.

4. 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

5. 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

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

7. 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.

8. 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

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

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

11. 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

12. 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

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