Parkinson’s disease is a chronic ,progressive disorder of the nervous system characterized by the cardinal features of rigidity,akinesia,brady kinesia,tremorand postural instability.
The term parkinsonism is used to refer a group of disorders that produce abnormalities of basal ganglia function.
Parkinson’s disease or primary parkinsonism is the most common cause affecting of about 78% of the patients. Secondary parkinsonism results from any different cause . Parkinsonism plus syndromes impilies to the symptoms of multiple system degeneration.
The basal ganglia plays an important role in the production of voluntary movement and control of postural adjustments associated with voluntary movements.
Damage to the basal gangila in PD results in motor disturbances which can be hyper or hypo kinetic.
(Hyper kinetic– chorea, dyskinesia, dystonia, Hypokinetic– akinesia , bradykinesia)
PD is associated with degeneration of dopaminergic neurons that produce dopamine. Loss of these neurons influence leads to a reduction in spontaneous movements, thus the patients wants to move but cannot.
- Postural instability
- Indirect impairements and complications include poverty of movements, fatigue, masked face, musculo-skeletal changes, gait disturbances, swallowing and communication dysfunctions, cognitive and behavioural dysfunctions, autonomic dysfunctions, cardio-pulmonary issues.
An assessment of functional status of the patient plays an important role.
Measures of functional ability by using FIM(functional independence measure), katz index of independence in activity of daily living.
Disease specific measures by using unified parkinson’s disease rating scale (UPDRS-assess the direct and indirect effects of PD and effect of drug related fluctuations.it is divided into three parts
- 1) Mental status
- 2) ADLs
- 3) Motor scale )
Parkinson’s disease questionnaire (PDQ-39) – this contains 39-item questionnaire which adresses on the imact of PD on daily life and also health related quality of life dimensions like mobility, ADL’s, emotional well-being, stigma, social support, cognition etc
- Relaxation exercises- gentle rocking and roation exercises, PNF techniques like rhythemic initiation
- Flexibility exercises- ROM exercises, stretchings, positioning, hold relax and contract relax techniques.
- Mobility exercises- based on functional movement patterns, bed mobility exercises, pelvic mobility exercises, weight bearings.
- Balance training in sitting and standing
- Gait training for improving stepping, lengthen stride, improve heel-toe gait pattern, increase contra-lateral trunk movement and arm swing, PNF activity of braiding, side stepping and cross stepping
- Motor learning strategies-
In early stages: training sessions to improve learning and performance of complex movements, dual tasks
In late stages: compensatory strategies, use of visual and and auditory cueing
- Respiratory exercises- diaphragmatic breathing exercises, air shifting techniques , exercises that recruit neck, shoulder and trunk muscles
- Aerobic conditioning- upper and lower extremity ergometry and walking
- Group and home exercises
- Patients are advised to take high-calorie low protein diet(not more than 15% of calorie from protein)
- Education about the symptoms and disease entails
- Possible strategies to solve movement patterns- teaching of optimal self care, completion of daily tasks etc.