Change Your World Week Fall 2021 (Archived)

Parkinson’s disease is the second most common neurodegenerative disorder with no known cure. It is a chronic, progressive disorder where symptoms continue to worsen overtime. Parkinson’s results from the loss of cells in the brain that produce dopamine which is a chemical that controls the body’s movements. Tremors develop, muscle movements become rigid and slower & reflexes become impaired which leads to balance difficulties. PD causes kyphosis, or extensive flexion of the spine which leads to a bent posture altering their center of gravity. They walk with a stiff, shuffling gait with a tendency to freeze in place while walking.

Parkinson’s Disease will typically present with cognitive changes before the onset of motor dysfunctions. Recognizing these changes is essential for early detection and possible disease-modifying interventions. Cognitive dysfunctions such as attention, working memory & information processing are the first primary symptoms. Depression is common due to the depletion of dopamine and can cause lack of ambition and behavioral changes. When motor dysfunction appears, the most common manifestation is the tremor of PD. It often appears unilaterally and may be confined to one upper limb, but it is usually seen first as a rhythmic back-and-forth motion of the finger, referred to as the pill-rolling tremor. Muscle stiffness in the face occurs (from the lack of dopamine production) and causes the mask like facial expression of PD. This causes difficulty with chewing, swallowing, speech and the ability to show emotion. Sleep-wake cycles are disrupted due to the chemical changes in the brain causing less restful sleep over time. Bowel and bladder functions can become altered due to the disruption of the brains ability to send messages. The ability to perform known tasks, such as walking, changing direction, writing and basic ADL’s is diminished.  

Pharmacological Treatments

Levodopa: metabolic precursor of dopamine that crosses the blood-brain barrier easily. Usually started first for symptomatic treatment. Helps to achieve better control of motor systems. 

Monoamine Oxidase-B: 

Catechol-O-Methyl Transferase inhibitors

Dopamine agonists: often introduced as initial treatment 

Deep brain stimulation: a surgery that helps to reduce motor fluctuation in advanced Parkinson's 

Levodopa-carbidopa: intestinal gel that is pumped into the body delivered continuously through out the day. It has a faster absorption then oral Levodopa. 

Non Pharmacological Treatments

Physiotherapy 

Physical exercise: walking, running, strength training, whole body vibration, functional exercises to help reduce the risk of falls, motor performance improvements, balance & gait

Speech therapy: to improve speech volume, swallowing issues

Occupational therapy: for home issues and ADL's

Life Expectancy is Decreased:

If diagnosed early progression is slower. With late onset the progression is rapid. 

Impact on over all health:

Tremors, bradykinesia, rigidity and inflexibility, postural instability, freezing gait, micrographia, mask like expression

Impaired Gross Motor Coordination 

Difficulties swallowing or chewing

Cramping

Production of excess saliva

Sexual disfunction 

Difficulty with bathing and grooming

Limited driving and traveling

Take home safety precautions due to increased risk of falls 

Parkinson's disease can make daily activities seem frustrating and time consuming. Along with family, a PT can help manage the symptoms and a treatment program can help the person be as independent and active as possible. PT's can help in suggesting assistive devices if needed, and can develop strategies to make moving easier and help prevent injury. They can also make suggestions on home environment changes to make daily functions more efficient. 

A PT can provide: 

Education and self management advice

Exercise routines that help with mobility 

Ways to maintain safety when exercising 

Help with walking, balance, stability, posture, getting around in and out of car, stairs and uneven ground

Address fear of falling

Increasing physical activity to at least 2.5 hours a week can improve quality of life by decreasing the progression of the disease. Exercise can increase muscle strength, flexibility, and balance. There is growing evidence that regular physical activity can improve physical function, as well as lower caregiver burden. Physical therapy with someone with Parkinson's Disease has been found to significantly improve gait, gait freezing, functional mobility, and balance. Because of the positive outcomes, physical therapy has been known to decrease depression due to being able to be more independent. 

Cavallaro Goodman, Catherine, et al. Pathology for the Physical Therapy Assistant Second Edition. Elsevier, Inc, 2017

Horne, Jeremey T., et al. “Functional Outcomes of an Integrated Parkinson’s Disease Wellbeing Program.” Australasian Journal on Ageing, vol. 39, no. 1, Mar. 2020, pp. e94–e102. EBSCOhost, doi:10.1111/ajag.12705. 

www.healthline.com/health/parkinsons/life-expectancy Cherney, Kristen. "What's the Life expectancy for Parkinson's Disease".

Rizek, Philippe MD, Niraj Kumar MD DM, Mandar S. jog MD, "An update on the dignosis and treatment of Parkinson's Disease". CMAJ 2016.DOI:10.1503/cmaj.151179.

Oliveira de Carvalho, Alessandro, Alberto Souza sa Filho, Eric Murillo-Rodriguez, Nuno Barbosa Rocha. "Physical Exercise For Parkinson's Disease: Clinical and Experimental Evidence".  2018 March 30. doi:10.2174/1745017901814010089.

DeMaagd, George, and Ashok Philip. “Parkinson's Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis.” P & T : a peer-reviewed journal for formulary management vol. 40,8 (2015): 504-32.

Wong, Suzy & Gilmour, Heather & Ramage-Morin, Pamela. (2014). Parkinson's Disease: Prevalence, diagnosis and impact. Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé. 25. 10-14. 10.13140/2.1.4842.9767.