Parkinson's disease (PD)

A neurodegenerative disorder that affects predominately the dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.

 These cells normally produce dopamine, a chemical (neurotransmitter) that transmits signals between areas in the brain that, when working normally, coordinate smooth and balanced muscle movement. Parkinson's disease causes these nerve cells to die, and as a result, body movements are affected.

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.

 Symptoms of Parkinson's Disease

Common symptoms of Parkinson's disease include:

1.Muscle rigidity

2.Tremors

3.Bradykinesia (the slowing down of movement and the gradual loss of spontaneous activity)

4.Changes in walking pattern and posture

 5.Changes in speech and handwriting

6.Loss of balance and increased falls 

7.Orthostatic hypotension (a drop in blood pressure when standing, resulting in lightheadedness or fainting)

Treatments for Parkinson’s disease

Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms. 

Medicines for Parkinson’s disease

 Medicines can help treat the symptoms of Parkinson’s by: 

  • Increasing the level of dopamine in the brain
  •  Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells 

Helping control non-movement symptoms 

The main therapy for Parkinson’s is levodopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. 

Therapies

Other therapies that may help manage Parkinson’s symptoms include:

  • Physical, occupational, and speech therapies, which may help with gait and voice disorders, tremors and rigidity, and decline in mental functions 
  • A healthy diet to support overall wellness 
  • Exercises to strengthen muscles and improve balance, flexibility, and coordination 

Massage therapy to reduce tension 

  • Yoga and tai chi to increase stretching and flexibility

GAIT

  • An abnormal stooped posture contribute to development of festinating gait ,characterized by a progressive  increase in speed with a shortening of stride
  • Gait can be anteropulsive or retropulsive 
  • Some  patients are able to stop only when they come in contact with an object or a wall

Plantarflexion contracture leads to be walking and adds to postural in stability

 EXERCISE TRAINING

RELAXATION EXERCISE                                                 

  • Gentle rocking to produce relaxation                                                          
  • PNF technique of rhythmic initiation                                          
  • Relaxation audio tapes

FLEXIBILITY EXERCISE

  • Emphasize on active rom
  • traditional stretching technique
  • ROM exercise in physiological patterns of movements  

STRENGTH TRAINING

  • Strengthening exercise are indicated for patients with primary muscle weakness and insufficient central activate of the motor unit as well as for disuse weakness associated with prolonged inactivity

FUCTIONAL TRAINING 

  • Mobility in bed 
  • Exercise in sitting posture tom improve pelvic mobility
  • Sit to stand transition
  • Standing training
  • Teach how to get up after a fall
  • Mobilizing facial muscles