Parkinson’s disease also known as Shaking Palsy

The loss of dopamine-producing nerve cells in the brain is the main cause of Parkinson’s disease, a progressive ,degenerative neurological condition that impairs mobility. Both motor and sensory systems are impacted, and symptoms usually appear gradually and get worse with time.

 

Parkinsonism:

A general term for a group of neurological conditions characterized by symptoms like tremors, slow movements, and stiffness, similar to those seen in Parkinson’s disease.

Pathophysiology

It includes both motor and sensory symptoms caused by the gradual loss of dopamine-producing neurones in the brain, mostly in the substantia nigra. It is believed that ageing, genetics, environmental exposures, and the buildup of aberrant proteins like alpha-synuclein are some of the causes of this deterioration.

Cardinal Signs are

• Tremor,
• Rigidity,
• Bradykinesia (slow movement)
• Postural instability

Epidemiology

Parkinson’s disease (PD) is a neurodegenerative disorder with a global prevalence of over 8.5 million individuals. The disease’s epidemiology shows variations across age, sex, geography, and ethnicity, with incidence and prevalence increasing with age.

Important Epidemiological Characteristics:

• Age: Parkinson’s disease is mostly an aging-related condition, with a rapid rise in incidence beyond the age of 60 and an uncommon beginning before 50.
• Sex: With a male-to-female ratio of around 1.5:1, men are more prone than women to get Parkinson’s disease.
• Geography: Prevalence varies greatly by geography, with some research indicating a gradient from northwest to southeast in both the US and Canada.
• Ethnicity: Although some research indicates that PD may be less prevalent in Asian and Black people than in White populations, the findings are mixed and might be impacted by variables such as response rates and case ascertainment.
• Environmental variables: An elevated risk of Parkinson’s disease (PD) has been associated with exposure to specific environmental variables, such as pesticides.
• Lifestyle Behaviours: Research indicates that physical exercise, smoking, and coffee use may protect against Parkinson’s disease (PD), although other variables, such as specific drugs, may also play a protective role.
• Genetic Factors: Although the majority of Parkinson’s disease patients have no known aetiology, genetic risk factors have been found, such as monogenetic reasons that are uncommon in unselected groups.
• Socioeconomic position: Disease risk is increased for those with a lower socioeconomic position. Other variables: A history of melanoma, traumatic brain injury, and dairy product use are other variables that may influence Parkinson’s disease.

 Types:.

1. Idiopathic Parkinsonism (85%)

The most common form, also called Parkinson’s disease, with unknown cause. It shows classic motor symptoms like bradykinesia, tremor, rigidity, and postural instability.

2. Parkinson’s Plus Syndrome

A group of neurodegenerative disorders that mimic Parkinson’s disease but with additional neurological features, cranial nerve involvement, and poor response to dopaminergic therapy (like levodopa). They progress more rapidly than idiopathic Parkinson’s disease and often have cognitive and autonomic symptoms.

3. Vascular Parkinsonism

Results from multiple small strokes affecting basal ganglia. Presents with lower body parkinsonism and gait disturbances.

4. Drug-Induced Parkinsonism

Caused by medications like antipsychotics (e.g. haloperidol). Symptoms usually reversible after stopping the drug.

Physiotherapy Management for PD

The primary aim of physiotherapy in PD is to improve the quality of life by enhancing or maintaining functional independence, safety, and well-being.

Physiotherapy Assessment Steps:

1. Demographic data collection through patient and caretaker interviews.
2. Record medical history – present illness, past illnesses, and family history.
3. Note current medications.

Observations to do:

• General body build.
• Types of tremors (resting, action, postural).
• Skin changes (noted as “tropical” but likely meant “trophic”).
• Signs of muscle wasting.
• Facial expressions – check for mask-like face.
• Drooling of saliva.

Other Examinations

• Position (standing, lying down).
• Verify the tightness, stiffness, and tone of your muscles.
• Bradykinesia is assessed by tapping or movement speed.
• Speech: dysarthria, monotonia, and hypophonia.
• Balance and coordination.
• Evaluation of gait: festination, cadence, and step length.
• assessment of the heart and lungs.
• The 6-minute walk test is an endurance test.
• ADL testing using standard measures is known as functional evaluation.

Hoehn and Yahr Scale rates PD severity from Stage 0 (no signs) to Stage V (severe, bedridden).

Physiotherapy’s objectives

• Offer psychological assistance.
• Preserve or enhance the range of motion (ROM) of your joints.
• Avoid deformities and contractures.
• Prevent deconditioning of the heart and muscles.
• Boost your level of physical fitness.
• Lessen tremors and stiffness.
• Deal with psychological problems such as depression.
• Boost posture and gait.
• Boost cardiovascular and muscular stamina.

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Physiotherapy Techniques and Interventions

Balance Training:

• To enhance balance, use a little push method.
• Swiss ball activities.
• Weight-shifting and reaching exercises.
• Move from a lower Centre of Gravity (COG) to a higher one.

Motor Control and Endurance

• Doing two things at once will help you become more coordinated.
• Teach transitional skills, like as sitting from a supine position.
• To slowly progress, combine moves.

Cardiopulmonary Conditioning

• Segmental and diaphragmatic breathing.
• Blowing balloons, changing air, and deep breathing.
• PNF and chest movement during breathing.
• Aerobic activities, such as walking

Gait Training

• Enhance your base of support and stride length with gait training.
• High stepping and weight transfer.
• Stepping sideways with or without assistance.

Psychosocial Support

• Therapy including family members.
• Counselling to increase self-reliance.
• Promote social interaction.
• Encourage self-control and an optimistic outlook

Relaxation & Home Program

• Instruct students on breathing, relaxation, and stretching.
• Avoid prolonged inactivity or over-doing it
• Moderate workouts and morning warm-ups.
• Using relaxing music and a rocking chair.

Enhancement of ROM and Flexibility

• Stretch the main muscle groups gently.
• Procedures for joint mobilisation.
• Self-stretching three to five times for 15 to 30 seconds.
• If necessary, use bracing for tense muscles.

Positioning and Mobility

• To prevent malformations, use passive positioning.
• PNF and mobility-enhancing rhythmic workouts.
• Exercises for trunk and bed mobility (e.g., Swiss ball).
• Teach mobility exercises for the upper limbs and pelvis.

The length of physiotherapy varies depending on condition. While chronic disorders like Parkinsonism may require continuous or long-term treatment, acute difficulties may only require two to six weeks of therapy. Depending on the needs and development of the patient, sessions are usually held two to three times a week.

what mayo says on this disease