Parkinson’s Disease

Pathophysiology & Epidemiology

Parkinson's disease is a chronic, neurodegenerative disorder marked by the death of dopamine-producing
neurons in the brain, disrupting movement coordination. This leads to motor symptoms such as tremors,
stiffness, and bradykinesia. Non-motor symptoms like cognitive impairment and mood disorders are also
common. Parkinson's is typically idiopathic, but atypical forms exist. Progressively worsening over time, it is
estimated to affect over 10 million people globally, a number likely underestimated due to underdiagnosis.

Causes
The exact cause of Parkinson's disease remains unclear, however it's thought to be a combination of genetic
and environmental factors. Some identified genetic mutations have been linked to Parkinson's disease, though
they are rare except in cases where multiple family members are affected. Certain environmental triggers, like
exposure to pesticides and a history of head injury, may also increase the risk.

Clinical Presentation Signs and Symptoms: Impact on Quality of Life

• Resting tremor (commonly a "pill-rolling" tremor
of the hands)
• Bradykinesia (slowness of movement)
• Muscular rigidity and stiffness
• Postural instability leading to balance issues
• Non-motor symptoms include cognitive changes,
depression, anxiety, sleep problems and autonomic
dysfunction
• Festinating gait
• Difficulty initiating movement
- Tremors can make tasks like writing or eating difficult
- Bradykinesia affects mobility and tasks like walking or
standing up, this can make it difficult to complete many
ADLs independently
- Cognitive changes can disrupt communication,
slowing conversation and leading to frustration
- Anxiety and depression are common, as a result of
the various impacts on quality of life
- Increased falls risk, resulting in increased family and
health professional support

Multidisciplinary Team and Their Roles

• Neurologists diagnose Parkinson's Disease and help to manage medication and other treatments
• Physiotherapists provide exercises for mobility and balance to improve general health and function
• Occupational therapists offer aids for daily tasks, like adaptive utensils, home modifications, equipment etc
• Speech therapists help improve speech clarity and swallowing safety
• Psychologists help to support the patient through emotional challenges like anxiety and depression

Physiotherapy Management of Parkinson's Disease

Physiotherapy management varies based on the individual's condition and level of function within their
diagnosis of Parkinson's Disease. Evidence-based treatment, customised to the patient’s needs and goals, is
crucial. The focus is on improving function, managing/preventing symptoms and slowing disease progression.

Interventions may include:

• Regular assessment and reassessment of functional abilities and progress
• Balance and gait training exercises to improve mobility and reduce falls risk
• Strength and flexibility exercises to maintain muscle function and joint mobility
• Aerobic exercises to promote cardiovascular health and overall fitness
• Recommendations for adaptive equipment (like canes or walkers) to assist with mobility
• Education on strategies for safer and efficient movement
• Pain management, if necessary, through non-pharmacological strategies like psychosocial support

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