Parkinson’s Disease

Parkinson’s Disease

is a group of
progressive disorder
of the central Disruptions in daily
nervous system functions, roles, and average age of onset
Onset is insidious is 50 to 60 years.
(CNS) with primary activities, as well as Suffering / after
with a slow rate of
disturbance in depression, are Common in older Alzheimer’s disease
progression
Dopamine system of common in than 65 years of age
basal ganglia with individuals with PD.
both motor and non-
motor symptoms.
 Etiology / Types:

Parkinsonism

Idiopathic parkinsonism-plus syndromes

parkinsonism Secondary (those conditions that mimic PD in

some respects, but the symptoms are
parkinsonism caused by other neurodegenerative
78% of patients disorders)
 Idiopathic Parkinson’s Disease

Late-onset Early-onset (<40 years; often

>40 years; generally sporadic familial)

Juvenile (<21 years) Young-onset (>21 years)

 Grouping

Parkinson’s / “the
shaking palsy

Postural instability gait

disturbed [PIGD] tremor predominant
Stages according to involved area of brain:

Early on (stage 1) In stage 4,

In stage 5,
lesions are found in the lesions in
neocortex and
medulla oblongata cortex
prefrontal
(dorsal IX/X nucleus or (temporal
neocortex
intermediate reticular mesocortex
sensory area.
zone). and allocortex).

In stage 2, lesions of In stage 3,

the caudal raphe nigrostriatal In stage 6, sensory
nuclei, gigantocellular system (pars association areas of the
reticular nucleus, and compacta of neocortex and
coeruleus- the substantia premotor areas
subcoeruleus complex. nigra).
Stages/
Grading
of PD:
 Symptoms
Motor Symptoms/ Cardinal Features Non-motor symptoms

• Rigidity • Loss Of Sense Of Smell

• Bradykinesia • Constipation
• Tremor • Rapid Eye Movement (REM) Sleep Behavior
• Postural Instability Disorder
• Mood Disorders
• Orthostatic Hypotension
• Altered Bladder Function
• Excessive Saliva
• Integumentary Changes
• Difficulty Speaking And Swallowing
• Cognitive Problems (Slowed Thinking,
Confusion And Dementia)
Symptoms
 • Bradyphrenia
• Akinesia
Bradykinesia: • Hypomimia
1. Cogwheel rigidity is a jerky, ratchet- slowness of • Hypokinesia
like resistance to passive movement movement
• micrographi
as muscles alternately tense and
relax. It occurs when tremor
coexists with rigidity.
2. Lead pipe rigidity is a sustained
resistance to passive movement, Rigidity:

PD
Tremor: involuntary
increased shaking or oscillating
with no fluctuations resistance to movement of a part or
parts of the body resulting
passive from contractions of
motion opposing muscles.
Affect: proximal muscles first,
especially the shoulders and neck, and
it progresses to involve muscles of the
face and extremities
• Resting Tremor
Postural • Postural Tremor
Instability
• Action Tremor
CLINICAL COURSE
Unified Parkinson’s
Disease Rating Scale
(UPDRS)
 MEDICAL MANAGEMENT

MEDICAL
MANAGEMENT

Pharmacological Nutritional Deep Brain

REHABILITATION
Management Management Stimulation
Physical
therapy:
 Protocol:
Exercise Training
Motor Learning Strategies
• random practice order (i.e., Relaxation Exercises
practice in which the patient • Gentle rocking
switches back and forth • rhythmic initiation
between tasks) • Stress management techniques
• Relaxation audiotapes
• Use of structured instructional
sets
• External cues (Visual cues ,
Rhythmic auditory stimulation,
Auditory cues, Multisensory
cueing)
Flexibility
Exercises
Resistance Training (According to progressive overload principle.)

Functional Training
• Bed mobility skills (i.e., rolling, bridging, supine-to-sit transitions)
• Sitting (Anterior and posterior tilts, side-to-side tilts, and pelvic clock exercises can be practiced while sitting on
a therapy ball, which enhances ease of movement)
• Sit-to-stand
• Standing
Balance Training

Locomotor Training

Spinal Orthotics

Pulmonary Rehabilitation (diaphragmatic breathing exercises, air-shifting techniques,

and exercises that recruit neck, shoulder, and trunk muscles, vibration and shaking )
Speech therapy

Aerobic Exercise

Group and Home Exercises