BRADYKINESIA IN PARKINSON’S DISEASE

A
NEUROLOGY UNIT
PRESENTATION
BY
OGBUJI MACDONALD C.
26 JULY 2023
th
TABLE OF CONTENTS
INTRODUCTION
RELEVANT ANATOMY
PREVALENCE
PREDISPOSING FACTORS
CAUSES
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
COMPLICATIONS
ASSESSMENT
MANAGEMENT
CASE STUDY
RECOMMENDATION AND CONCLUSION
REFERENCES
INTRODUCTION
Bradykinesia is one of the cardinal motor symptoms of
Parkinson’s disease, along with resting tremors, muscle
rigidity, and postural instability.
It is a common and significant feature of the disease.
Bradykinesia refers to slowness of movement and a
gradual reduction in the ability to initiate and complete
voluntary movements.
It can affect various aspects of a person’s movements,
including walking, writing and performing everyday
tasks.
INTRODUCTION CONT’D
Dopamine is a neurotransmitter that helps transmit
signals within the brain and is involved in coordinating
smooth, purposeful movements.
The depletion of dopamine in Parkinson’s disease leads
to an imbalance in the brain’s motor control circuitry,
resulting in bradykinesia and other motor symptoms.
RELEVANT ANATOMY

 Parkinson’s Disease is considered predominantly a disorder

of the basal ganglia.
 The basal ganglia are a group of nuclei situated deep and
centrally at the base of the forebrain.
 They have robust connections with the cerebral
cortex and thalamus in addition to other areas of the brain.
 Their vast system of communication allows them
involvement with a variety of functions, including
automatic and voluntary motor control, procedural learning
relating to routine behaviours and emotional functions.
RELEVANT ANATOMY CONT’D
The association with other cortical areas ensures
smoothly orchestrated movement control and motor
behaviour.
PREVALENCE
 Nearly one million people in the U.S. are living with Parkinson's disease
(PD). This number is expected to rise to 1.2 million by 2030.
 Parkinson's is the second-most common neurodegenerative disease after
Alzheimer's disease.
 Nearly 90,000 people in the U.S. are diagnosed with PD each year.
 More than 10 million people worldwide are living with PD.
 The incidence of Parkinson’s disease increases with age, but an
estimated four percent of people with PD are diagnosed before age 50.
 Men are 1.5 times more likely to have Parkinson's disease than women.
 The estimated crude prevalence of PD in Nigeria was lower (10 to
249/100 000) compared to studies published in Europe (65.6 to 12
500/100 000).
PREVALENCE CONT’D

Up to 98% of all people with Parkinson's experience

slowness of movement.
Elevated percent time in bradykinesia (≥30%) was
estimated to have occurred in 79% of individuals with
PD, including all individuals with mBKS ≥26, most
individuals with mBKS 24 to <26, and in a small
proportion of individuals with mBKS 22 to <24.
PREDISPOSING FACTORS
 Age. Young adults rarely experience Parkinson's disease. ...
 Heredity. Having a close relative with Parkinson's disease
increases the chances that you'll develop the disease. ...
 Sex.Men are more likely to develop Parkinson's disease than
are women.
 Exposure to toxins.
 Head trauma.
CAUSES
 Parkinson’sdisease involves a small, dark-tinged portion of the
brain called the substantia nigra.
 Thisis where you produce most of the dopamine your brain uses.
Dopamine is the chemical messenger that transmits messages
between nerves that control muscle movements as well as those
involved in the brain’s pleasure and reward centers.
 Aswe age, it’s normal for cells in the substantia nigra to die.
This process happens in most people at a very slow rate.
 Butfor some people, the loss happens rapidly, which is the start
of Parkinson’s disease. When 50 to 60 percent of the cells are
gone, you begin to see the symptoms of Parkinson’s.
CAUSES CONT’D
Bradykinesia is one of the early signs of movement
disorder such as Parkinson’s or parkinsonism.
The specific mechanism behind bradykinesia in
Parkinson’s disease are not fully understood but it is
believed to result from the degeneration of
dopaminergic neurons in a region of the brain called the
substantia nigra.
These neurons are responsible for producing dopamine,
a neurotransmitter that plays a crucial role in regulating
movement and coordination.
PATHOPHYSIOLOGY
 No specific, standard criteria exist for the neuropathologic
diagnosis of Parkinson disease, as the specificity and sensitivity
of its characteristic findings have not been clearly
established.
 However, the following are the 2 major neuropathologic
findings in Parkinson disease:
 Loss of pigmented dopaminergic neurons of the substantia
nigra pars compacta
 The presence of Lewy bodies and Lewy neurites
SIGNS AND SYMPTOMS
 Some common manifestations of bradykinesia in Parkinson’s disease
include:
 Slow movements; Patients may experience a general slowing down of
movement, making simple tasks, such as getting out of a chair or dressing,
more difficult and time-consuming.
 Reduced arm swing; When walking, the normal swinging motion of the
arms may decrease or becoming limited, leading to distinctive shuffling
gait.
 Micrographia
 Difficulty with fine motor tasks
 Freezing of gait; some individuals with Parkinson’s disease may experience
episodes where they feel as if their feet are stuck to the ground making it
COMPLICATIONS
 Thinking difficulties.
 Depression and emotional changes
 Swallowing problems
 Chewing and eating problems
 Sleep problems and sleep disorders
 Bladder problems
 Constipation
 Excessive salivation
 Excessive sweating
 Bladder problems
ASSESSMENT
 Physiotherapyassessment considers ways in which the condition is
affecting the individual with Parkinson’s, whilst being aware of
the impact on close carers and relatives, especially when
someone is newly diagnosed or has been diagnosed for some time.
 The history taking and physical assessment aspects of the
assessment enable an honest discussion of what is realistic of the
things the person wants to do.
 Thecore areas of physiotherapy interventions for which there is
evidence of effectiveness for people with Parkinson’s are:
 Physical Capacity
 Transfers
ASSESSMENT CONT’D

 Manual Activities
 Quality of Movement
 Posture

 Balance and Falls

 Gait

 Pain
MANAGEMENT

Medical Management; Treatment of bradykinesia in

Parkinson’s disease primarily involves medication that aim to
increase dopamine levels in the brain, such as levodopa or
dopamine agonists.
 These medications help alleviate the symptoms and improve
overall motor function.
 In some cases deep brain stimulation may also be considered
for individuals with severe and medication-resistant
bradykinesia.
MANAGEMENT CONT’D
 PHYSIOTHERAPY MANAGEMENT;
 Maintain and improve levels of function and independence, which will
help to improve a person’s quality of life
 Use exercise and movement strategies to improve mobility
 Correct and improve abnormal movement patterns and posture, where
possible
 Maximise muscle strength and joint flexibility
 Correct and improve posture and balance, and minimize risks of falls
 Maintain a good breathing pattern and effective cough
 Educate the person with Parkinson’s and their care-giver or family
members
 Enhance the effects of drug therapy
 It is most important to focus on high power, high effort, and high amplitude movements during your exercise.
RECOMMENDATION AND CONCLUSION
 In addition to medications, exercise should be part of your
treatment plan for all Parkinson's symptoms.
 Staying active is an essential element of living well with PD.
 Research also suggests that music therapy can reduce
bradykinesia and other Parkinson's symptoms.
 While there’s currently no cure for Parkinson’s, there are
various treatments available to help manage symptoms and
improve quality of life.
 It’simportant to work closely with a healthcare provider to
develop a personalized treatment plan that works best for you.
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