Parkinson’s Disease

by Catherine McConnery and Claire

Liew
Pathogenesis
• How does it occur?
no direct cause – combination of environmental and genetic factors
• What is the disease prevalence ?
8.5 million individuals with PD worldwide (WHO,2019)
• How does the disease progress?
As dopamine levels decrease, symptoms arise and worsen overtime
• What is the diagnostic tool?
clinical assessment of symptoms
Sample Footer Text

Anatomy and
physiology
Accumulation of Lewy –
Bodies causes degeneration
of dopaminergic pathways in
the substantia nigra

04/29/2024
3
Signs and symptoms
• Motor symptoms
– Postural instability
– Hypokinesia
– Akinesia
– Tremors
– Bradykinesia
– Rigidity (freezing gait, masked face, stooped posture)
• Cognitive symptoms
– Depression
– Anxiety
– Hallucinations
– Memory loss
Selected impairment
Postural instability

 Muscle hypertonia
 Inappropriate scaling of muscle response
 Disorganized motor programing

https://parkinsons-info.weebly.com/postural-instability.html
 General treatment of disease
As Parkinson's Disease (PD) is a chronic and progressive disease, care plans are put into place to alleviate
the symptoms and improve the quality of life of PD patients. Due to having such a large affected population,
treatment for the disease ranges from case to case
• Medications are used to reduce tremors, stiffness, involuntary movement, and bradykinetic symptoms
– In PD, Dopaminergic medications are used to alleviate symptoms, most commonly Levodopa (L-dopa)

• Physical therapy (PT) to improve functional connectivity, balance, circulation, strength

– Finding suitable assistive devices to accomidate the patients needs

• Deep Brain Stimulus (DBS) electrodes that are implanted in the brain to target specific areas and alleviate symptoms
of PD
 POSTURAL INSTABILITY – SELECTED IMPAIREMNT
Contributing factors to Postural Instability (PI) are:
1. Bradykinesia – slowness of movement
2. Tremors
3. Rigidity

• PI is regarded as a primary symptom, however, the onset is often later in

disease progression
• PI is the leading cause of falls in PD patients and can cause worsening
of symptoms
• PI is observable in static and dynamic movement
– Increased postural sway (mediolateral direction)
– Rigidity in gait
 Targeted intervention for Postural instability
In a study conducted by Shah et al., they explored the use of pedaling and the pedaling
rate in relation to changes in motor connectivity.
• In this study, 27 PD patients were randomly assigned to 8 weeks of either, force-rate
exercise (FE) or voluntary-rate exercises (VE) using a stationary bike.
• Imaging using MRI was used to assess the functional connectivity (FC) of patients
before and post exercise. After 4 weeks, there was a strong positive correlation
between the FC and the pedaling rate, effects were mostly seen in the motor cortex Wheelchair with pedals
and the ipsilateral thalamus (Shah, 2016).
Functional connectivity in higher amounts is known to alleviate many of the symptoms
associated with PD.
Pedaling can be done in an indoor and outdoor setting, mobile or stationaty—there are
also adaptations made for patients who are wheelchair bound.
conclusion
 Parkinson's Disease is a chronic and progressive neurodegenerative disease with no cure
 Many symptoms occur overtime as the disease progress
 Postural Instability, despite being one of the primary symptoms does not occur until later in the
progression of the disease
 Interventions utilizing pedalling in order to improve motor connectivity are good ways to alleviate
symptoms common in PD, including PI
 Interventions using pedalling are highly accessible to different populations
 Adaptable, cost effective, effective
References
• World. (2023, August 9). Parkinson disease. Who.int; World Health Organization: WHO.
https://www.who.int/news-room/fact-sheets/detail/parkinson-disease
• ‌Kandel, Eric R. Principles of Neural Science. 5th ed., McGraw-Hill Medical, 2013.