What is Parkinson's disease and neuro condition and management,treatment

INTRODUCTION

• Parkinson's disease is a progressive and degenerative 

                            

movement disorder with primary motor symptoms.

Parkinson's disease results from degeneration of

dopamine-releasing neurons of the substantia nigra.

MOTOR SYMPTOMS

• The cardinal symptoms are:

• Tremor: maximal when the limb is at rest, and

decreased with voluntary movement.It is typically

unilateral at onset.

• Rigidity: stiffness; increased muscle tone. In

combination with a resting tremor, this produces

"cogwheel" rigidity when the limb is passively moved.

• Bradykinesia/akinesia: respectively, slowness or

absence of movement. Rapid, repetitive movements

produce a dysrhythmic and decremental loss of

amplitude. Also "dysdiadokinesia", which is the loss of

ability to perform rapid alternating movements

• Postural instability: failure of postural reflexes, which

leads to impaired balance and falls.

Other motor symptoms include:

 􀀀 Gait and posture disturbances:

– Shuffling: gait is characterized by short steps, with

feet barely leaving the ground, producing an audible

shuffling noise. Small obstacles tend to trip the patient

– Decreased arm swing: a form of bradykinesia

– Turning "en bloc": rather than the usual twisting of

the neck and trunk and pivoting on the toes, PD

patients keep their neck and trunk rigid, requiring

multiple small steps to accomplish a turn.

– Stooped, forward-flexed posture. In severe forms,

the head and upper shoulders may be bent at a right

angle relative to the trunk.

– Festination: a combination of stooped posture,

imbalance, and short steps. It leads to a gait that gets

progressively faster and faster, often ending in a fall.

– Gait freezing: "freezing" is another word for akinesia,

the inability to move. Gait freezing is characterized by

inability to move the feet, especially in tight, cluttered

spaces or when initiating gait.

– Dystonia (in about 20% of cases): abnormal,

sustained, painful twisting muscle contractions,

usually affecting the foot and ankle, characterized by

toe flexion and foot inversion, interfering with gait.

However, dystonia can be quite generalized, involving

a majority of skeletal muscles; such episodes are

acutely painful and completely disabling.

OTHER MOTOR SYMPTOMS:

􀀀 Fatigue

􀀀 Masked faces (a mask-like face also known as

hypomimia), with infrequent blinking

􀀀 Difficulty rolling in bed or rising from a seated position;

􀀀 Micrographia (small, cramped handwriting);

􀀀 Impaired fine motor dexterity and motor coordination;

􀀀 Impaired gross motor coordination;

􀀀 Poverty of movement: overall loss of accessory

movements, such as decreased arm swing when

walking, as well as spontaneous movement.

SPEECH AND SWALLOWING DISTURBANCES:

• Hypophonia: soft speech. Speech quality tends to be

soft, hoarse, and monotonous. Festinating speech:

excessively rapid, soft, poorly-intelligible speech.

• Drooling: most likely caused by a weak, infrequent

swallow and stooped posture.

• Non-motor causes of speech/language disturbance in

both expressive and receptive language: these include

decreased verbal fluency and cognitive disturbance

especially related to comprehension of emotional content

of speech and of facial expression

• Dysphagia: impaired ability to swallow. Can lead to

aspiration, pneumonia.

Non-motor symptoms

• Mood disturbances – depression

• Cognitive disturbances – slowed reaction, dementia,

hallucinations and delusions may develop.

• Short term memory loss

• Sleep disturbances – insomnia

Sensory disturbances

• Visual problems: Impaired spatial reasoning and colour

discrimination, double vision.

• Dizziness and fainting; usually attributable orthostatic

hypotension, a failure of the autonomous nervous

system to adjust blood pressure in response to changes

in body position .

• Impaired proprioception.

• Reduction or loss of sense of smell (microsmia or

anosmia)

• Pain: neuropathic, muscle, joints, and tendons,

attributable to tension, dystonia, rigidity, joint stiffness,

and injuries associated with attempts at accommodation

AUTONOMIC DISTURBANCES

• Urinary incontinence, typically in later disease

progression

• Nocturia (getting up in the night to pass urine)

• constipation and gastric dysmotility that is severe enough

to endanger comfort and even health

• Altered sexual function: characterized by profound

impairment of sexual arousal, behavior, orgasm, and

drive is found in mid and late Parkinson disease.

• Weight loss, which is significant over a period of ten

years.

AUTONOMIC DISTURBANCES

• Urinary incontinence, typically in later disease

progression

• Nocturia (getting up in the night to pass urine)

• constipation and gastric dysmotility that is severe enough

to endanger comfort and even health

• Altered sexual function: characterized by profound

impairment of sexual arousal, behavior, orgasm, and

drive is found in mid and late Parkinson disease.

• Weight loss, which is significant over a period of ten

years.

MEDICAL MANAGEMENT

• There is no cure for PD.

• Medical therapy is symptomatic and individualized.

Drugs:

• Levodopa (L-dopa)

• Carbidopa / L-dopa (sinemet)

• Anitcholinergic agents

• Dopamine agonist drugs

SURGICAL MANAGEMENT

• Stereotactic surgery

• Pallidotomy

• Thalamotomy

• Deep brain stimulation

• Neurotransplantation (Fetal cell transplants)

AIMS OF PHYSIOTHERAPY INCLUDE:

• To improve endurance

• To improve postural control

• To improve motor function

• To decrease pain

• To improve balance and coordination

• To improve gait and locomotion

• To improve aerobic capacity and cardiovascular

endurance

• To teach adaptive strategies to be functionally

independent.