Comprehensive Guide to Parkinson's Disease: Role of Physical Therapy

1. VIDEOS

2. Role of Physical Therapy: Parkinson’s Disease

3. Progressive loss of function Impairment Activity Participation

4. Continuum of Therapeutic Interventions Compensation Recovery Learning (new) Re-learning Practice Practice

5. Pathology Progressive degenerative disorder, degeneration of pigmented neurons in the substantia nigra responsible for producing dopamine, by time of diagnosis loss, may be 60% loss of neurons History: slow progression – onset, unilateral symptoms, balance later, cognitive decline later First signs: lack of armswing (unilateral) slow to get going or to get things done (dressing, out of bed), hand-writing smaller Classic signs: tremor (pill-rolling) bradykinesia rigidity

6. What is the motor control problem? • Loss of automaticity, skilled movements • Loss of ability to activate such movements and continue sequence of movements • Akinesia, difficulty initiating movements • Freezing phenomena: doorway, microwave example • Postural instability – falls • Drooling, especially at night • Low volume, monotone voice • Masked face • Lack of automatic associated movements • Gait: forward head, stooped posture, diminished or absent armswing, lack DF on heel strike, lack full hip ext., flexed throughout • Cognitive changes: STM, dementia • Depression

7. Secondary effects/ Consequences over time : ACTIVITY Increased time to perform ADLs Difficulty turning in bed, getting out of bed Difficulty with hand dexterity for buttoning, holding cards, etc. Decreased overall activity Musculoskeletal changes: Loss of extension and rotation Posturing in flexion: Neck, trunk, hips, knees Decline in respiratory capacity Loss of balance Increased risk of falls

8. Secondary effects/ Consequences over time : PARTICIPATION ROLES: Provider Spouse - Partner Socially Parent Family member Recreationally Handle finances……….. Actor Attorney General

9. Medical Treatment: Drug Therapy: does not change rate or course of disease, but diminishes symptoms, allows movement Rx begins: when quality of life altered by bradykinesia or other problems Therapy is based on imbalance of transmitter activity

10. BALANCE Dopamine Cholinergic activity: acetylcholine IF excess: dyskinesia IF excess: rigidity IF Dopamine then, Cholinergic effect • Anticholinergics • Replace dopamine: given orally, used up peripherally, cannot cross • blood-brain barrier • Problem: Blood-brain barrier • Soln: Levodopa: Precursor to dopamine, Xs • Problem: Peripheral use Soln: Add Carbidopa: inhibits use of dopamine • peripherally, time to X BB barrier and be converted to dopamine • Sinemet = L-dopa and carbidopa • Problem: Enzyme: monamine oxidase breaks down dopamine in • brain reducing amount available • Soln: Add Eldepryl to Sinemet: inhibit enzyme, conserves dopamine • availability

11. Good news Changes symptoms Changing rate of disease progression? Bad News

12. Other medical/surgical options • Pallidotomy • Deep brain stimulation/implant • Transplants

13. GOALS What does person with PD want? Maintain optimal function (Teach strategies) Prevent complications of inactivity/immobilty Patient/Family/Caregiver education PDFoundation, Support Groups McGoon, Courage Behind the Mask Caregiver!

14. Role of Physical Therapy: Parkinson’s Disease