Physiotherapy & rehabilitation in Parkinson’s disease

Parkinson’s disease (PD) is a progressive neurological syndrome, especially affecting the basal ganglia of brain. First described in 1817 by an English physician, James Parkinson and after that the famous French neurologist, Charcot, further described the syndrome.

The main features of Parkinson’s disease include bradykinesia, rigidity, tremor and later on, postural instability. Though it tends to develop in later life, but is also diagnosed in the younger population.

It is the most common movement disorder affecting 1-2 % of the general population over the age of 65 years however the second most common neurodegenerative disorder after Alzheimer´s disease (AD). Prevalence rates in men are slightly higher than in women; reason unknown, though a role for estrogen has been debated.

Risk factors of PD

Age is the most important risk factor as neurodegenerative issues and also positive family history, Male gender, environmental exposure (Herbicide and pesticide exposure, metals-manganese & iron, farming, rural residence, wood pulp mills; and steel alloy industries), race, life experiences (trauma, emotional stress, personality traits such as shyness and depressiveness), an inverse correlation between cigarette smoking and caffeine intake in case-control studies also showed as risk factors.

Usually four types of PD as Primary (idiopathic) Parkinsonism, Secondary (acquired, symptomatic), Heredodegenerative Parkinsonism and Multiple system degeneration (Parkinsonism plus syndromes).

Variable course of progression and symptom implies different biochemical or degenerative mechanisms.

Early disease onset (25%): Longest duration till death, delay before falls and cognitive decline

Tremor dominant (31%): Same life expectancy, falls history and hallucinations as non-tremor dominant

Non-tremor dominant (36%): Strong association with cognitive impairment (Lewy body pathology)

Rapid disease progression without dementia (8%): Older, early depression, midline symptoms, often tremulous onset, increased mentation, freezing

The usual medication for PD as Dopaminergic including Levodopa - replacement therapy, Dopamine agonists and Monoamine-oxidase-B inhibitor besides anticholinergics (antimuscarinics) also used for PD as the advice of physicians.

Principles of physiotherapy & rehabilitation in PD

The principles of physiotherapy for PD according to scientific evidence as early implementation of exercise programme to prevent deconditioning and other preventable complications, utilisation of a meaningful and practical assessment procedure to allow monitoring and identification of rehabilitation priorities, the identification of deterioration and timely, appropriate intervention, the opportunity for targeted therapy for restoration or compensation of function besides the involvement of patients and carers in decision-making and management strategies would be much effective.

NICE Guidelines recommends particular consideration should be given to gait re-education, improvement of balance and flexibility, enhancement of aerobic capacity, improvement of movement initiation, improvement of functional independence, including mobility and activities of daily living and provision of advice regarding safety in the home environment.

Different scientific study suggested that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson’s disease for improving walking capabilities.

The overall suggestions of PD patients are that they should follow-up with expert neurologists and they have to continue physiotherapy treatment and rehabilitation program under the supervision of a qualified expert neuro-physiotherapists. The expert guided home advice (Exercise and care) could be much helpful to improve the quality of life and decrease supports. The family and society could show positive attitude towards PD patients as it could chance to fall on PD of everyone as increasing life expectancy, unhealthy food habits, lake of physical activities, pesticides & chemical intake through food and indiscipline life leading.

 

Physiotherapy & rehabilitation in Parkinsons disease

Parkinsons disease (PD) is a progressive neurological syndrome, especially affecting the basal ganglia of brain. First described in 1817 by an English physician, James Parkinson and after that the famous French neurologist, Charcot, further described the syndrome. The main features of Parkinsons disease include bradykinesia, rigidity, tremor and later on, postural instability. Though it tends to develop in later life, but is also diagnosed in the younger population. It is the most common movement disorder affecting 1-2 % of the general population over the age of 65 years however the second most common neurodegenerative disorder after Alzheimers disease (AD). Prevalence rates in men are slightly higher than in women; reason unknown, though a role for estrogen has been debated. Risk factors of PD Age is the most important risk factor as neurodegenerative issues and also positive family history, Male gender, environmental exposure (Herbicide and pesticide exposure, metals-manganese iron, farming, rural residence, wood pulp mills; and steel alloy industries), race, life experiences (trauma, emotional stress, personality traits such as shyness and depressiveness), an inverse correlation between cigarette smoking and caffeine intake in case-control studies also showed as risk factors. Usually four types of PD as Primary (idiopathic) Parkinsonism, Secondary (acquired, symptomatic), Heredodegenerative Parkinsonism and Multiple system degeneration (Parkinsonism plus syndromes). Variable course of progression and symptom implies different biochemical or degenerative mechanisms. Early disease onset (25%): Longest duration till death, delay before falls and cognitive decline Tremor dominant (31%): Same life expectancy, falls history and hallucinations as non-tremor dominant Non-tremor dominant (36%): Strong association with cognitive impairment (Lewy body pathology) Rapid disease progression without dementia (8%): Older, early depression, midline symptoms, often tremulous onset, increased mentation, freezing The usual medication for PD as Dopaminergic including Levodopa - replacement therapy, Dopamine agonists and Monoamine-oxidase-B inhibitor besides anticholinergics (antimuscarinics) also used for PD as the advice of physicians. Principles of physiotherapy rehabilitation in PD The principles of physiotherapy for PD according to scientific evidence as early implementation of exercise programme to prevent deconditioning and other preventable complications, utilisation of a meaningful and practical assessment procedure to allow monitoring and identification of rehabilitation priorities, the identification of deterioration and timely, appropriate intervention, the opportunity for targeted therapy for restoration or compensation of function besides the involvement of patients and carers in decision-making and management strategies would be much effective. NICE Guidelines recommends particular consideration should be given to gait re-education, improvement of balance and flexibility, enhancement of aerobic capacity, improvement of movement initiation, improvement of functional independence, including mobility and activities of daily living and provision of advice regarding safety in the home environment. Different scientific study suggested that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinsons disease for improving walking capabilities. The overall suggestions of PD patients are that they should follow-up with expert neurologists and they have to continue physiotherapy treatment and rehabilitation program under the supervision of a qualified expert neuro-physiotherapists. The expert guided home advice (Exercise and care) could be much helpful to improve the quality of life and decrease supports. The family and society could show positive attitude towards PD patients as it could chance to fall on PD of everyone as increasing life expectancy, unhealthy food habits, lake of physical activities, pesticides chemical intake through food and indiscipline life leading.