Physiotherapy for Parkinson’s Disease

Parkinson’s disease is a chronic and progressive movement disorder.  Development of the disease is gradual, but worsens over time.  Parkinson’s involves the malfunction and death of vital nerve cells in the brain (neurons).

Signs and Symptoms

• Resting tremor, or shaking, most often of the hands, but also can occur in the arms, legs, jaw and face. It often appears as a back and forth rubbing of the thumb and forefinger called a pill rolling tremor
• Bradykinesia or slowness of movement
• Rigidity or stiffness of the limbs and trunk
• Postural instability, which is impaired balance and coordination
• Speech changes – talking softly, quickly, slurring words, or hesitation before talking

Causes

The cause of Parkinson’s disease is unknown. There is a genetic mutation that has been identified, but it is uncommon except in cases where many members of the same family are affected.

The symptoms of the disease are caused by dying neurons. These cells produce dopamine which is a chemical messenger which controls movement and coordination.  As the disease progresses the amount of dopamine produced in the brain decreases, which leaves the person unable to control movement normally.

Who gets it?

Parkinson’s beings in middle age or late in life, the risk of getting the disease increases with age.  Mean age to develop it is 60.  Men are more likely than women to get the disease and having a close relative with Parkinson’s increases your chances of developing it.  Studies also show an ongoing exposure to herbicides and pesticides increases the risk of development.

Diagnosis

Neuropathologic examination is the best way to diagnose the disease.  A patient must have Motor Parkinsonism:

Bradykinesia (slowness in movement) and resting tremor (shaking present at rest, which goes away when person initiates movement) or rigidity (resistance to passive movements of major joints).

Treatment

• Pharmacologic (drug therapy)
• Levodopa (most effective drug for symptoms)
• Combination of levodopa and carbidopa calledSinemet is the overall most effective therapy.
• Dopamine agonists (bromocriptine, pramipexole, ropinirole, rotigotine)
• MAO B inhibitors (selegiline, rasagiline)
• Anticholinergic agents
• Amantadine
• COMT inhibitors
• Nonpharmacologic
• Exercise and physical therapy – regular exercise promotes physical and mental well-being. Exercise does not slow the progression of disease, but it can alleviate orthopedic effects of rigidity and flexed posture like shoulder, hip, and back pain and improve function in motor tasks.  Exercise also improves balance, flexibility and strength.
• Physical therapy
• Occupational therapy
• Speech Therapy
• Nutritional support

Prognosis

Parkinson’s disease usually progresses until it leaves the patient completely debilitated.  The condition usually worsens over about 15 years.  The rate Parkinson’s disease progresses is variable among patients.  In some people, the course is slow and they have little disability after 20 years.  In others, the disease may be more aggressive and the person is severely disables after 10 years.  Those patients that have an earlier onset of the disease tend to have shorter life spans than those with disease later on.

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