Introduction:
Parkinsonism is a clinical syndrome characterised by a disorder of movement consisting of tremor, rigidity, elements of brady-kinesia (slowness of movement), hypo-kinesia (reduced excursion of movement) and akinesia (slowness in initiating movement with loss of spontaneous movement) and postural abnormalities.
Parkinson's disease(PD) is a disease which affect the basal ganglia which in turn produce characteristic types of motor dysfunction such as involuntary movements ,tremor, changes in muscle tone, slowness of movement and posture. It was first described by James Parkinson as 'shaking palsy' which now bears his name.
PD is the third most common neurologic disease that affects some 1 in 1000 of population, both men and women. The average age of this disease is around 58 years.
Cause of Parkinsonism:
Brain nerve cells produce a chemical like substance called Dopamine which was drastically reduced in patients with PD was shown to have a casual role in the disease.
Sign & symptoms of parkinsonism:
1. Tremor at rest is a cardinal sign of PD and is often the first sign of disease, tremor is defined most simply as the rhythmic, mechanical oscillation of a body part. Tremor is usually maximal at the periphery and affects the arm more frequently than leg, tremor activity is usually suppressed by voluntary movement, willed activity, sleep and complete relaxation.
2. Akinesia is the most disabling manifestation of PD, individual with PD demonstrates a loss of spontaneous movements easily recognized by reduced facial expression and reduced arm swing during gait.
3. Rigidity is characterized by increased stiffness throughout range of passive movement at a joint, this stiffness has the same intensity in both extensor and flexor muscles. Mechanical changes in the muscle have also been shown to contribute to resistance to passive movement. There are two types of Parkinson rigidity- one is 'lead pipe' where the resistance is smooth or plastic, and second one is 'cogwheel' where the resistance is intermittent.
4.The freezing phenomenon, difficulty in starting or continuing rhythmic repetitive movements such as speech, handwriting and gait is a well known and incapacitating problem in PD. It particular affects gait and person experience freezing when walking through an enclosed space or when turning. The feet appear to get stuck to the floor while momentum carries the center of body mass forward, with an increasing likelihood of falls as postural adjustments are impaired.
5.The typical posture of a man with Parkinson's disease is 'simian posture' due to slight flexion at all joints.
Diagnosis of Parkinsonism:
Diagnosis is primary clinical and is based on medical history and physical examination by Physical Therapist, from head to toe assessment and evaluation done by physical therapist such as reaction time(RT) and movement time(MT) and the ability to perform simultaneous or sequential movements confirms the diagnosis of PD.
A therapist evaluates the balance reaction of patient and is asked to
→ sit unsupported for 1 minute
→ stand without an aid for 5 seconds
→ stand on one leg and then the other without an aid for 5 seconds.
Another method is positron emission tomography(PET) is being used to determine striatal dopamine concentrations which may indicate an increased likely hood of pre-symptomatic PD. At the end of assessment the therapist should be in a position to categorise the patient's disease severity and list the aims of treatment.
Treatment of Parkinsonism:
Physical therapy should be the first line of treatment of Parkinson's disease followed by medication and lifestyle changes. The aim of Physical therapy should be to help the patient maintain his independence for as long as possible. Physical therapy techniques were focused on musculoskeletal Sequel and were aimed at
➤increasing range of motion
➤decreasing rigidity
➤improving coordination
➤maintaining functional abilities
➤stretching soft tissue technique
➤proprioceptive neuromuscular facilitation(PNF)
Rigidity is generally considered by physical therapist to b the major deficit underlying the disability and physical therapy aimed at decreasing rigidity is thus expected to lead automatically to an improvement in functional ability.
To overcome rigidity some manual techniques were performed by qualified licensed Physical therapist such as PNF and stretching which has a very good result on patient with PD. Physical therapy is always given in conjunction with drug treatment and occupational and speech therapy.
Postural awareness training by Physical therapist in lying, sitting, standing and walking is also included in the treatment program particularly in the early stages of disease. The position of one part of the body in relation to the adjoining part and to the body as a whole is a useful method used by Physical therapist.
With more severely disabled patients group work at clinic is impracticable and patients should be treated on individual basis. Domiciliary treatment should be considered for these patients, some patients find regular hospital and clinic visits exhausting both physically and emotionally.
As Parkinson's disease is progressive so Physical therapy must be concerned with helping the patient to maximize his/her physical potential so that the quality of life can be improved at that time. The difficulties and goals will constantly change as the disease progresses but prolongation of functional independence is important with Physical therapy.
General care and advised to relatives is also important because relatives and family member tend to be over anxious to help and must be advised to allow and encourage the patient to remain independent however long it takes for him/her.
Ergonomic changes is also advised by Physical therapist such as advice to have a higher chair (raised lavatory seat), zips and velcro fastening to clothes, electric razor and toothbrush are such examples of ergonomic changes in day to day life.
- Related article -: Gait
Conclusion:
For a person suffering from Parkinson's disease regular physical therapy should be encouraged and person should remain at work if possible and continue to maintain and interest in hobbies, sports and social activities.
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