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Parkinson’s Disease is a chronic
progressive degenerative disease of the
nervous system.
Deficiency of the brain chemical dopamine
occurs in the basal ganglia.
Patient typically exhibit classic clinical
signs of Rigidity, Bradykinesia,
RestingTremor and Impaired Postural
Reflexes.
RIGIDITY
 Rigidity is defined as Resistance to Passive
motion that is not Velocity Dependent.
BRADYKINESIA
It refers to Slowness and difficulty in
maintaining movements.
TREMOR
Resting tremor or Pill rolling tremor.
POSTURAL INSTABILITY
 Frequent Falls results due to Progressive loss of
Balance Reactions.
 Fatigue
– In Feet & Ankle
 Masked Face
 Postural Deformities – Kyphosis, Scoliosis
 Osteoporosis
 Swallowing Difficulties
 Micrographia – Abnormally small hand writing
 Visual Abnormalities
 Sensory disturbances
 Edema
FESTINATING GAIT
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Due to Abnormal Stoop Posture,
Gait is characterized by a
progressive increase in Speed &
Shortening of the Step
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The Patient takes Multiple Short
Steps to catch up the Centre of the
Mass & Avoid Falling And
Eventually break into a Run
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Turning & Changing Directions are
difficult
Abnormally small hand writing seen
in Parkinson’s Disease
STAGE
1
2
3
4
5
CHARACTER OF DISABILITY
Minimal or Absent; Unilateral if present
Minimal Bilateral or Midline involvment
Balance not Impaired
Impaired Righting Reflexes, Unsteadiness
When turning or rising from chair. Some
activities are restricted, but patient can
live Independently and continue
some form of Employment.
All symptoms are present and severe.
Standing and walking possible only with
Assistance.
Confined to bed or Wheelchair.
A Diagnosis can be made if At least 2 of the
4 Cardinal Features are Present
 Hand Writing Samples, Speech & Physical
Examinations are Performed
 Glabellar reflex
 It is elicited by repetitive tapping on the
forehead.
 Subjects blink in response to the first
several taps.
 If the blinking persists, this is known
as Myerson's sign – seen in Parkinson’s
disease.

Myerson's sign

Atrophy of Substantia Niagra is noted.

Mostly Help Full in Ruling Out Other CNS
Pathologies
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ANTICHOLINERGIC DRUGS
Trihexyphenidyl
Bentropin
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DOPAMINERGIC DRUGS
Levadopa
Carbidopa
Sinemet
SURGICAL MANAGEMENT
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Pallidotomy
Thalamotomy
Deep Brain stimulation
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Relaxation exercises
ROM exercises & Stretching
Facial exercises
Respiratory Management
Breathing exercises
Airway clearance techniques
Balance training
Sitting balance
Sit to stand transition
Standing balance
Kitchen sink exercises
Gait training
Aerobic exercises – Walking is beneficial
Goals
1)Weight Transference,
Pelvic & Trunk Movts
2) Increase Stride
Length & Base of
Support
3) Reciprocal Arm
Swing
4) Rhythm
5) To Promote Normal
Heel Toe Progression
Activities
- Static Marching,
Stepping Forward &
Backward & wt Bearing
- Floor Markings
( Visual – Cues)
- Wand
-
Oral Counts
( Auditory - Cues)
- A Wedge is placed
inside the shoe
OTHER ACTIVITIES
 Starting & Stopping
 Walking Sideways
 Walking Across Obstacles
 Turning Around
 Regular Walking Exercises to Prolong
Functional Independence