Parkinson's disease
♦ Is a neurodegenerative disorder
♦ Develops around age 50
* incidence rises with age
* affects 1-2% of population > age 65
♦ Higher incidence in men (62%) compared to women
(38%)
Early Signs and Symptoms

Cardinal
Characteristics
 Resting
tremor
 Bradykinesia
 Rigidity
 Postural instability

Other
 Micrographia
 Masked
face
 Slowing of ADLs
 Stooped, shuffling gait
 Decreased arm swing
when walking
Additional Signs and Symptoms






Difficulty arising from a chair
Difficulty turning in bed
Hypophonic speech
Sialorrhea
Loss of the sense of smell
Foot dystonia
Criteria for Diagnosis



At least two of three: rest tremor, bradykinesia,
rigidity
Absence of a secondary cause—drugs, metabolic,
etc.
Definitive diagnosis can only be made by autopsy
Pathophysiology


: Deficiency of the brain chemical dopamine occurs
in the basal ganglia.
Degeneration of nigrostriatal pathway (Substantia
Nigra to corpus striatum.
Drug Classes in PD

Dopaminergic agents
 Levodopa
 Dopamine


agonists
Anticholinergics
Amantadine
Surgical Treatments for Parkinson’s Disease

Ablative
 thalamotomy
 pallidotomy

Electrical stimulation
 VIM
thalamus, globus pallidus internus, sub-thalamic
nucleus

Transplant
 human
fetal, genetically engineered transplants
Treatment Plan
Maintain or increase
ROM in all joints
 Efforts to improve
postural control and
standing balance
 Prevent disuse atrophy
and muscle weakness
 Improve motor function
and mobility

Physical Therapy: Goal
 Maintain
or increase activity level
 Decrease rigidity and bradykinesia
 Facilitate movement and flexibility; optimize gait
 Maximize gross motor coordination and balance
 Maximize independence, safety, function
Rehabilitation
Hoehn and Yahr Rating scale
Divided into five stages

Stage 0 = no visible
disease;

Stage I = disease that
involves only one side
of the body;

Stage II = disease that
involves both sides of
the body. but does not
impair balance:

Stage III = disease that
impairs balance or
walking;

Stage IV = disease
that markedly impairs
balance or walking:
and

Stage V = disease that
results in complete
immobility.
Cardiopulmonary Impairment
The patient's flexed posture can lead to kyphosis, cause a
reduction in pulmonary capacity, and produce a restrictive
lung disease pattern.
 Breathing exercises, postural reeducation, and trunk
exercises may be helpful.
 Institution of a general conditioning program can increase
the patient's endurance.
 If pulmonary function progressively worsens, assisted
coughing techniques, incentive spirometry, and respiratory
therapy intervention may be required.

Physical Therapy





Static and dynamic postural controls emphazing whole
body movements sitting and standing
Stationary bike training to help reciprocal movements
Exercise: walking(1+mile/day),swimming,golf,dancing
Use of assistive devices, mobility aids, orthotics
Family training and home program


Proper and energy conservation techniques
After 6 mths benefit of therapy if not coninued will be gone
Aerobic activities such as:

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Using a treadmill
Using a stationary bike or rowing machine
Walking
Swimming
MAKE GOOD POSTURE A HABIT

Stand against a wall
and be sure your
lower back and
shoulder BLADES are
touching the wall
MAKE GOOD POSTURE A HABIT

lie flat on your back,
with just enough
support to keep your
head and neck from
tipping back for 5
minutes.
FLEXIBILITY OR STRETCHING
FLEXIBILITY OR STRETCHING
STRENGTHENING EXERCISES
STRENGTHENING EXERCISES
Alzheimer's Disease

Alzheimer’s disease is an irreversible, progressive
brain disease that slowly destroys memory and
thinking skills, symptoms first appear after age 60.