Parkinson’s Disease

A chronic, progressive neurological disorder that targets brain cells that control movement
and neurons that produce dopamine & is characterized by symptoms consisting of:
 Resting tremor
 Rhythmic activity alternating in antagonistic muscles, resembling a pill-rolling
movement
 Bradykinesia
 Reduced movement speed and amplitude
 Rigidity
 Muscular stiffness throughout the range of movement in both extensor & flexor muscle groups in a limb
 Postural Instability
 Difficulty maintaining upright stance with narrow base of support in response to a perturbation to the
center of mass or with eyes closed
 Difficulty maintaining stability while sitting or when transferring from one position to another; can manifest
as frequent falling
 Gait abnormalities
 Generally short-stepped, shuffling walk with decreased arm swing, forward-stooped posture and have
poorer walking economy
Other Movement Disorders seen in Individuals with PD
 Akinesia - Difficulty initiating movements
 Dyskinesia - Over-reactivity of muscles
Non-motor Symptoms in PD
 Cardiovascular - Symptomatic orthostasis, fainting, light-headedness
 Sleep/fatigue - Sleep disorders, excessive daytime sleepiness, insomnia, fatigue, lack of energy, restless legs
 Mood/cognition - Apathy, depression, loss of motivation, loss of interest, anxiety syndromes and panic attacks,
cognitive decline
 Perceptual problems/hallucinations - Hallucinations, delusion, double vision
 Attention/memory - Difficulty in concentration, forgetfulness, memory loss
 Gastrointestinal- Drooling, swallowing, choking, constipation
 Urinary - Incontinence, excessive urination at night, increased frequency of urination
 Sexual function - Altered interest in sex, problems having sex
 Miscellaneous - Pain, loss of smell/taste and appetite/weight, excessive sweating, fluctuating response to
medication
Hoen & Yahr Staging Scale of Parkinson’s Disease
Stage
0
1
2
2.5
3
4
5
Symptoms
No signs of disease
Unilateral disease
Bilateral disease, without impairment of
balance
Mild bilateral disease, with recovery on pull test
Mild-to-moderate bilateral disease, some
postural instability, physically independent
Severe disability, able to walk and stand
unassisted
Wheelchair bound or bed-ridden unless aided
Early Disease
Moderate Disease
Advanced Disease
Causes of PD
 Accumulation of proteins (Lewy Bodies) in the brain’s neurons
 These normally occur, but start to spread out and aggregate (accumulate/clump together)
 This causes cell dysfunction and or death in the Substantia Nigra
 Substantia Nigra has neurons that releases dopamine
 Causes  Dopamine released
 Dopamine is required for proper functioning of the Basal Ganglia
 Less dopamine, the function of the Basal Ganglia is disrupted
 Basal Ganglia is important for motor, emotional and cognitive functioning
Treatments for PD
 Symptoms can be treated, but can't prevent the disease from happening
 Pharmacological
 L-Dopa - Drug that mimics dopamine, works best early on in disease progress, works less further along
 Surgical – Deep brain stimulation (DBS)
Benefits of Exercise for Individuals with PD
  BF & O2 supply to the neurons
 Releases dopamine
  Inflammation
 Improved gait performance
 /Maintains - Strength, Balance & mobility, ADL performance, Exercise capacity/fitness, Cognition, Sleep, QOL
 /Maintains– Tremor
*In PD px, we expect decreases in most of the symptoms, so even if it stays the same (maintenance) this is a positive
result
Exercise Testing for Individuals with PD
 Most individuals with PD have impaired mobility, problems with gait and balance, functional ability, which is
often accompanied by low physical fitness, making it difficult to test and should be assessed before hand
 Tests of balance, gait, mobility, ROM, flexibility and muscular strength are recommended
 ANS dysfunctions can occur in PD patients, altering HR/BP results
 Want to be conducting test during peak medication effects so patient has optimal mobility
ASCM Exercise Prescription Guidelines for PD
Aerobic
Frequency 2-3 d/wk
Resistance
2 d/wk
Flexibility
Daily, especially during joint
contracture or spasticity
Intensity
40-59% HRR
20 RM for each exercise
Time
Begin with 5-10 min bouts + 5
min recovery, progress to 20 min
with little rest periods
Arm/leg ergometry, recumbent
stepping
Begin with 1-2, and work up to
3 sets of 8-10 reps
Do NOT stretch to slight
discomfort, only 2/10 for pain
Each muscle group 3-4 min/d
Type


Accessible resistance
machines, DB, bands, cuffs
Active stretching, low intensity
passive stretching
During resistance training, emphasize extensor muscles of the trunk and hip to prevent faulty posture, also want to
be training all major muscles of lower extremities to maintain mobility
Incorporate Neuromotor Exercises daily (balance, coordination, gait, agility & proprioceptive training)
Special Considerations for individuals with PD
 Rigidity makes movement more difficult and can  EE, increasing perception of effort and fatigue
 Medications to treat PD, may further impair ANS functions
 L-Dopa has shown to cause exercise bradycardia, tachycardia & dyskinesia
 Take caution when training individuals who just had a change in medication
 Avoid using dual task or multitask exercises with novice exercisers
 Most falls in PD occur during multiple tasks or long and complex movement
 Slow static stretches should be performed for all major muscle group