Anatomy:Parkinson’s disease (PD) is a chronic progressive disease that affects the motor component of the central nervous system. In simpler terms this means that the brain does not send correct signals to muscles for accurate body movements.Symptoms result from a slow death of dopamine-generating cells in the substantia nigra, a region of the mid-brain. Newer research is also exploring the idea that loss of cells in other areas of the brain and body contribute to Parkinson’s disease. It has been discovered that another sign of Parkinson’s disease is the formation of Lewy Bodies or clumps of a protein that form in nerve cells in the brain.
Causes:The cause is unknown but there are possible links to genetic mutations and environmental exposure to toxins or viruses.
Symptoms:PD is characterized by rigidity, tremor, and slowness of movement. Other symptoms may include: shuffling while walking, lack of facial expression, small handwriting, excessive saliva, difficulty swallowing, difficulty speaking, frequent falls, and freezing. The progression of Parkinson’s disease varies for each individual. Parkinson’s disease is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years. Movement symptoms vary from person to person as well as the rate at which the disease progresses.
Diagnosis:A neurologist will diagnose Parkinson’s disease from the medical history and physical examination. There are no lab tests that clearly identify the disease, but brain scans are sometimes used to rule out other disorders with similar symptoms. Sometimes patients may be given levodopa and a decrease in motor symptoms helps to confirm diagnosis.
Frequency:PD most often develops after age 50 but can also develop in younger individuals. It is one of the most common nervous system disorders of the elderly.According to the Parkinson’s disease Foundation approximately 60,000 Americans are diagnosed with Parkinson’s disease each year. An estimated 7 to 10 million people worldwide are living with the disorder. The incidence of PD increases with age, with only four percent of people with PD being diagnosed before the age of 50. It affects both men and women, but men are one and a half times more likely to have Parkinson’s disease.
Treatment: Physician Treatment:There is no known cure for Parkinson’s disease. The goal of treatment is to control symptoms. The medication for PD helps treat the symptoms by increasing the brain’s supply of dopamine, the chemical messenger in the brain that is decreased with PD.
Physical Therapy: A recent study by Dr. J Eric Ashlskog suggests that an intense exercise program can have positive modifying effects slowing the progression of PD. Physical therapists are uniquely qualified to design an exercise program for individuals with PD whether a person is newly diagnosed or has been diagnosed for years.
Physical therapists can improve an individual’s confidence and function while promoting safety with daily functional activities. Ideally, physical therapy should begin as soon as an individual is diagnosed, but gains can also be made in the later years of PD progression. The early stages are the best time to begin a program that is specially tailored to improve or slow down the progression of movement symptoms. The goal of therapy is to teach an exercise program that can be performed on a daily basis and become a lifelong routine.
A good exercise program for an individual with PD will be challenging and address functional limitations. These functional limitations can be as simple as rolling over in bed or getting up out of chair and as challenging as playing golf or performing work activities. Exercises should focus on several different factors including improving spinal mobility, balance, posture, strength, and speed of movements such as walking. Physical therapy will also include education and evaluation for assistive devices and home modifications to prevent falls. For an exercise program to have the most benefit it is important to think of it as a daily medication. We do not want to miss a dose of medication because we know it will have negative effects. Missing a dose of exercise is similar in that we will not see maximum benefits (and may not be able to slow the progression of PD) if it is not performed on a daily basis.
Surgery:For individuals who experience disabling tremors, wearing-off spells and medication-induced involuntary movements, Deep Brain Stimulation (DBS) is sometimes a good option. DBS is not a cure for Parkinson’s disease and it does not slow disease progression. The goal is to help control motor symptoms and improve quality of life when symptoms cannot be adequately controlled with medication. During DBS surgery, electrodes are inserted into the targeted brain region. A device called an impulse generator is implanted under the collarbone and sends an electrical impulse to the electrodes placed within the brain. This changes the brain activity and helps to decrease motor symptoms including tremors. This article was written by Aleacha Wallington PT.
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