The term Parkinson's disease is a condition named after an English/British doctor by name James Parkinson, who established treatment for the condition in 1817, where it was then referred to as "Shaking Palsy". It is known in diverse terms as hypokinetic rigid syndrome, Shaking palsy, primary or idiopathic parkinsonism and Paralysis agitans .
All these names can be used to refer to Parkinson's disease.
Parkinson's disease is a progressive disease of the central nervous system. The condition affects motor function due to damaged cells that produce dopamine.
The brain is divided into three main sections :
•The cerebrum
•The medulla Oblongata
•The brain stem
The latter contains most important areas that assist in motor functions(both voluntary and involuntary motor functions). These areas are the substantial nigra(#SN) and the corpus striatum.(#CS) of the basal ganglia.
The substance called dopamine acts as a messenger between two brain areas - the substantia nigra and the corpus striatum - to produce smooth, controlled movements. Most of the movement-related symptoms of Parkinson's disease are caused by a lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra.
When the amount of dopamine is too low, communication between the substantia nigra and corpus striatum becomes ineffective, and movement becomes impaired; the greater the loss of dopamine, the worse the movement-related symptoms.
Other cells in the brain also degenerate to some degree and may contribute to non-movement related symptoms of Parkinson's disease.
~Parkinson's disease is a neurodegenerative disorder, which leads to progressive deterioration of motor function due to loss of dopamine-producing brain cells.
~The cause of Parkinson’s Disease is unknown but researchers speculate that both *genetic and environmental factors* are involved; some genes have been linked to the disease.
The four main features of Parkinson's disease may include;
1.Resting tremors
2.Rigidity
3.Bradykinesia
4.Postural Instability
Some secondary symptoms include:
~Anxiety
~Depression
~Dementia
Most people with Parkinson's disease are diagnosed with the disease when they are 60 years old or older, but early-onset(20-40yrs) as well as juvenile onset(onset before 21years)of parkinson's disease also occurs.
Several staging systems for Parkinson’s disease exist.
The Parkinson's Disease Foundation(PDF) supports 5 stages, which include:
Stage1:This is a stage where symptoms are mild and do not interfere with the person’s quality of life.
Stage 2:In this stage, symptoms worsen and daily activities become more difficult and patient takes more time to complete.
Stage3: This stage too is considered mid-stage parkinson’s disease. The individual loses balance, moves more slowly, and falls are common too. Symptoms impair daily activities, for example, dressing, eating, and brushing teeth.
Stage4:This stages is where symptoms become severe and the individual needs assistance walking and performing daily activities.
Stage5: The most advanced stage of Parkinson’s disease. The individual is unable to walk and will need full time assistance with living.
CAUSES/RISK FACTORS
Though Parkinson's disease occurs when there's deterioration of neurotransmitter, dopamine, but what really causes this atrocity is unknown. Scientists attribute it to genetic and environmental factors:
Scientists have found that exposure to certain chemicals such as fungicides, herbicides, and insecticides can cause death of dopamine-producing cells.
Also exposure to metals and chemicals used in factories such as Manganese, Lead and trichlorethylene (TCE).
Also, exposure to the neurotoxin MPTP (N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) produces a sudden dramatic onset of PD.
What Raises Someone's Risk for
Parkinson's?
This is a complex picture, but you may be more likely to get Parkinson's based on:
Age. Since it mostly affects people at 60yrs and above, your risk goes up as the years go by.
Family history. If your parent, brother, or sister has it, you're a little more likely to get it.
Job. Some types of work, like farming or factory jobs, can cause you to have contact with chemicals linked to Parkinson's.
Race. The disease shows up more often in white people than other groups.
Serious head injury. If you hit your head hard enough to lose consciousness or forget things as a result of it, you may be more likely to get Parkinson's later in life.
Gender. Men get it more than women. Doctors aren't sure why.
Where you live. People in rural areas seem to get it more often, which may be tied to chemicals used in farming.
SIGNS AND SYMPTOMS
The primary symptoms of Parkinson's disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some people are more affected than others are. Studies have shown that by the time that primary symptoms appear, individuals with Parkinson's disease will have lost 60% to 80% or more of the dopamine-producing cells in the brain. Characteristic motor symptoms include:
#Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head. Usually tremors occur while resting, but not while involved in a task. Tremors may worsen when a person is excited, tired, or stressed.
#Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult.
#Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless, "mask-like" appearance, "Parkinsonial mask" to be precise.
#Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls.
#Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to start walking and to make turns. Individuals may freeze in mid-stride and appear to fall forward while walking.
Other symptoms of Parkinson's disease may include:
-Slowness of voluntary movements, especially in the initiation of such movements as walking or rolling over in bed
-Decreased facial expression, monotonous speech, and decreased eye blinking
-A shuffling gait with poor arm swing and stooped posture
-Unsteady balance; difficulty rising from a sitting position
Continuous "pill-rolling" motion of the thumb and forefinger
-Abnormal tone or stiffness in the trunk and extremities
-Swallowing problems in later stages
-Lightheadedness or fainting when standing (orthostatic hypotension).
HOW DOES PHYSIOTHERAPY PLAY A ROLE IN PD TREATMENT??
Exercise programs are recommended in people with Parkinson's disease and a physiotherapist is one of the professionals in PD Rx.
There is some evidence that speech or mobility problems can improve with rehabilitation, although studies are scarce and of low quality.
Regular physical exercise with or without physical therapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life. When an exercise program is performed under the supervision of a physiotherapist, there are more improvements in motor symptoms, mental and emotional functions, daily living activities, and quality of life compared to a self-supervised exercise program at home.
In terms of improving flexibility and range of motion for people experiencing rigidity, generalized relaxation techniques such as
1.#Gentle rocking, have been found to decrease excessive muscle tension.
Other effective techniques to promote relaxation include:
2.#Slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing, and meditation techniques.
As for gait and addressing the challenges associated with the disease such as hypokinesia (slowness of movement), shuffling and decreased arm swing; physiotherapists have a variety of strategies to improve functional mobility and safety. Areas of interest with respect to gait during rehabilitation programs focus on, but are not limited to improving gait speed, the base of support, stride length, trunk and arm swing movement. Strategies include:
3.#Utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and altering environments (surfaces, inputs, open vs. closed).
4.#Strengthening exercises have shown improvements in strength and motor function for people with primary muscular weakness and weakness related to inactivity with mild to moderate parkinson's disease.
However, reports show a significant interaction between strength and the time the medications was taken. Therefore, it is recommended that people with PD should perform exercises 45mins-1hour after medications when they are at their best.
Also, due to the forward flexed posture, and respiratory dysfunctions in advanced Parkinson's disease,
5.Deep diaphragmatic breathing exercises are beneficial in improving chest wall mobility and vital capacity.
~Exercise may improve constipation.
It is unclear if exercise reduces physical fatigue in PD.
NB: Parkinson's disease is manageable. The earlier your intervention, the better your symptoms become manageable.
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Article By:Thomas Adjei Bio(TAB).
ST. JOHN OF GOD COLLEGE OF HEALTH
BOX, 32
DUAYAW NKWANTA MUNICIPAL.
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