Parkinson’S Disease
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Parkinson’s Disease Neuropathology Neuropathology Classification Classification Diagnosis Diagnosis Management Management
Transcript of Parkinson’S Disease
Parkinson’s Disease
NeuropathologyNeuropathology
ClassificationClassification
DiagnosisDiagnosis
ManagementManagement
NEUROPATHOLOGY
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Neuropathology
Loss of pigmented dopaminergic neurons in
Substantia Nigra mostly in the ventral and
lateral areas (pars Compacta) Presence of lewy bodies
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Neuropathology
Normal Parkinson’s
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Neuropathology
CLASSIFICATION
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Classification
CLASSIFICATIONCLASSIFICATION
Idiopathic
Secondary or ACCQUIRED
Parkinson’s plus syndromes
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Idiopathic
Most common form.
1% of population over age 50 yrs., Incidence 40,000/yr.
Incidence increase with age, peak 60-80 yrs.
Male = female.
CLASSIFICATIONCLASSIFICATION
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Secondary or Acquired
CLASSIFICATIONCLASSIFICATION
Drugs( neuroleptics, metoclopramide, reserpine )
- Toxics( manganese, carbon monoxide, carbon disulfide )
- Stroke, postencephalitis, head injury, boxer's brain
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CLASSIFICATIONCLASSIFICATION
Parkinson’s PLUS
Progressive supranuclear palsy
Shy-Drager syndrome
Normal pressure hydrocephalus
Alzheimer disease
Wilson's disease
DIAGNOSIS
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DIAGNOSISDIAGNOSIS
Diagnosis
Presence of at least three of bradykinesia
Rigidity
4-6 Hz resting tremor
Postural instability( primary visual, vestibular, cerebellar or proprioceptive dysfunction excluded )
Unilateral onset
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DIAGNOSISDIAGNOSIS
Diagnosis
Persistent asymmetry Absence of clinical exclusion criteria Excellent response to l-Dopa Clinical course of 10 years or more
MANAGEMENT
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Management
Medications Medical and nursing care Physical therapy Occupational therapy Speech therapy Psychological therapy
MANAGEMENTMANAGEMENT
MEDICATIONS
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MANAGEMENTMANAGEMENT
Medications
Neurotransmitter replacement( l-dopa, carbidopa with l-dopa )
Anticholinergic( trihexyphenidyl, benztropine mesylate, procyclidrin )
Receptor agonist( amantadine, bromociptine, pergolide mesylate)
Other( selegiline )
SURGICAL
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Surgical
Thalamotomy Pallidotomy Deep brain stimulation Striatal grafting of Dopaminergic fetal
tissue
MANAGEMENTMANAGEMENT
MEDICAL AND NURSING
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Medical and Nursing
Firm bed
- Monitor for orthostatic hypotension
- Regular meal with low protein
- Measure vital capacity
- Bowel program for hypomobility
- Bladder evaluation and urodynamic study
- Artificial tears for lack of blinking
- anticholinergic for excessive drooling
- Administration of medications prior a mealtime
MANAGEMENTMANAGEMENT
PHYSIOTHERAPY
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PHYSIOTHERAPY
Requires Prior Assessment:Can be based on Specific Scales Eg: UPDRSCan be Based on General Scales Eg: Barthel Index
TreatmentSymptomatic Problem Based ApproachHolistic
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Physiotherapy
Relaxation technique to decrease rigidity
- Slow rhythmic rotational movement
- ROM exercise, stretching and preventing contracture, pectoralis stretching, hip extensor and quadriceps isometric exercise
- Back flexion-extension exercise and pelvic tilting
MANAGEMENTMANAGEMENT
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Physiotherapy
- Proper sitting and postural control
- Mat activities
May be tilt table
- Functional mobility training, rocking chair or chair lift
- Stationary bicycling for reciprocal training MANAGEMENTMANAGEMENT
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Physiotherapy
- PNF, NDT and biofeedback to facilitate the slow movement
- Auditory and rhythmic cueing in alternating movement
- Standing balance
- Progressive ambulation training, blocking, proper heel-toe gait, feet 12-15 in apart, arm swing
MANAGEMENTMANAGEMENT
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Physiotherapy
- Use of assistive devices( weight walker or
wheel walker )
- Aerobic conditioning exercise( walking, swimming )
MANAGEMENTMANAGEMENT
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Physiotherapy
- Frequent rest period
- Frenkel's exercise
- Family training and home program
MANAGEMENTMANAGEMENT
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Occupational Therapy
ROM activities and stretching of upper extremity
- Fine motor coordination skills
- ADL training
- Hand cycling for reciprocal training
MANAGEMENTMANAGEMENT
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Occupational Therapy
- Rocking chair for mobilization
- Handwriting skills
MANAGEMENTMANAGEMENT
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Occupational Therapy
- Adaptive devices
- Position and posture training
- Family training and home program
MANAGEMENTMANAGEMENT
SPEECH THERAPY
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Speech Therapy
Diaphragmatic breathing exercise and deep breathing before talking
- Swallowing training
- dysarthria training
- Facial, oral and lingual muscle exercise
MANAGEMENTMANAGEMENT
PSYCHOLOGY
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Psychology
Psychological support
Patient and family counseling
Antidepressant as indicated
Cognitive remediation
Group therapy
MANAGEMENTMANAGEMENT
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Bibliography
Required ReadingRehabilitation: O’SullivanTherapeutic Exercises: Kisner, Neurological Rehabilitation: Umphred Darcy
Further ReadingNeurological Rehabilitation: DobkinsNeurological Physiotherapy: Carr and Shepherd
