Parkinson's Disease Flashcards
What is Parkinson’s disease?
a chronic, progressive neurodegenerative disorder resulting from the degernation of dopamine producing neurones in the substantia nigra of the basal ganglia
How is it characterised?
tremor and disturbance of voluntary movement, posture and balance
What are the causes of Parkinsons’ disease?
Genetic cause- usually due to a faulty gene
Environmental factors- farmers, pestacides
What are the cardinal signs?
Tremor
Regitity
Akinesia or Bradykinesia
Postural instability
What is tremor?
resiting tremor
occurs in 70% of patients
tends to go away with movement
pill rolling
What is regitity?
Increased tone stiff or inflexible muscles resistant to passive movements lead pipe rigity cog wheel rigity- rigity when flex or extend
What is Akinesia?
lack or loss of movement
a slower initiation of movement and a progressive reduction in the speed and amplitude of repeitive actions
What is Bradykinesia?
slowness in movement
What is postural instability?
develops later in the disease
characteristic flexed posture
unable to access balance reactions
flexed hips and knees
line of gravity at the edge of the base of support
can’t respond as quickly so have poor balnce reaction
What are the other signs and symptoms?
difficulty initiating motor tasks lack of spontaneus movement slow shuffling gait- festinating gait freezing episodes lack of facial expression monotone speech microgaphia- writing gets smaller problems with swallowing, drooling sleep disorders depression
Pathophysiology
normal movement is a balance of direct and indirect pathways which is balanced by the substantia nigra through the release of dopamine
this excites the direct pathway and inhibits the indirect pathway
as the amount of dopamine reduces the balance is lost and tipped in favour of the indirect pathway which causes less facilitation and moreinhibition of movement
Drugs to help
Dopamine replacements- Levadope which aims to replace the lost dopamine
Dopamine copycats
Dopamine protectors- monoamine Oxidase B inhibitors, protect current levels of dopamine by inhibiting the enzymes that break it down
What is the Hoehn and Yahr Scale
used to classify parkinsons disease
0= no sign of the disease
1= minimal functional disability
1.5= unilateral movement involving the neck and the spine
2= no impairment of balance
2.5= mild bilateral symptoms
3= postural instability, physcially independent
4= severe disability but can walk or stand unassited
5= need a wheelchair or bedridden if not assisted
key points for physiotherapy
Posture Balance and falls Functional gait Transfers Bed mobility Muscle strength and power Pain Condition of feet and footwear effects of parkinsons on functional ability wellbeing and quality of life
What are some of surgical options?
Deep brain stimulation- electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms
Pallidotomy- good results for patients with severe tremor or severe involuntary movements
Foetal implants
