Parkinsons

Question 1

What is it?

Answer 1

• Progressive, neurodegenerative disorder
• Involves diminishing basal ganglia function
• Causes slowed movements, tremor, rigidity, and a wide variety of other symptoms.
• “Neurodegenerative” refers to the degeneration of neurons, which are the basis for all brain activity.

Question 2

Etiology

Answer 2

• Cause of Parkinson’s is unknown
• Destruction of brain cells in the substantia nigra.
• Substantia nigra controls muscular movements by releasing dopamine (neurotransmitter).

Question 3

Primary symptoms of PD

Answer 3

Bradykinesia: impairment of voluntary motor control

• Festinating gait or shuffling gait
• Tremors:
• Rigidity
• Poor Balance

Question 4

Diagnosis & Medical Treatment

Answer 4

• No specific test for Parkinson’s
• A systematic neurological exam will include testing reflexes and observing things like muscle strength throughout their body, coordination, balance, and other details of movement.
• These tests are also necessary to rule out other nerve dysfunction, narrowing of the spinal canal, which other treatments are needed.

Question 5

Parkinson’s and ROM

Answer 5

• Usual ROM and strength testing protocol attempted
• AF ROM should reveal decrease in ROM if rigidity present
• P ROM will reveal uniform resistance in the flexor and extensor
  groups acting on affected joints
• May reveal cogwheel rigidity (intermittent resistance)
• R ROM will not be useful if rigidity present

Question 6

Special Tests

Answer 6

Sensory testing: results vary depending on the clients sensory impairment

• Specific orthopaedic tests depending on the complaint
• Bradykinesia Test: positive test is movement becomes slower & more difficult

Question 7

Contraindications
*

Answer 7

• Prolonged vigorous or painful techniques should be avoided ( no stimulating the SNS)
• Areas sensitive to touch are avoided
• Pressure and hydro are modified in area of altered sensation
• Positioning, techniques, hydro are modified if hypertension present.
• Hypotension is a threat due to autonomic dysfunction. (watch during position changes)
• Don’t hold down tremors

Question 8

Treatment goals

Answer 8

• Maintain proper alignment
• Decrease SNS firing
• Decrease edema if present
• Maintain tissue health
• Decrease pain
• Address postural changes and muscle imbalances
• Limit contractures
• Reduce constipation
• Address diaphragm muscles
• Maintain thoracic mobility
• Encourage whole body integration

Question 9

Home Care

Answer 9

• Encourage relaxation with diaphragmatic breathing
• Regular, moderate exercise can improve motor control
• Encourage them to continue with ADLs
• Maintain functional ability by moving joints through simple ROM,
  and balance activity.