Parkinsonism

Perkinsonism: It is a chronic and progressive degenerative disease of the brain that impairs motor control,speech and other function.

Causes:

a)      Infectoin.

b)      Nausea.

c)      Trauma.

d)     Stroke.

e)      Epilepsy.

f)       Exposure to manages or other toxins.

g)      Alzheimer’s disease.

Pathology:Idiopathic degenerative process in which there is loss of pigmented dopaminergic neurons in the substaina nigra.Decreased dopaminergic inhibitory output from substaina nigra to the basal ganglia is thought to account for much of the hypokinetics motor symptoms of parkinson’s disease.

Clinical features:

[A]General:

a)      Expressionless face.

b)     Greasy skin.

c)      Soft,rapid,indistinct speech.

d)     Impaired postural reflexes.

[B]Gait:

a)      Slow to start walking.

b)     Shortened stride.

c)      Rapid,small steps,tendency to run.

d)     Reduced arm swing.

e)      Impaired balance on turning.

[C]Tremor:

a)      Resting 4-6 Hz:

·         Usually first in fingers/thumb.

·         Coarse,Complex movements,flexion/extension of fingers.

·         Abduction/adduction of thumb.

·         Supination/Pronation of forearm.

·         May affect arms,legs,feet,jaw,tongue intermittent.

·         Present at rest and when distracted.

·         Diminished on action.

b)     Postural 8-10 Hz:

·         Less obvious,faster,finer amplitude.

·         present on action or posture,persists with movement.

[D]Rigidity:

a)      Cogwheel type,mostely upper limbs.

b)     Plastic(lead pipe)type,mostly legs

.

[E]Bradykinesia:

a)      Slowness in initiating or repeating movements.

b)     Impaired fine movements,especially of fingers.

Complication:

a)      Depression.

b)      Sleep problem.

c)      Dofficulty chewing and swallowing.

d)     Urinary problems.

e)      Constipation.

f)       Sexual dysfunction.

Physiotherapy management:

[A]Aims of treatment:

a)      Chest therapy.

b)      Postural correction.

c)      Treatment of musculoskeletal condition:

·         Maintaining ROM.

·         Normalizing muscle tone.

·         Improving muscle strength.

d)     Gait re education.

e)      Improvement of balance.

f)       Maintain posture.

g)      Awarness program.

h)      Assistive device prescription.

i)        Over all improve the quality of life.

[B]Menas of treatment:

a)      To maintain clear airways by:

·         Positioning.

·         Assisted coughing.

·         Chest mobilization(If chest pain present)

b)     To normalize rigidity by:

·         Positioning in lying,sitting.

·         Weight bearing exercise through upper & lower limb.

·         Prolong ice over the rigid muscle.

c)      To prevent movement disorders by:

·         Active assisted movement.

·         Practice functional task.

·         Practice selective movement of upper & lower limb.

d)     To re-educate about posture control and balance by:

·         Mobilization of trunk and limbs joints.

·         Posture control exercise by using a gymnastic ball.

e)      To maintain normal joint ROM by:

·         Active assisted movement.

·         Pulley exercise.

·         Cycling.

f)       To re educate gait by:

·         Practice close kinetic chain exercise.

·         Encourge to do heel strike and wlking on a straight line.

g)      To control drooling by:

·         Massage around facial muscle in antigravity direction.

h)     To give psychological support:

·         Provide psychological support to patient to reduce dementia.