Transcript Parkinsons
VIDEOS Role of Physical Therapy: Parkinson’s Disease Progressive loss of function Impairment Activity Participation Continuum of Therapeutic Interventions Compensation Recovery Learning Re-learning (new) Practice Practice Pathology Progressive degenerative disorder, degeneration of pigmented neurons in the substantia nigra responsible for producing dopamine, by time of diagnosis loss, may be 60% loss of neurons History: slow progression – onset, unilateral symptoms, balance later, cognitive decline later First signs: lack of armswing (unilateral) slow to get going or to get things done (dressing, out of bed), hand-writing smaller Classic signs: tremor (pill-rolling) bradykinesia rigidity What is the motor control problem? •Loss of automaticity, skilled movements • Loss of ability to activate such movements and continue sequence of movements •Akinesia, difficulty initiating movements •Freezing phenomena: doorway, microwave example •Postural instability – falls •Drooling, especially at night •Low volume, monotone voice •Masked face •Lack of automatic associated movements •Gait: forward head, stooped posture, diminished or absent armswing, lack DF on heel strike, lack full hip ext., flexed throughout •Cognitive changes: STM, dementia •Depression Secondary effects/ Consequences over time : ACTIVITY Increased time to perform ADLs Difficulty turning in bed, getting out of bed Difficulty with hand dexterity for buttoning, holding cards, etc. Decreased overall activity Musculoskeletal changes: Loss of extension and rotation Posturing in flexion: Neck, trunk, hips, knees Decline in respiratory capacity Loss of balance Increased risk of falls Secondary effects/ Consequences over time : PARTICIPATION ROLES: Provider Spouse - Partner Socially Parent Family member Recreationally Handle finances……….. Actor Attorney General Medical Treatment: Drug Therapy: does not change rate or course of disease, but diminishes symptoms, allows movement Rx begins: when quality of life altered by bradykinesia or other problems Therapy is based on imbalance of transmitter activity BALANCE Dopamine Cholinergic activity: acetylcholine IF excess: dyskinesia IF excess: rigidity IF Dopamine then, Cholinergic effect 1. Anticholinergics 2. Replace dopamine: given orally, used up peripherally, cannot cross blood-brain barrier Problem: Blood-brain barrier Soln: Levodopa: Precursor to dopamine, Xs Problem: Peripheral use Soln: Add Carbidopa: inhibits use of dopamine peripherally, time to X BB barrier and be converted to dopamine Sinemet = L-dopa and carbidopa Problem: Enzyme: monamine oxidase breaks down dopamine in brain reducing amount available Soln: Add Eldepryl to Sinemet: inhibit enzyme, conserves dopamine availability Good news Changes symptoms Changing rate of disease progression? Bad News Other medical/surgical options 1. Pallidotomy 2. Deep brain stimulation/implant 3. Transplants GOALS What does person with PD want? Maintain optimal function (Teach strategies) Prevent complications of inactivity/immobilty Patient/Family/Caregiver education PDFoundation, Support Groups McGoon, Courage Behind the Mask Caregiver! Role of Physical Therapy: Parkinson’s Disease