Transcript Parkinson’s disease is a slowly progressive disorder that

Neurology and Rehabilitation
Target Day
24-11-04
Parkinson’s Disease
Dr Bruce Covell
Amanda Horlor
Linda Lloyd
Programme
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Introduction
Set Objectives
Pathology
Group Work
Diagnosis
4 Groups:
Maintenance
Complex
Feedback from Groups
Drugs
Parkinson’s Plus Syndrome
M.S.A.
P.S.P.
C.B.G.D.
Discussion and Handouts
Palliative
Service Description
The West Herts Adult Rehabilitation Service is an
interdisciplinary rehabilitation service for people with
complex needs within west Hertfordshire. Our main focus
is for people with neurological conditions. The service is
based primarily between two sites: Jackets Field Rehab
Unit in Abbots Langley and Holywell Rehab Unit at
St.Albans City Hospital. Both sites offer an outpatients
service and in addition, Holywell Unit offers six inpatient
beds for 24 hour rehab programmes.
The Approach
The Adult Rehab Service provides an empowering and enabling environment,
which aims to maximise independence and incorporates a range of therapies
that can be tailored to each individuals needs. These needs can be addressed
by:
Assessment
Intervention
advice
Specialist teaching
Inpatient rehab
Outpatient programme with one professional or a team
Sign posting to other agencies
Specialist equipment, assessment and supply
Liaison and joint planning with Community Health and Adult Care Services.
Liaison and joint planning with Acute Hospital Services
Parkinson’s disease is a slowly progressive disorder that affects movement, muscle control and
balance. Part of the disease process develops as cells are destroyed in certain parts of the brain
stem, particularly the crescent-shaped cell mass known as the substantia nigra. Nerve cells in
the substantia nigra send out fibres to tissue located in both sides of the brain. There the cells
release essential neurotransmitters that help movement and coordination.
Basal ganglia dysfunction as seen
in Parkinson’s disease leads to:
• Impaired performance of well-learnt motor
skills and movement sequences.
• Difficulty performing two or more welllearnt tasks simultaneously.
• Difficulty shifting motor and cognitive set.
• Increased time needed for mental
processing.
The role of the basal ganglia in the
performance of ADL’s
• Pre-movement planning and preparation.
• Initiation of movement
• Sequencing and timing of sub-movements.
• Shifting set.
Parkinson’s disease.
Main Symptoms
• Tremor
• Bradykinesia
• Rigidity
Other Symptoms
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Postural instability
Fatigue
Speech impairment
Pain
Muscle cramps/dystonias
Postural hypotension
Constipation and bladder problems
Anxiety and depression
Dementia (mild – moderate)
Introduction to Parkinson’s Disease Group
Holywell Rehabilitation Unit
St.Albans City Hospital
PROGRAMME
Friday Mornings 11.00 – 12.30
27th June 2003
11.00 – 12.30
Linda Lloyd
Physiotherapist (introduction and video)
4th July 2003
11.00 – 11.45
11.45 – 12.30
Sarah Holmes
Merce Boixet
Citizens’ Advice Bureau
Clinical psychologist
11th July 2003
11.00 – 11.45
11.45 – 12.30
Pnina Phillips
Amanda Horlor
Pharmacist
Parkinson’s Community Support Worker
18th July 2003
11.00 – 11.45
11.45 – 12.30
Sarah Biggerstaff
Helen Spiers
Community Occupational Therapist
Dental Hygienist
25th July 2003
11.00 – 11.45
11.45 – 12.30
Pamela Radley
Jane Bradshaw
Dietician
Speech and Language Therapist
Exercise Group for people with
Parkinsons Disease.
The benefits of PD Information
and Exercise Groups
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Reduction in future referrals.
Fitter PD patients.
A well informed patient.
An empowered and enabled patient.
An opportunity to share experiences.
A happy patient (Reduction of depression and stress levels).
Reduction in future complications.
Fewer falls.
Parkinson’s disease pathways
•Diagnosis
•Maintenance
•Complex
•Palliative
Drugs
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Amantadine
Selegeline
Anticholinergic
Dopamine Agonists
Levodopa – Sinemet & Madopar
Apomorphine
Parkinson’s Plus Syndrome
• M.S.A
Multiple System Atrophy Shy Drager
Syndrome.
• P.S.P.
Progressive Supranuclear Palsy.
• C.B.G.D. Corticobasal Ganglionic Degeneration.