Dealing Life with Parkinsonism : A Physiotherapist’s Insight ( Part 1)

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Managing life with Parkinsonism: A Physiotherapist’s Insight ( Part 2 )
January 28, 2018
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Parkinson’s : A Medical Puzzle

Can you imagine one morning you get up and unable to get yourself out of bed.  You can’t lift a glass of water because your entire body is shaking. U can’t socialise, can’t eat outside as it may become embracing because food may spill anywhere and people laugh at you.

You are scared that the next step and u may fall and so on and so many functional restrictions.

I can imagine, as a Physiotherapist when I see a patient with Parkinson’s, how difficult it is for them. It is such a deteriorating condition which leaves a patient helpless. Yes, helpless.

Living With Parkinson can be difficult

Why? You can read below.
Parkinson’s disease is a progressive neurological movement disorder. Brain is a functional unit of our body and if it is not functioning normally our system too fails to function. According to studies , It affects 1% of male population our 60 years of age.

Looking at the symptoms in details

There are four common symptoms associated with this disease.
1) Tremor or Shakiness : It is an involuntary shakiness of hands, jaws, face and trunk. The most common is pill rolling movement of the thumb and index finger, as if rolling a pin between the fingers. This movement generally leads to deformities in hand with most of the patients.

2) Rigidity or Stiffness : In this there is stiffness in body. It mostly appears in arms and legs. It is of two types lead pipe and cogwheel. Rigidity is responsible for stooped posture and almost expressionless face or mask face.

3) Bradykinesia or Slowness of movement : Patients all movements become slow. Some patients have hypokinesias i.e. lessened movements and akinesia i.e no movements at all. Bradykinesia leads to sudden freezing of gait which increases the tendency to fall. Also it is the cause of short shuffling gait or festinating gait which is commonly seen in patients with Parkinson’s disease.

4) Postural Instability (Gait and Balance) : This is a late feature of the disease. It causes the problems with balance and lead to fall. Both static and dynamic balance is significantly affected. Patient has difficulty sitting unsupported as well as standing and walking unsupported. At this stage patient is almost bedridden.

These are the major motor symptoms. There is unending list of non motor systems as well.
Such as orthostatic hypotension, constipation, sleep deprivation, slowness of speech, difficulty in swallowing, bladder infection, depression, dementia and so on.

With all these symptoms obviously the patient become helpless, isn’t it?

Let’s see how this occurs?
There isn’t any specific cause for it.

Parkinson’s : Causes

Environmental actors like Exposure to pesticides and a history of head injury have each been linked with Parkinson disease (PD), but the risks are modest.
Research indicates that PD is the product of a complex interaction of genetics and environmental factors.
In our brain there are various neurotransmitters which receive and send information from brain to our body and vice a versa. One of such neurotransmitter know as Dopamine present in Substantia Nigra in our brain is significantly reduced in Parkinson’s.


Nerve cells in Basal Ganglia are responsible for producing this chemical called Dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.
If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement can’t work normally, causing movements to become slow and abnormal.
The loss of nerve cells is a slow process. The symptoms of Parkinson’s disease usually only start to develop when around 80% of the nerve cells in the Substantia Nigra have been lost.
So Dopamine is the main culprit.

.
Lets understand the Types of Parkinson’s
There are different types of Parkinson’s.

Living With Parkinson’s can be a lifetime pain

Parkinsonism is a term that covers a range of conditions that have similar symptoms to Parkinson’s.
Most people with a form of Parkinsonism have idiopathic Parkinson’s disease, also known as Parkinson’s.
1. Idiopathic Parkinson’s disease – or Parkinson’s – is the most common type of Parkinsonism. Idiopathic means that the cause is unknown.

.
The main symptoms of idiopathic Parkinson’s are tremor, rigidity (stiffness) and slowness of movement.
2. Vascular Parkinsonism (also known as Arteriosclerotic Parkinsonism) affects people with restricted blood supply to the brain – usually older people who have health issues such as diabetes. Sometimes people who have had a mild stroke may experience this form of Parkinsonism. The common symptoms are walking difficulties, urinary incontinence and memory problems. The symptoms of Vascular Parkinsonism are often the same as normal pressure hydrocephalus, which mainly affects the lower half of the body. Some people with Vascular Parkinsonism may swing their arms less than those with Parkinson’s.

.
3. Drug induced Parkinsonism – A small number (around 7%) of people diagnosed with Parkinsonism develop symptoms following treatment with particular medication.
Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders) which block the action of dopamine are thought to be the biggest cause of drug-induced Parkinsonism. The symptoms of drug-induced Parkinsonism tend to be static. Only in rare cases do they change in the manner that the symptoms of Parkinson’s do.Most people will recover within months, and often within hours or days, of stopping the drug that is the cause.

.
4. Other types of Parkinson
Multiple system atrophy (MSA)
Both multiple system atrophy and Parkinson’s cause stiffness and slowness of movement in the early stages.
People with multiple system atrophy can also develop symptoms such as incontinence, difficulty with swallowing and dizziness. These symptoms are unusual in early Parkinson’s.
The condition used to be known as Striato Nigral degeneration, Shy-Drager syndrome, or Olivopontocerebellar atrophy.
Progressive Supranuclear palsy (PSP)
Progressive Supranuclear palsy affects eye movement, balance, mobility, speech and swallowing. It is sometimes called Steele-Richardson-Olszewski syndrome.
.

.

Next Article will be covering Management Of Parkinson’s ….

 

Dr. Swati Sangolkar : An Expert Physiotherapist for in Nerul , Sanpada, Sea woods, Belapur, Navi Mumbai

Contributed By :

Swati Songolkar

Physiotherapist (Mumbai)

 

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