VIDEOS

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VIDEOS
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Role of Physical Therapy Parkinsons Disease
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Progressive loss of function
Impairment
Activity
Participation
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Continuum of Therapeutic Interventions
Recovery
Compensation
Learning (new)
Re-learning
Practice
Practice
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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) bradyki
nesia rigidity
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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

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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
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Secondary effects/ Consequences over time
PARTICIPATION
ROLES Provider Spouse - Partner
Socially Parent Family member
Recreationally Handle finances.. Act
or Attorney General
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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
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BALANCE
Dopamine
Cholinergic activity acetylcholine
IF excess dyskinesia
IF excess rigidity
IF Dopamine
Cholinergic effect
then,

• Anticholinergics
• 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

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Good news
Changes symptoms
Changing rate of disease
progression?
Bad News
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• Other medical/surgical options
• Pallidotomy
• Deep brain stimulation/implant
• Transplants

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GOALS
What does person with PD want? Maintain optimal
function (Teach strategies) Prevent
complications of inactivity/immobilty Patient/Fam
ily/Caregiver education PDFoundation, Support
Groups McGoon, Courage Behind the
Mask Caregiver!
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Role of Physical Therapy Parkinsons Disease
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