Neurology and Rehabilitation Target Day24-11-04

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Neurology and RehabilitationTarget Day 24-11-04

• Parkinsons Disease
• Dr Bruce Covell
• Amanda Horlor
• Linda Lloyd

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Programme

• 1) Introduction
• 2) Set Objectives
• 3) Pathology
• 4) Group Work - 4 Groups
• Diagnosis Maintenance Complex Palliative
• 5) Feedback from Groups
• 6) Drugs
• 7) Parkinsons Plus Syndrome
• M.S.A. P.S.P. C.B.G.D.
• 8) Discussion and Handouts

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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.

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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

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Parkinsons 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.
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Basal ganglia dysfunction as seenin Parkinsons
disease leads to

• Impaired performance of well-learnt motor skills
  and movement sequences.
• Difficulty performing two or more well-learnt
  tasks simultaneously.
• Difficulty shifting motor and cognitive set.
• Increased time needed for mental processing.

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The role of the basal ganglia in the performance
of ADLs

• Pre-movement planning and preparation.
• Initiation of movement
• Sequencing and timing of sub-movements.
• Shifting set.

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Parkinsons disease.Main Symptoms

• Tremor
• Bradykinesia
• Rigidity

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Other Symptoms

• Postural instability
• Fatigue
• Speech impairment
• Pain
• Muscle cramps/dystonias
• Postural hypotension
• Constipation and bladder problems
• Anxiety and depression
• Dementia (mild moderate)

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Introduction to Parkinsons Disease
GroupHolywell 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 Sarah
  Holmes Citizens Advice
  Bureau
• 11.45 12.30 Merce
  Boixet Clinical
  psychologist
• 11th July 2003
• 11.00 11.45 Pnina
  Phillips Pharmacist
• 11.45 12.30 Amanda Horlor
  Parkinsons Community Support Worker
• 18th July 2003
• 11.00 11.45 Sarah
  Biggerstaff Community
  Occupational Therapist
• 11.45 12.30 Helen Spiers
  Dental Hygienist
• 25th July 2003
• 11.00 11.45 Pamela
  Radley Dietician

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Exercise Group for people with Parkinsons Disease.

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The benefits of PD Information and Exercise Groups

1. Reduction in future referrals.
2. Fitter PD patients.
3. A well informed patient.
4. An empowered and enabled patient.
5. An opportunity to share experiences.
6. A happy patient (Reduction of depression and
   stress levels).
7. Reduction in future complications.
8. Fewer falls.

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Parkinsons disease pathways

• Diagnosis
• Maintenance
• Complex
• Palliative

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Drugs

• Amantadine
• Selegeline
• Anticholinergic
• Dopamine Agonists
• Levodopa Sinemet Madopar
• Apomorphine

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Parkinsons Plus Syndrome

• M.S.A Multiple System Atrophy Shy Drager
  Syndrome.
• P.S.P. Progressive Supranuclear Palsy.
• C.B.G.D. Corticobasal Ganglionic Degeneration.