Parkinson’s or Parkinson’s Disease (PD) is an

incurable progressive neuro-degenerative

condition primarily affecting the Basal Ganglia It is
the seconds most common neuro-degenerative
condition in the world after Alzheimer It is caused
by decreased dopamine production in the basal
ganglia due to degeneration of dopamine-secreting
neurons
 Diagnosis

Idiopathic Parkinson's has been divided into three clinical stages:

1. Pre-clinical stage: disease can predicted or early detected through biomarkers

such as blood tests, saliva and/or genetic markers. In this stage, people with risk
factors could be identified and triaged for early intervention.

2. Prodromal Parkinson’s: this stage is characterized by the presence of

symptoms such as decreased sens of smelling (hyposmia), low mood/ depression.
bowel symptoms and/or sleep changes.

3. Clinical Parkinson’s: symptoms defined by dopamine-responsive motor

features; bradykinesia (with a large scale of sensory motor changes symptoms and
symptoms and fatigue), tremors and /or rigidity.
 There are No specific, standard criteria to diagnose Parkinson’s because the
specificity and sensitivity of its characteristics are hard to clearly establish. The
aetiology is unclear and most cases are hypothesised to be due to a combination of
genetic and environmental factors. In most people, the diagnosis of Parkinson’s is
based on clinical findings
 Bradykinesia
 Muscular rigidity
 4–6 Hz resting tremor
 Postural instability not caused by primary
visual, vestibular, cerebellar or
proprioceptive dysfunction. it is marker
of parkinson's but no essentially a diagnostic
criteria. it could be due to many other conditions.
 Imaging tests — such as MRI, CT, ultrasound of
the brain, and PET scans — may also be used
to help rule out other disorders. Imaging tests
aren't particularly helpful for diagnosing
Parkinson's disease
Assessment

 Physiotherapists play a vital role in

supporting people with Parkinson’s Disease
to choose management strategies, prioritize
and address the challenges they face over
the course of the condition. Improving
Movement and Safety is usually the
main focus of physiotherapy in light of the
progressive pathology and the disability and
participation restrictions this can cause.
Physical capacity
It is known that people with Parkinson’s are less active than their
peers as the condition progresses, resulting in muscle weakness
and power, increased falls risk and reduced walking speed, itself an
indication of reduced life expectancy. Physiotherapist must
understand the importance of education on staying active and
develop a management plan that tackles all physical problems that
result in reduced activity levels.

Transfers
Difficulties arise for people with Parkinson’s due to the complexity
of changing position – e.g. rising from lying or sitting, turning
activities

Manual activities
These become difficulty due to the combination of sequential sub-
tasks, dexterity and co-ordination requirements
 Quality of Movement
Parkinson's is associated with different movement patterns
which are associated with functional decline on the long-term:
 Dyskinesia : rapid, random, jerky movement
 Freezing: where the person cannot move – either to start a
movement (or speech), or where they come to a halt
 Festinaton: involuntary gait quickening
 Dystonia: sustained muscle contractions (can cause
abnormal postures and be painful)
 Falling: often during complex movement e.g.turning, or
misjudging clearance.
 Bradykinesia: longer latencies for muscle force
production and relaxation, initially affecting power and
strength
 Posture
Varied postural changes are common among people
with PD including:
 Camptocormia: an involuntary forward flexion
(usually greater than 45°) when person is upright, that
reduces/ disappears when the person lies down.
 Antecollis: forward flexion of head and neck
 Pisa syndrome: a sustained lateral flexion of the
trunk; not necessarily to the Parkinson’s dominant side
 Postural flexion changes affect the quality of life
and make people more prone to vertebral fractures.
 Balance & Falls
 Balance impairment and falls (30-70% of people with PD
experience falls) are common problems for people with
Parkinson’s; these problems often start after about 5 years of
diagnosis due to worsening of the systems that maintain body
position, the progressive slowness of movement, trunk rigidity
and reduced proprioception.
The following factors are considered to be risk
factors and predictors of falls in PD
 Age
 Length since Parkinson’s onset,
 Associated neuro-musculo-skeletal changes
 Reduced leg muscle strength
 Proprioception and gait speed changes
 Increased gait variability
 Freezing of gait
 Respiratory Problems
 Associated respiratory problems with Parkinson's require acute care
intervention. Shortness of breath on exertion is reported by
35.8%Patients, cough and sputum production were reported by 17.
9% and 13% respectively. Whenever a symptoms of ventilatory
dysfunction is present, pulmonary function test is recommended
to identify the dimensions of the problem and tackle it with a proper
care plan

Pain
 Pain is a multi-dimensional phenomenon and could be
assessed using different measuring scales and questionnai
res
to include in the management plan. 30 to 50% of PD patients
experience pain mainly musculoskeletal pain in the neck, arm,
paraspinal or calf muscles. MSK pain is more likely to be caused
by rigidity. Radicular and neuropathic pain are experienced by 5-20%
of PD patients. Dystonic pain, restless leg syndrome and akathitic.
discomfort were reported to be associated with PD.
Clinical Presentation
 Impaired performance of well-learnt motor skills and
movement sequences
 Problems maintaining sufficient movement amplitude
 Difficulty in performing more than one task simultaneously
(dual-tasking)
 Difficulty in shifting motor and cognitive sets
 Slower mental processing
 Perseveration (repetition) in thought and action
 Tremor
 Slowed movement (bradykinesia)
 Rigid muscles
 Impaired posture and balance
 Loss of automatic movements
 Speech changes
 Parkinson's was primarily thought to have
motor symptoms only and the non-motor
symptoms symptoms were managed
separately.
 The main motor (movement) symptoms of
Parkinson’s are:
 Tremor (involuntary shaking of parts of the
body)
 Rigidity (experienced as muscle stiffness)
 Bradykinesia (experienced as slow
movement)
Typical gait pattern in PD
People with PD often experience increased gait impairments as
the disease progresses and symptoms become more severe.
Impairments include;
 Hypokinesia (decreased step length with decreased speed)
 decreased coordination
 Festination (decreased step length with increased cadence)
 Freezing of gait (the inability to produce effective steps at the
initiation of gait or the complete cessation of stepping during gait)
 difficulty with dual tasking during gait
 Coupled with these gait impairments are an increased risk and
Rate of Falling. Increased probability of falls not only
increases the risk of injury such as Hip fracture but also affects
an individual's independence and ability to interact within the
community. Additionally, fear of falling has psychological
consequences and can lead to Self-isolation and
Depression. [
Aims of Physiotherapy
 Maintain and improve levels of function and
independence, which will help to improve a person’s
quality of life
 Use exercise and movement strategies to improve
mobility
 Correct and improve abnormal movement patterns and
posture, where possible
 Maximize muscle strength and joint flexibility
 Correct and improve posture and balance, and minimise
risks of falls
 Maintain a good breathing pattern and effective cough
 Educate the person with Parkinson’s and their carer or
family members
 Enhance the effects of drug therapy
 Physiotherapy Management

 Flexibility exercises
The training focused on stretching, improving balance and range of
movements, thrice a week for six months. However, there was
more significant improvement in the walking group (warming up,
technique training, endurance training and cooling down)
 Strength Training
It is emphasized that exercise training improves aerobic
capacities, muscle strength, walking, posture and
balance parameters. Rehabilitation programs should
begin as soon as possible, last several weeks and be
repeated. They should include aerobic training on
bicycle or treadmill and a muscle strengthening
program.
Balance Training
 Clinical trials
 Healthy eating
( eating foods high in fiber and drinking an
adequate amount of fluids )

Exercise
o Increase your muscle strength, flexibility and balance
o Improve your well-being and reduce depression or anxiety
o Walking, swimming, gardening, dancing, water aerobics or
stretching

Balance
 Try not to move too quickly.
 Aim for your heel to strike the floor first when you're walking.
 If you notice yourself shuffling, stop and check your posture. It's
best to stand up straight.
 Look in front of you, not directly down, while walking.
 Avoiding falls
 Make a U-turn instead of pivoting your body over
your feet.
 Distribute your weight evenly between both feet,
and don't lean.
 Avoid carrying things while you walk.
 Avoid walking backward.
Daily living activities
 Dressing, Eating, Bathing and Writing