parkinson's disease

Parkinson’s (PD) is a neurological condition characterised by, tremors, shaking and muscle rigidity. Nerve cells (neurons) in a part of the brain called the Substantia nigra die or become impaired. There is a failure of the cells to be stimulated due to inadequate production of the neurotransmittor (a chemical to help pass messages between cells) called Dopamine. The substantia nigra is a part of the brain which contributes to stimulation of the brain cortex to assist with the performance of smooth and coordinated muscle and body movements. In particular, the speed of production of movements is slowed down with PD. Once approximately 70% of the dopamine-producing cells have been damaged, symptoms of PD will start to appear. It is unknown what causes these changes to take place.

Other neurological conditions can affect the same parts of the brain that are affected in Parkinson’s and therefore cause similar symptoms, this is called ‘Parkinsonism’ to distinguish it from the disease itself. Some medications, strokes, brain injuries or meningitis can cause Parkinsonism.

Common primary impairments of Parkinson’s include:

• Tremor Involuntary rhythmic shaking in an extremity (like an arm or leg), or in the face. Tremor tends to be worst at rest or when stressed and gets better with movement; it often disappears during sleep. In the hand, the thumb may move back and forth against the other fingers –this motion is often called 'pill rolling'. Tremors commonly begin in one limb, progressing to another limb and later to the other side of the body.
• Bradykinesia A term meaning slowness of movement. People with bradykinesia seem to freeze: they have trouble initiating movements and are slow in changing position. This contributes to stooping and shuffling while walking. The voice can sound monotonous, and a fixed, staring, unblinking expression can develop.
• Muscular rigidity Muscles become stiff, rigid, and resistant to being passively moved. Rigidity may be experienced in a series of ratchet-like steps called 'cogwheel rigidity', or throughout the entire movement, this is known as ‘lead-pipe rigidity’.

Activity changes include:

• Postural instability contributed to by slowness of activating postural responses ( bradykinesia), weakness in muscles and reduction in sensory awareness.
• Difficulty moving on the bed and changing position
• Walking difficulties including stooping and shuffling, reduced arm swing, difficulty with turning and sudden direction changes, festinating (steps becoming faster and smaller) and freezing.

Secondary symptoms of Parkinson’s can include:

• Pain and discomfort due to decreased movement , muscle stiffness and contracture, depression, slowness in thinking and memory problems as well as tiredness and disturbed sleep.
• Lethargy is common due to sleeping difficulties and can also be a side-effect of many medications.
• Falls can occur for a number of reasons; tiredness, decreased speed of movement (reaction time) and poor balance, falls can also be a product of the environment.
• Micrographia (small hand writing) is often experienced as the muscles in the hand become affected.
• Constipation and bladder issues, and speech and swallowing difficulty can occur later in the disease.

Symptoms change over time, but the speed of progression varies between individuals.

Your physiotherapist is able to:

• Teach specific ways to use providing cueing to make walking easier.
• Assist with other movement re-training, eg getting out of a chair, rolling on the bed.
• Provide an individualised home program to assist with maintaining and improving strength, range of movement, assist pain control and improve mobility.
• Help relieve pain and discomfort through manual techniques such as soft tissue massage, stretching and mobilisation.
• Integrate exercise into functional activities that promote independence.
• Assist with falls prevention.

Your physiotherapist can also:

• Make recommendations on splints, braces and functional aides if required.
• Assess your home environment for falls risks, functionality and modifications if required.
• Provide links with useful community services.

Please contact us on 02 6162 0450, if we can be of assistance to you and your family.

For those in the country we offer consultations via skype with the call name of neurospace1.

links

Some websites you many find useful:

National Parkinson Foundation
http://www.parkinson.org

We Move
http://www.wemove.org
Covers a range of movement disorders, including PD

In Canberra the local support group for people with Parkinson's and friends is located in Pearce. They can be contacted on 02 6290 1984.