Parkinsons is a progressive neurological condition affecting movements such as walking, talking, and writing. It is named after Dr James Parkinson (1755-1824), the London doctor who first identified Parkinsons as a specific condition.
Parkinsons occurs as result of a loss of nerve cells in the part of the brain known as the substantia nigra. These cells are responsible for producing a chemical known as dopamine, which allows messages to be sent to the parts of the brain that co-ordinate movement. With the depletion of dopamine-producing cells, these parts of the brain are unable to function normally.
SIGNS AND SYMPTOMS
The symptoms of Parkinsons can be classified as motor and non-motor.
Motor symptoms define Parkinsons, with three primary features:
1. Tremor - This usually begins in one hand. This is the first symptom for 70% of people with Parkinsons
2. Slowness of movement (bradykinesia) - people with Parkinsons may find that they have difficulty initiating movements or that performing movements takes longer.
3. Stiffness or rigidity of muscles - problems with activities such as standing up from a chair or rolling over in bed may be experienced.
Various non-motor symptoms may also be experienced, for example:
- sleep disturbances
- urinary urgency
PHYSIOTHERAPY TREATMENT FOR PARKINSON DISEASE
Physiotherapists are trained to provide an assessment to see how Parkinsons affects the individual. This can be done with newly diagnosed, as well as those who have been diagnosed for some time. In the earlier stages, the emphasis of treatment will be mainly focused on understanding the condition and how a person might keep up their own general levels of fitness and maintain independence for them. In the later stages of the disease, the emphasis will include a support network for the individual, involving the family as part of the treatment.
The assessment will indicate to the physiotherapist what combination of education and intervention is required, some examples of which are listed below:
- Teach techniques that help make some automatic movements easier. For example, the activities of walking, sitting down and standing up are some of the tasks that may become difficult as Parkinsons progresses, but can be improved by learning new ways of doing things. Help you to maintain independence in your daily life if you are having difficulty with certain actions, such as getting up out of a chair or turning in bed. The physiotherapist may visit your home and be able to teach you a different way of doing the action, or could give advice on aids and adaptations that might be of use.
- Work on stiff muscles and joints to maintain a posture, keep your joints flexible and help relieve the effects of rigidity that might occur. This will help to make your actions more smooth and efficient. The physiotherapist can also teach you and your carer to do this.
- Improve or maintain muscle strength by the use of general or specific exercises, or by providing an exercise programe for you to follow in the hospital, or at home. A physiotherapist may help to maintain your level of fitness or advise you take up a sport, such as golf or swimming, or a class like yoga or tai chi, where the additional benefits of relaxation help to decrease stress that can worsen the symptoms of Parkinsons.
- Help prevent or manage falls. The physiotherapist may work on specific balance training and improving your confidence to decrease any fear of falling, or teach techniques to help you get off the floor or call for help. They work with an occupational therapist to look at ensuring your home environment is as free from hazards as possible.
- Maintain or improve effective breathing. The stiffness and weakening of the chest muscles can sometimes lead to a chest infection, for which the therapist might use positioning and other techniques to help clear the phlegm. Breathing exercises can also enhance your respiratory capacity and can help if you find your voice has become softer
- Help to prevent circulatory problems through handling and positioning, especially if your movement is severely restricted, hampering the effect of the natural pumping mechanism of the muscles.