BRADYKINESIA IN

PARKINSON’S DISEASE

A
NEUROLOGY UNIT
PRESENTATION
BY
OGBUJI MACDONALD C.
26th JULY 2023
TABLE OF CONTENTS
INTRODUCTION
RELEVANT ANATOMY
PREVALENCE
PREDISPOSING FACTORS
CAUSES
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
COMPLICATIONS
ASSESSMENT
MANAGEMENT
CASE STUDY
RECOMMENDATION AND CONCLUSION
REFERENCES
INTRODUCTION
Bradykinesia is one of the cardinal motor symptoms of
Parkinson’s disease, along with resting tremors, muscle
rigidity, and postural instability.
It is a common and significant feature of the disease.
Bradykinesia refers to slowness of movement and a
gradual reduction in the ability to initiate and complete
voluntary movements.
It can affect various aspects of a person’s movements,
including walking, writing and performing everyday
tasks.
INTRODUCTION CONT’D
Dopamine is a neurotransmitter that helps transmit
signals within the brain and is involved in coordinating
smooth, purposeful movements.
The depletion of dopamine in Parkinson’s disease leads
to an imbalance in the brain’s motor control circuitry,
resulting in bradykinesia and other motor symptoms.
RELEVANT ANATOMY

 Parkinson’s Disease is considered predominantly a disorder

of the basal ganglia.
 The basal ganglia are a group of nuclei situated deep and
centrally at the base of the forebrain.
 They have robust connections with the cerebral
cortex and thalamus in addition to other areas of the brain.
 Their vast system of communication allows them
involvement with a variety of functions, including
automatic and voluntary motor control, procedural learning
relating to routine behaviours and emotional functions.
RELEVANT ANATOMY CONT’D
The association with other cortical areas ensures
smoothly orchestrated movement control and motor
behaviour.
PREVALENCE
 Nearly one million people in the U.S. are living with Parkinson's disease
(PD). This number is expected to rise to 1.2 million by 2030.
 Parkinson's is the second-most common neurodegenerative disease
after Alzheimer's disease.
 Nearly 90,000 people in the U.S. are diagnosed with PD each year.
 More than 10 million people worldwide are living with PD.
 The incidence of Parkinson’s disease increases with age, but an
estimated four percent of people with PD are diagnosed before age 50.
 Men are 1.5 times more likely to have Parkinson's disease than women.
 The estimated crude prevalence of PD in Nigeria was lower (10 to
249/100 000) compared to studies published in Europe (65.6 to 12
500/100 000).
PREVALENCE CONT’D

Up to 98% of all people with Parkinson's experience

slowness of movement.
Elevated percent time in bradykinesia (≥30%) was
estimated to have occurred in 79% of individuals with
PD, including all individuals with mBKS ≥26, most
individuals with mBKS 24 to <26, and in a small
proportion of individuals with mBKS 22 to <24.
PREDISPOSING FACTORS
 Age. Young adults rarely experience Parkinson's disease. ...
 Heredity. Having a close relative with Parkinson's disease
increases the chances that you'll develop the disease. ...
 Sex.Men are more likely to develop Parkinson's disease than
are women.
 Exposure to toxins.
 Head trauma.
CAUSES
 Parkinson’sdisease involves a small, dark-tinged portion of the
brain called the substantia nigra.
 Thisis where you produce most of the dopamine your brain uses.
Dopamine is the chemical messenger that transmits messages
between nerves that control muscle movements as well as those
involved in the brain’s pleasure and reward centers.
 Aswe age, it’s normal for cells in the substantia nigra to die.
This process happens in most people at a very slow rate.
 Butfor some people, the loss happens rapidly, which is the start
of Parkinson’s disease. When 50 to 60 percent of the cells are
gone, you begin to see the symptoms of Parkinson’s.
CAUSES CONT’D
Bradykinesia is one of the early signs of movement
disorder such as Parkinson’s or parkinsonism.
The specific mechanism behind bradykinesia in
Parkinson’s disease are not fully understood but it is
believed to result from the degeneration of
dopaminergic neurons in a region of the brain called the
substantia nigra.
These neurons are responsible for producing dopamine,
a neurotransmitter that plays a crucial role in regulating
movement and coordination.
PATHOPHYSIOLOGY
 No specific, standard criteria exist for the neuropathologic
diagnosis of Parkinson disease, as the specificity and sensitivity
of its characteristic findings have not been clearly
established.
 However, the following are the 2 major neuropathologic
findings in Parkinson disease:
 Loss of pigmented dopaminergic neurons of the substantia
nigra pars compacta
 The presence of Lewy bodies and Lewy neurites
SIGNS AND SYMPTOMS
 Some common manifestations of bradykinesia in Parkinson’s disease
include:
 Slow movements; Patients may experience a general slowing down of
movement, making simple tasks, such as getting out of a chair or dressing,
more difficult and time-consuming.
 Reduced arm swing; When walking, the normal swinging motion of the
arms may decrease or becoming limited, leading to distinctive shuffling
gait.
 Micrographia
 Difficulty with fine motor tasks
 Freezing of gait; some individuals with Parkinson’s disease may experience
episodes where they feel as if their feet are stuck to the ground making it
COMPLICATIONS
 Thinking difficulties.
 Depression and emotional changes
 Swallowing problems
 Chewing and eating problems
 Sleep problems and sleep disorders
 Bladder problems
 Constipation
 Excessive salivation
 Excessive sweating
 Bladder problems
ASSESSMENT
 Physiotherapyassessment considers ways in which the condition is
affecting the individual with Parkinson’s, whilst being aware of
the impact on close carers and relatives, especially when
someone is newly diagnosed or has been diagnosed for some time.
 The history taking and physical assessment aspects of the
assessment enable an honest discussion of what is realistic of the
things the person wants to do.
 Thecore areas of physiotherapy interventions for which there is
evidence of effectiveness for people with Parkinson’s are:
 Physical Capacity
 Transfers
ASSESSMENT CONT’D

 Manual Activities
 Quality of Movement
 Posture

 Balance and Falls

 Gait

 Pain
MANAGEMENT

Medical Management; Treatment of bradykinesia in

Parkinson’s disease primarily involves medication that aim to
increase dopamine levels in the brain, such as levodopa or
dopamine agonists.
 These medications help alleviate the symptoms and improve
overall motor function.
 In some cases deep brain stimulation may also be considered
for individuals with severe and medication-resistant
bradykinesia.
MANAGEMENT CONT’D
 PHYSIOTHERAPY MANAGEMENT;
 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
 Maximise muscle strength and joint flexibility
 Correct and improve posture and balance, and minimize risks of falls
 Maintain a good breathing pattern and effective cough
 Educate the person with Parkinson’s and their care-giver or family
members
 Enhance the effects of drug therapy
Itis most important to focus on high power, high effort,
and high amplitude movements during your exercise.
CASE REPORT
 Name: H.K
 Age: 60 years
 Sex: Male
 Occupation: Retired civil servant
 Address: Road 1 world bank owerri
 Religion: Christianity
 Nationality: Nigerian
 Phone number: 08064705*******
SUBJECTIVE EVALUATION
 Complaint: Inability to walk properly, speak properly, and facial
deviation.
 History(Source; Patient): Pt was apparently well until Nov 2022, while Pt
was jogging in USA, Pt started feeling dizzy and decided to stop jogging
& go home, on getting home he was informed by his relatives about his
facial deviation and was immediately rushed to a hospital in USA. Pt bp
was said to be high and was immediately placed on anti-hypertensives pt
was told that he had TIA. After series of treatment including physical
therapy, there was 80% recovery as he was able to walk freely and carry
out ADL but was unable to speak properly. Around March 2023 when Pt
was now in Nigeria, he woke up one morning and was feeling so dizzy
and weak and while trying to walk noticed that he was unable to walk
properly.
SUBJECTIVE EVALUATION CONT’D
 Ptwas quickly taken to a peripherial hospital in owerri own by
a renowned neurologist (DR. Ajonuma). Who sent Pt to MRI of
the brain and result came up with the diagnosis of Parkinson
and referred Pt to Physiotherapy dept FUTHO for further
management.
 PAST MEDICAL HISTORY: HTN, TIA,
 SURGICAL HISTORY: NIL
 DRUG HISTORY: Anti-hypertensive drugs
 FAMILY ANDSOCIAL HISTORY: Pt is a retired civil servant,
married with 5 children, Pt lives in a bungalow, uses WC, drinks
satchet water, and neither drinks alcohol nor smokes.
OBSERVATION AND EVALUATION
 GENERAL OBSERVATION: A 60yrs old man walked into the assessment room in a
shuffling gait. Afebrile on touch, anicteric, acyanosed and in no respiratory distress,
well oriented in time place and person.
 SEGMENTAL ASSESSMENT:
 Head and Neck; Right facial deviation with slurred speech
 Thorax and abdomen: NAD
 Back and Spine; pain at the lumbar region
 LOWER LIMBS:
 Right; ROM: Full and painfree
 Gross muscle Power; 4
 Sensitivity; intact
 Muscle tone; Hypertonia
 Left Upper limb; ROM: Full and painfree
 Gross muscle Power; 4
 Sensitivity; intact
 Muscle tone; Hypertonia
 Grip strength: Good
LOWER LIMBS:
RIGHT:
Range of motion; Limited and slightly painful
Gross muscle power; 4
Muscle tone; Hypertonia
Spasticity present
Sensitivity present
LEFT
Range of motion; Limited and slightly painful
Gross muscle power; 4
Muscle tone; Hypertonia
Spasticity present
Sensitivity present
FUNCTIONAL ABILITIES/DISABILITIES
 Patient can feed self
 Patient can sit and stand without aid( though with some difficulty)
 Patient can dress self but cant bath
 Patient can walk without aid but in a slow and abnormal gait
 Patient is very slow in performing tasks
 Patient lacks balance and coordination
IMPRESSION; Reduced Functionality secondary to Parkinson
 AIMS:
 Improve ROM of both lower limbs
 Improve muscle strength of lower limbs
 Improve gait pattern
 Improve balance and coordination
 Reduce facial deviation
 Reduce pain at lower back.
RECOMMENDATION AND CONCLUSION
 In addition to medications, exercise should be part of your
treatment plan for all Parkinson's symptoms.
 Staying active is an essential element of living well with PD.
 Research also suggests that music therapy can reduce
bradykinesia and other Parkinson's symptoms.
 While there’s currently no cure for Parkinson’s, there are
various treatments available to help manage symptoms and
improve quality of life.
 It’simportant to work closely with a healthcare provider to
develop a personalized treatment plan that works best for you.
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