PARRKINSON’S

DISEASE
-BY
MRIDHULA .S
 PARKINSON’S DISEASE

DEFINITION:
 Parkinson’s disease (PD) is a progressive disorder of the central
nervous system (CNS) with both motor and nonmotor symptoms.
Motor symptoms include the cardinal features of rigidity,
bradykinesia, tremor, and, in later stages, postural instability.
 ETIOLOGY

CLASSIFICATION OF PARKINSONISM BASED ON ETIOLOGY

Idiopathic Parkinson’s Disease
 Late-onset (>40 years; generally sporadic)
 Early-onset (<40 years; often familial)
 • Young-onset (>21 years)
 • Juvenile (<21 years)
 ETIOLOGY [CONTD]

Parkinsonism Due to Identifiable Causes:

 Virus (e.g., encephalitis lethargica)
 Toxins (e.g., carbon monoxide, manganese,
 methylphenyltetrahydropyridine [MPTP])
 Drugs (e.g., phenothiazines, reserpine, butyrophenones,
 metoclopramide)
 Vascular disease (multi-infarct)
 Tumors of basal ganglia
 Normal pressure hydrocephalus
 ETIOLOGY [CONTD]

Metabolic
 • Wilson’s disease
 • Hepatocerebral degeneration
 • Hallervorden-Spatz disease
 • Hypoparathyroidism
Parkinsonism in Other Neurodegenerative Disorders
 Progressive supranuclear palsy
 Cortical–basal ganglionic degeneration
 Disorders with cerebellar/autonomic/pyramidal manifestation
CLINICAL FEATURES
 ASSESSMENT

 On observation
Posture : Head : forward head
Shoulders : protracted and internally rotated
Thorax : exaggerated kyphosis
Lumbar : lordosis reduced
Gait : festinating gait
Facial appearance: Mask like face
Tremors : Type of tremor and the side should be noted
 On palpation :
Tone is noted to check for rigidity
 On Examination :
1. Higher mental functions
Language : fluency of speech
Writing: Micrographia
Memory : Short term and long term memory should be assessed
2. Range of Motion – reduced
3. Muscle power – reduced
3. Tone assessment: through AROM and PROM , type of rigidity should be mentioned
4. Reflexes [ DTR] : usually exaggerated
5. Sensory examination : perform tests for sensation and note if there’s any deficits
MOTOR FUNCTION ASSESSMENT
1. Bradykinesia – movement time and reaction time needs to be calculated
2. Tremor – Location , pattern ( type) , aggravating and relieving factors of tremor should be noted .
3. Balance assessment – using berg balance scale – reduced or poor balance is typically
observed
4. Coordination tests – should be performed for assessing Coordination deficits
FUNCTIONAL ASSESSMENT: Based on ICF classification , list down the impairments,
activity limitation and participatory restrictions.
PROBLEM LIST
1. Rigidity- increased tone of muscle
2. Tremors
3. Bradykinesia – slowness in movement
4. Gait – festinant gait
5. Postural changes
6. Balance and Coordination issues
GOALS :
LONG TERM GOALS : 1. To maximize quality of life
2. To make the patient functionally independent
SHORT TERM GOALS : 1. To reduce tone of muscle
2. To improve ROM
3. To improve strength of muscles
 4. To improve posture and provide gait training
5. To improve balance and coordination
PT MANAGEMENT:
1. Relaxation exercises – gentle rocking exercises – reduces tension in muscles
2. Flexibility exercises- such as stretching and ROM exercises – to reduce rigidity and improve
range .
3. Locomotion training along with postural correction is done using visual and auditory
feedback with verbal commands ( Stand erect , walk faster) and a mirror for visual feedback
3. Balance Exercises : simple balance exercises done under supervision of therapist or
caretaker. Eg : Heel standing , toe standing , stepping – forward , backward , sideways
 REFERENCES

 Physical rehabilitation – Susan O Sullivan

 Neurological interventions for physical therapists - Kessler Martin
Thank you !