Monday, June 26, 2017

PT Pathologies: Parkinson's Disease

Parkinsonism Syndrome occurs as a secondary effect or disorder from another disease and is used to describe a group of disorders within subcortical gray matter of the basal ganglia that produces a similar disturbance of balance and voluntary movements.  Parkinson's disease is a primary degenerative disorder characterized by a decrease in production of dopamine and accounts for the majority of patients with Parkinsonism.  Because the disease progresses slowly over 25 to 30 years, a definitive diagnosis is often difficult during the early stages of the disease.  There are no laboratory or imaging studies that can be done to initially diagnose this disease.  Instead, diagnosis is made from a thorough medical history and examination, along with imaging studies such as CT and MRI to rule out other neurodegenerative diseases.  Although the cause of primary Parkinson's disease is unknown, there are some contributing factors that can produces symptoms of the disease such as genetic defect, toxicity from carbon monoxide, excessive manganese or copper, carbon disulfide, and other diseases such as Huntington's or Alzheimer's disease.

The majority of patients diagnosed with Parkinson's disease are between the ages of 50 and 79.  They typically first develop a resting tremor in the hands or feet the increases with stress and disappears with movement or sleep.  In the early stages, the patients may also develop symptoms similar to those caused by old age, such as balance disturbances, difficulty rolling over and rising from bed, and impairment with fine manipulative movements seen in writing, bathing and dressing.  As the disease slowly progresses, so do the symptoms, which may include hypokinesia, sluggish movement, difficulty with initiating and stopping movement, shuffling gait, bradykinesia, poor posture, and dysphagia.  They may also exhibit little to no facial expressions and experience freezing during ambulation, speech blinking and movement of the arms.

As the disease progresses, the patient may develop a stooped posture an increased risk for falling, dysphagia, difficulty with speech, and pulmonary impairment.  Once nutrition and mobility are further compromised a greater need for skin care is required.  Inactivity and deconditioning often lead to complications of bronchopneumonia and eventually death.

The medical management of Parkinson's disease relies heavily on pharmaceutical intervention, with dopamine replacement therapy being the most effective treatment to reduce symptoms such as movement disorders, rigidity, and tremor.  Physical, occupational and speech therapies may also be used intermittently throughout the course of the disease.  Physical Therapy focuses on current symptoms and should be used to maximize endurance, strength, and functional mobility as well as quality of life.  It is not used to prevent further degeneration of cure the movement disorder.  In addition, verbal cueing, oral/visual feedback, family teaching, balance activities, gait training, relaxation techniques, respiratory therapy, and psychological and nutritional counseling are all important n the treatment of Parkinson's disease.  A home care regimen using a competent caretaker is also vital for treatment in order to continue with mobility and endurance activities and avoid the damaging effects of the disease process.

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