A progressive disorder of the nervous system that mainly affects elderly people most often after the age of 50, which is associated with the destruction of brain cells that produce Dopamine . dopamine is a neurotransmitter formed in brain which is essential for normal functioning of CNS. Parkinson’s disease is also known as Paralysis agitans, Shaking Palsy. Males and females are equally affected. Slowness of movement and an inability to start a movement are hallmarks of the disease.
The pathologic change ( which causes the disease ) is degeneration / depletion of a group of nerve cell deep within the centre of the brain in an area called “Substantia Nigra “ substantia nigra is the layer of a large pigmented nerve cells in the mid brain that produces dopamine. These cells use dopamine to signal other nerve cells. As these cells stop functioning, dopamine fails to reach the areas of the brain that affect motor function.
What causes Parkinson’s disease
Low level of dopamine ,a chemical involved in controlling movement. The shortage of this chemical occurs when nerve cells in a part of the brain ( substantia nigra ) that produces dopamine fails and deteriorate. There is link between the Parkinson’s disease and factors such as Genetics, aging , toxins in environment and free radicals to some extent.
Symptoms of Parkinson’s disease
The type and severity of symptoms experienced by a person with Parkinson’s disease vary with each individual and the stage of Parkinson disease. Symptoms that develop in the early stages of the disease in one person may not develop until later or not at all in another person. Symptoms of Parkinson’s disease typically begin appearing between the age 50 and 60. They develop slowly and often go unnoticed by family, friends and even the person who has them.
A small number of people have symptoms on only one side of the body that never progress to the other side. The most common symptoms include
4) Parkinson’s mask
5) Flexed or stooped posture
Tremors( involuntary, shaking, rhythmic or twitching movements) or shaking occur most commonly in hands, arms or legs. These tremors occurs when the person is awake and sitting or standing still (resting tremors) and subsides when the person moves the affected body part. Initially tremors may appear in just one arm or leg or only one side of the body . it also affects chin , lips and tongue. As disease progress spread to both sides of body , but in some cases it remains on just one side. Emotions and physical stress tend to make it more noticeable sleep. Relaxation reduce or stop tremors.
Stiff muscles (rigidity) and aching muscles
One of the most common early sign of Parkinson’s disease is reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of legs, face, neck or other parts of body and may cause muscles to feel tired and achy.
Slow, limited movement ( bradykinesia)
When the person tries to move from a resting position ,there may be difficulty in performing tasks like difficulty in getting out of chair, or turn over in bed.
Weakness of face and throat muscles (Parkinson’s mask)
Due to the weakness of muscles of face and throat talking and swallowing becomes more difficult and person may cough, choke or drool. Speech becomes soft. Loss of movement in muscles of face can cause fixed facial expression often called Parkinson’s face.
Stooped or flexed posture
In such patients there is difficulty in walking and balance. patient usually take small steps and shuffle with his or her feet close together and bend forward slightly at the waist (called stooped posture)and have trouble in turning around.
In addition to these symptoms Parkinson’s patient show other features also
a) Decrease coordination, changes in handwriting are common with writing become smaller . activities such as dressing and eating becomes difficult.
b) There is cramps in the muscles and joints.
c) Oily skin and increased dandruff
d) Digestive and urinary problems are there, controlling urination may be difficult or sometimes there may be urgency . patient usually complaints of constipation.
e) There is increased sweating, low B.P when person stands up(orthostatic hypotension). There is problem with sexual function.
f) Freezing is common i.e. sudden inability to move.
g) Problem in falling asleep(insomnia) which is due to depression or physical restlessness. These people may not be able to sleep because they cannot turn over or change position in bed.
Physiotherapy treatment of Parkinson’s disease
Exercise is an important part of treatment for the people with Parkinson’s disease. physiotherapist mainly focuses on
1)maintain muscle strength and improve coordination
2) maintain and increase endurance
3)improve flexibility and range of motion
4)improve cardiovascular fitness
5) control weight
6)reduce the likelihood of becoming constipated
7) improve balance and walking
8 ) use of walking aids correctly
Physiotherapy help to learn exercises and stretches to do at home to improve posture, strength, flexibility and endurance. Recognizing and dealing with depression is a important part of home treatment. Physiotherapy relieve muscle and joint stiffness and discomfort by the use of exercise, relaxation, physical treatment such as heat and cooling and by carefully moving joints and by stretching muscles(manipulation). People with Parkinson’s disease often develop difficulties with everyday actions such as walking, getting up from chair, turning over and getting in and out of bed. These teach how to get round these problems and make it easier. They recommend any walking aids and appliances and other equipment that would be suitable.