Parkinson’s Disease (PD) is a progressive neurodegenerative condition that leads to the development of symptoms such as shaking, stiffness, and problems with walking and balance. In 2018 it was estimated that 145,519 people aged 20 and over lived with PD in Britain, with that number expected to rise to 229,674 by 2045. Currently, the prevalence of PD in men aged between 50 and 89 is 1.5 times greater than women in that same age bracket.
PD symptoms develop due to a substantial degeneration or decline in the number of cells that produce dopamine (a naturally occurring neurotransmitter) in an area of the brain called the substantia nigra. The resulting reduction in dopamine affects another area of the brain, the basal ganglia, which uses dopamine to regulate body movement. Too little dopamine will lead to delayed and uncoordinated movements, and the classic symptoms of PD. A person with PD may have lost up to 80% of substantia nigra dopamine-producing neurons before symptoms develop enough to meet the criteria for diagnosis.
The pathophysiology of PD is highly complex, producing a diverse range of symptoms. Very early-stage symptoms can include loss of smell, sleep disturbances, constipation, low mood, and fatigue. However, by the time of diagnosis, motor symptoms such as resting tremor, bradykinesia (slowness of movement), hypokinesia (decreased amplitude of movement) and rigidity may also be prominent. These impairments can significantly impact on an individual’s performance of activities and levels of participation. As the condition progresses, tremors and reduced movement speed can worsen, potentially impacting the ability to carry out activities of daily living such as dressing, and fine motor tasks such as writing.
Common later stage motor features can include Parkinson’s gait and freezing of gait. Parkinson’s gait typically presents as short stepping with increased step frequency, along with a narrow base of support and poor foot clearance. This can limit mobility and increase the risk of falls. Freezing of Gait on the other hand, can leave people feeling like their lower half is stuck to the floor. It causes someone to halt either at the beginning of walking, during turning or when traversing narrow doorways. These gait disorder are commonly more pronounced while performing secondary tasks such as turning or carrying objects and when something interrupts the normal sequence of movement. Flexed postures can also develop which may lead instability that could hinder activities such as getting out of bed and standing up from a chair. Other later stage features can include cognitive, neuropsychiatric, autonomic and gastrointestinal disturbances.
The management pathways for treating PD include medication, assessment, education and rehabilitation that combine compensatory techniques, coping methods and alternative strategies for complexities that may arise due to disease progression. The primary management is medication, with Levodopa commonly prescribed, to help increase dopamine levels in the brain and facilitate an improvement in symptoms. However, medication alone is not enough to control all symptoms arising from PD.
How can physiotherapy help?
Physiotherapy can help people in several areas including with transfers, balance, and gait. Physiotherapy strategies to improve gait can include motor learning that focuses on the methods and compensatory skills needed to overcome motor impairments such as freezing of gait. Cueing, for example, uses visual or auditory stimuli to facilitate the initiation or continuation of movement. Visual stimuli can include placing lines of tape on the floor that a person can use to aim their feet at whilst they walk. Auditory stimuli can include the use of a metronome that a person can time their movements to. Cueing strategies can help people overcome gait freezing and can improve gait pattern. Techniques such as visualisation, mental rehearsal of desired movement patterns, and the breakdown of movement sequences can also be physiotherapy led to overcome motor impairments, improve balance, and reduce the risk of falls. Physiotherapy can also help with the prescription of walking aids and the encouragement of physical activity that may promote lifestyle changes that enhance psychological wellbeing and social interaction. Consistent physical activity in a comfortable environment is encouraged to avoid muscle atrophy, rigidity, reduced exercise capacity and social isolation.
Respiratory dysfunction can be common in those with PD, especially as the disease progresses, with Pneumonia being a major cause for hospital admission. Physiotherapists specialising in respiratory conditions can educate and help people to manage the symptoms of respiratory dysfunction through the use of airway clearance techniques such as Active Cycle of Breathing, and advice on staying physically active.
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