“Riches, mediocrity and poverty begin in the mind.”
– Remez Sasson
What is Parkinson ’s Disease?
Parkinson’s disease is a progressive disorder that affects the nerve cells in the part of the brain called Basal Ganglia. It’s the third most common neurologic disease that affects some 1 in 1000 of the population, both men and women and 1 in 100 people over 75 years old.
The age of onset is variable with a mean average onset of about 58 years when it becomes clinically obvious but younger individuals are not excluded. Incidence in those above 50 years rises exponentially and recent epidemiological community-based data suggest that Parkinson’s disease may be more prevalent in Europe and North America compared with some other countries, notably Asia, and Africa.
The basal ganglia are made up of five large and well connected sub-cortical nuclei: the caudate nucleus, the putamen, globus pallidus, subthalamic nucleus, and substantia nigra which participate in the control of movement. The role of the basal ganglia is considered to be involved in higher-order aspects of motor control which is the process of planning and execution of complex motor performance.
Motor disturbances in diseases of the basal ganglia characteristically produce either excessive movements or diminished movements. A major breakthrough in understanding how basal ganglia dysfunction may lead to either excessive movements as in Huntington’s
Disease or reduced movement or Akinesia in Parkinson’s Disease has come from the finding that there are two pathways that mediate striatal influences over activity of the thalamo-cortical neurons: a direct pathway that tends to facilitate on-going motor behavior and an indirect pathway that dampens motor activity.
Parkinson’s disease also called paralysis agitans is the most common disease affecting the basal ganglia and a clinical syndrome characterized by a disorder of movement consisting of tremor, rigidity, elements of bradykinesia (slowness of movement), hypokinesia (reduced excursion of movement), and akinesia (slowness in initiating movement and loss of spontaneous movement) and postural abnormalities.
10 Early Warning Signs of Parkinson’s Disease
How to tell if you or someone you love might have Parkinson’s
It can be hard to tell if you have Parkinson’s disease.
Here are the 10 signs you might have the disease. No single one of these signs means that you should worry. But if you have more than one symptom you should make an appointment to talk to your doctor.
Tremor or Shaking
Have you noticed a slight shaking or tremor in your finger, thumb, hand, chin or lip? Does your leg shake when you sit down or relax? Twitching or shaking of limbs is a common early sign of Parkinson’s disease.
What is normal? Shaking can be normal after lots of exercise, if you have been injured, or could be caused by a medicine you take.
Has your handwriting suddenly gotten much smaller than in it was in the past? You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. A sudden change in handwriting is often a sign of Parkinson’s disease.
What is normal? Sometimes writing can change as you get older, if you have stiff hands or fingers or poor vision, but this happens over time and not suddenly.
Loss of Smell
Have you noticed you no longer smell certain foods very well? If you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinson’s disease.
What is normal? Your sense of smell can be changed by a cold, flu or a stuffy nose, but it should come back after you are better.
Do you thrash around in bed or kick and punch while you are deeply asleep? You might notice that you started falling out of bed while asleep. Sometimes, your spouse will notice, or will want to move to another bed. Sudden movements during sleep may be a sign of Parkinson’s disease. What is normal? It is normal for everyone to have a night when they ‘toss and turn’ instead of sleeping.
Trouble Moving or Walking
Do you feel stiff in your body, arms or legs? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. You might notice that your arms don’t swing when you walk, or maybe other people have said you look stiff. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem ‘stuck to the floor.’
What is normal? If you have injured your arm or shoulder, you may not be able to use it as well until it is healed or another illness like arthritis might cause the same symptom.
Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinson’s disease and you should talk to your doctor.
What is normal? If you do not have enough water or fiber in your body, it can cause problems in the bathroom. Also some medicine will cause constipation too. If there is no other reason such as diet or medicine that would cause you to have trouble moving your bowels, you should speak with your doctor.
A Soft or Low Voice
Have other people told you that your voice is very soft when you speak in a normal tone, or that you sound hoarse? If there has been a change in your voice you should see your doctor about whether it could be Parkinson’s disease. Sometimes you might think other people are losing their hearing, when really you are speaking more softly.
What is normal? A chest cold or other virus can cause your voice to sound different but you should go back to sounding the same when you get over your cough or cold.
Have you been told that you have a serious, depressed or mad look on your face more often, even when you are not in a bad mood? This serious-looking face is called masking. Also, if you or other people notice that you have a blank stare or do not blink your eyes very often, you should ask your doctor about Parkinson’s disease.
What is normal? Some medicines can cause you to have the same type of serious or staring look, but you would go back to the way you were after you stopped the medication.
Dizziness or Fainting
Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be signs of low blood pressure and can be linked to Parkinson’s disease.
What is normal? Everyone has had a time when they stood up and felt dizzy, but if it happens on a regular basis you should see your doctor.
Stooping or Hunching Over
Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease.
What is normal? If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.
The specific group of symptoms that an individual experiences in Parkinson’s disease varies from person to person. Primary motor signs of Parkinson’s disease include the following:
- Tremor is essentially rhythmic, mechanical oscillation of a body part that suppresses will activity sleep and complete relaxation. There could be tremor of the hands, arms, legs, jaw and face.
- Rigidity is characterized by increased stiffness throughout range of passive movement at a joint.
- Akinesia is the most disturbing and disabling manifestation of Parkinson’s disease and includes a complex variety of motor deficits, slow performance of voluntary movement, difficulty reaching a target with a single continous movement, delayed initiation of movement, rapid fatigue with repetitive movement, and difficulty in both executing simultaneous actions and sequential movements.
- Freezing phenomenon is difficulty in starting or continuing rhythmic repetitive movements such as speech, handwriting, and gait especially when walking through an enclosed space or when turning.
- Speech and swallowing disorder is found in about 92% of patients and include abnormal voice modulation (dysphonia), with hoarseness, decreased volume and monotonous tone, phonation articulation, and reduced facial expression. Swallowing problems is believed to be in about 50% of patients assessed by Barium swallowing.
- Postural dysfunction and body transport is an integral part of Parkinson’s disease especially when walking through an enclosed space or turning. Patients always have episodes of freezing, breaks in motion, and hesitation when switching from one movement to another.
- Gait dysfunction typically affecting the Reaction Time, Moment Time and the ability to perform simultaneous and sequential movements. The most frequently observed gait disorders are slowness of movement and difficulty in initiation.
- Muscular Aches and Cramps potentially contributes to increasing incapacity and frustrations.
- Respiratory dysfunction and cardiovascular de-conditioning is thought to result from motor control deficits of flexed posture and immobility associated with Parkinson’s disease.
- Mood disturbances, dementia, and memory impairment are other variables that are consistent with Parkinson’s disease.
New Direction in Movement Rehabilitation and the tons of intervention tools and equipment showing up in medical practice are driving the turning of tides against the debilitating effects of Parkinson’s disease.
The major roles of physiotherapy intervention are to promote functional activities as a means of maintaining an active lifestyles, flexible neuro-musculoskeletal system and physical fitness; establishing with the individual effective means of developing and practicing strategies for solving everyday functional problems. Physiotherapists would assist to accomplish an activity based program by working together with him or her in a created environment similar to the ones she might find at home.
Objectives of Highly Specialized Physical Rehabilitation Programs
- Enhanced Functional Movement
- Enhanced Balance Function
- Enhanced Gait and Coordination
- Enhanced Body Posture and Trunk Rotation
- Enhanced Speech and Phonation
- Enhanced Activities of Daily Living
- Enhanced Muscle Tones and Functions
Highly Specialized Physical Rehabilitation Programs for Parkinson’s Disease will be based on these important Techniques and Strategies:
- Task and Context-related Therapies
- Visual Cueing Techniques
- Rhythm and Auditory Cueing Techniques
- Attention and Behavioural Intervention Strategies
- Physical Activity Exercises
- Flexibility Maintenance Exercises
- Vestibular Stimulation
- Cognitive Stimulation and Training
- Multi-sensory Stimulation
- Cognitive Phenotypes Stimulation particularly Memory, Language, Visuospatial ability and Executive Functions.
In a Physical Rehabilitation Center, individuals with Parkinson’s Disease will be taken through 3 stations of therapy which will involve extensive activities in the Gymnasium to activate functional movement from sit to stand, stand to move and incorporations of turning, reverse turning, maneuvering around obstacles in open and closed spaces.
Also Static and Dynamic Balance training will be incorporated to address issues fall and loss of balance when it’s impossible to quickly adjust balances. A disturbance of standing posture has long been considered characteristics of Parkinson’s Disease and has been argued that the basal ganglia are primarily responsible for the automatic execution of learned motor plans.
Gait Training to address the most frequently observed gait disorders of slowness and difficulty in initiation. Parkinson’s disease individual is observed to walk with short, shuffling steps, uneven step lengths, typical flexed posture, reduced movement of arms, and decreased angular displacement of the lower limb joints.
The second station will take care of activities to enhance rolling, rolling to sit, sit to stand on the bed , passive mobilization, manipulation and arm positioning in bed, massage therapy, heat therapy, electrotherapy, tactile stimulation and a host of other strategies to enhance independence in activities of daily living.
The third station will be based on enhancing the functional use of the limbs in activities of daily living incorporating grooming, eating, writing, cooking, preparing meals and a host of other complex recreational activities like knitting and sewing, playing Wii Games, Nintendo Games, Xbox, and Playstations.
It is only recently that the effects of physiotherapy methods have been subjected to formalized scrutiny in terms of their effectiveness. A gradually increasing understanding of the basic dyscontrol mechanisms underlying the clinical signs together with biomechanical studies of both able-bodied and deficient motor performance are stimulating the development and testing of new methods of physiotherapy which will assist PD individuals to optimized their functional effectiveness and improve their sense of well being.
#MaterialCredit: Parkinson.org, Daily Mail UK, Web MD, Women’s Health,