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Parkinson’s Disease

It is a long term degenerative disease of CNS that mainly affects the motor system. Caused due to substantia nigra, cells that make the chemical dopamine start to die. Dopamine acts like a messenger that tells another area of your brain when you want to move a part of your body.The typical appearance of parkinson’s patient is

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EPIDEMIOLOGY

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CAUSES

Oxidative Stress

Lewy bodies

Increasing age

Genetics mutations in the LRRK2, PARK7, PINK1, PRKN, or SNCA gene

Environmental factors

PATHOPHYSIOLOGY

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CLINICAL FEATURES

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PHYSICAL EXAMINATION AND DIAGNOSIS

Physical examination includes Medical history, Signs, posture, gait, appearance etc discussed below

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Imaging techniques applied includes
MRI, CT scan, PET, SPECT Imaging Testings and Dopamine transporter imaging are used to confirm parkinson’s disease

DIFFERENTIAL DIAGNOSIS

Idiopathic parkinson’s

Essential tremor

Huntington disease

Multi system atrophy

PHYSIOTHERAPY MANAGEMENT

Medical management includes use of drugs that increase dopamine levels like combination of Carbidopa-Levodopa, Dopamine agonists, MAO-B inhibitors, COMT inhibitors.

Physiotherapy management includes Exercises that require balance and preparatory adjustment of the body important along with rhythmic activities such as dancing, skipping and cycling that can maintain the ability to perform reciprocal movements.   Finally, exercises that promote attention and learning are beneficial. 

Types of exercises that do this:

Walking

Dancing

Yoga classes

Tai Chi classes

Stepping over obstacles

Marching to music with big arm swings

Sports (ping pong, golf, tennis, volleyball)

Aerobic/Jazz exercise classes  

The European Guideline provides a section that describes the use of motor learning. It takes the form of cued functional and dual task training, compensatory strategy training uses external cues, self-instruction and attention. Examples include:

Visual cueing

Auditory cueing

Attention

Proprioceptive cueing

Along with the same proper gait training, use of assistive devices like walkers rollators etc, balance and posture training and Movement strategy training are also prescribed

Rollators for Parkinson’s

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