Parkinson's Sample

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W&P Health and Social Care Training provides Parkinsons Training Courses.

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Parkinson's Sample

  1. 1. Parkinson’s Disease W&P Assessment and Training Centre SAMPLE ONLY
  2. 2. Introduction <ul><li>When was Parkinson’s first recognised? </li></ul><ul><li>An English Doctor by the name of James Parkinson in 1817 observed six patients who had involuntary shaking of the arms, legs and body. The Doctor noticed that the shaking movements of his patients were similar to each other but different to any other medical causes of shaking that were noticed at this time. At this time this condition was known as shaking palsy it was not until later that the condition became known as Parkinson’s disease after the doctor who had first recognised it. </li></ul>SAMPLE ONLY
  3. 3. How common is Parkinson’s? <ul><li>Parkinson’s is very common; it affects 1 in every 500 people. This means that at any one time there are approx 100,000 people with Parkinson Disease in the United Kingdom. It is reported that Parkinson’s is more common than Multiple Sclerosis, although not as common as Epilepsy. </li></ul><ul><li>Most people develop Parkinson’s between the age of 50 and 80 years. It does affect younger people in their 30 and 40s and even children, although it is rare under the age of 30 years. </li></ul><ul><li>Parkinson’s becomes more common as people get older; it affects about 1 person in 60 between the ages of 70 and 80 years. It is also reported that the disease becomes less common again after the age of 80 years. </li></ul>SAMPLE ONLY
  4. 4. What’s gone wrong? <ul><li>Parkinson’s may be best described as mainly a problem with movement, but it is not a disease of the muscles. </li></ul><ul><li>It is important that we understand how a movement is made; </li></ul><ul><li>We need muscles in order to move our arms and legs. When we decide to move the signal originates in the brain and reaches the muscles through a network of nerves that behave like telephone wires-transmitting the message from one part of the body (brain) to another (muscles). </li></ul><ul><li>The co-ordination of the nerve message to the muscles in different parts of the body occurs within the brain. One particular part of the brain concerned with this co-ordination is called the Basal Ganglia. This area is located in the centre of the brain. </li></ul>SAMPLE ONLY
  5. 5. Symptoms of Parkinson Disease <ul><li>Movement </li></ul><ul><li>As already mentioned Parkinson’s disease is a problem with co-ordinating different muscle groups. Doctors recognise three principal types of movement problem in Parkinson’s disease. </li></ul><ul><li>AKINESIA and BRADYKINESIS </li></ul><ul><li>RIGIDITY </li></ul><ul><li>TREMOR </li></ul><ul><li>The above may begin on one side of the body and, in some people remain limited to one side for a long time. In most people however, the condition progresses to involve both arms and both legs, although to varying degrees. </li></ul>SAMPLE ONLY
  6. 6. Speech <ul><li>The ability to speak requires co-ordination not only of the muscles in the larynx (voice box) but also the muscles that deal with breathing and movement around the throat, tongue and nasal passages. To speak clearly an intricate co-ordination of all these different muscle groups is required. In Parkinson’s some of these muscles can be affected by akinesia which causes abnormalities in speech. </li></ul><ul><li>In more severe cases speech becomes slurred, extremely quiet and monotonous and difficult to understand. In some severe cases speech may be unintelligible. </li></ul>SAMPLE ONLY
  7. 7. Posture <ul><li>The standing posture in Parkinsons Disease is one of increased flexion (bending forwards) in the spine, arms and legs. This feature gives the characteristic stooped appearance, with the head and chest bent forward to a degree that depends on the severity of the illness. The arms are held partially bent at the elbows, with the hands poised towards the front. The knees are slightly bent. This posture tends to throw the centre of gravity forward so that the stability of the body is upset and patients easily fall over. </li></ul>SAMPLE ONLY
  8. 8. Loss of dexterity <ul><li>Movement of the hands are affected by the akinesia. Mild problems may produce difficulties in fastening buttons, threading needles and counting change. With more advanced difficulties there are also problems in many normal everyday activities. This includes washing, dressing and eating. The persons writing tends to become smaller and irregular. </li></ul>SAMPLE ONLY
  9. 9. Tremor Sheet <ul><li>Tremor (a shake) is a rhythmical, involuntary oscillatory movement that affects a part of the body, for example the hand. In people with Parkinson’s, tremor can occur at rest, for example while lying in bed when the body is relaxed and fully supported. It can also occur on action, for example while trying to hold a newspaper steady or during a movement, for instance writing. </li></ul><ul><li>The most characteristic tremor of Parkinson’s is called a ‘pill-rolling’ rest tremor as it resembles the deliberate action of rolling a pill with the thumb and index finger. Tremor is often the sign that leads to a medical consultation and, thus, a diagnosis of Parkinson’s. </li></ul>SAMPLE ONLY
  10. 10. Other symptoms <ul><li>There are several anti-Parkinsons drugs that may interfere with sleep in various ways. Drugs such as Amantadine (Symmetrel) or Selegiline (Eldepryl) can keep people awake at night particularly if they are taken in the evening. In some people with advanced Parkinson’s, high dose Levodopa or dopamine agonist drugs such as pramipexole (Mirapexin) may also cause “insomnia”. Other substances and drugs taken for different conditions can also interfere with sleep. </li></ul>SAMPLE ONLY
  11. 11. Treatment and recovery <ul><li>Medication </li></ul><ul><li>There's no cure for Parkinson’s although new research is just starting to suggest that some drugs already used for the condition do have some effect in holding back progression of the disease. </li></ul><ul><li>A lot can be done to relieve symptoms, especially in the early stages, by replacing the missing dopamine in the brain. This can be done very effectively with a drug called Levodopa - a synthetic chemical that's converted into dopamine in the brain. However, there can be severe side-effects with prolonged usage. </li></ul><ul><li>Because of these problems, doctors usually try to delay using Levodopa, especially in younger people. Instead, they use other drugs that boost dopamine activity or mimic its effects, known as dopamine agonists. These drugs also have side-effects and doses have to be carefully tailored to individual needs. </li></ul>SAMPLE ONLY
  12. 12. Speech and Language Therapists <ul><li>Speech and language therapists help with communication or swallowing difficulties. </li></ul><ul><li>Improvement of vocal loudness, pitch and range to optimise speech intelligibility ensuring that an effective means of communication is maintained, including use of assistive technologies </li></ul><ul><li>Review and management to support the safety and efficiency of swallowing and to minimise the risk of aspiration. </li></ul>SAMPLE ONLY
  13. 13. Palliative Care <ul><li>Palliative care requirements should be considered throughout all phases of the disease. </li></ul><ul><li>People with Parkinson’s and their carers should be given the opportunity to discuss end-of-life issues with appropriate healthcare Professionals. Individuals and their families need to be allowed time to come to terms with the fact that the disease has reached a stage where no more can be done. </li></ul>SAMPLE ONLY
  14. 14. Palliative Care <ul><li>Decisions will need to be made about management and treatment in the future, and end-of-life decisions (i.e. do-not-resuscitate policies and advance directives (living wills)). These are never easy issues to discuss but they can provide an opportunity for the individual to state treatment preferences should they lose their capacity for decision making in the future. </li></ul><ul><li>They derive their authority from the principle of informed consent and the promotion of personal autonomy and should be considered before mental or physical disability precludes their completion. </li></ul>SAMPLE ONLY
  15. 15. Parkinsonism <ul><li>Conditions that can initially be confused with Parkinson’s disease </li></ul><ul><li>Benign essential tremor </li></ul><ul><li>Infections </li></ul><ul><li>Side-effects of drugs </li></ul><ul><li>Poisonous substances </li></ul><ul><li>Degenerative diseases of the nervous system </li></ul><ul><li>Stroke </li></ul><ul><li>Inherited disease </li></ul><ul><li>Head trauma </li></ul><ul><li>Thyroid disease and other similar metabolic disorders. </li></ul>SAMPLE ONLY

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