Parkinson’s Disease in Rehabilitation Nai-Fen SuPennsylvania State University
Presentation Overview• Purpose• Definition• Symptoms• Causes• Who gets Parkinsons disease• Parkinson’s disease and rehabilitation
Purpose of Presentation• The topic was inspired by story of Michael Fox. When Michael J. Fox was diagnosed with Parkinsons Disease nearly 20 years ago, he never imagined that the illness would completely redefine the way he looked at life, for the better. “Acceptance doesnt really mean youre resigned to it. It just means acknowledging that thats what it is”- Michael Fox, 2009.
Definition of Parkinson’s Disease• James Parkinson(1871) called "the shaking palsy."• Parkinsons disease (PD) is a degenerative disorder of the central nervous system.• Parkinsons disease belongs to a group of conditions called movement disorders.• PD is chronic— it persists over a long period of time.• PD is progressive— its symptoms grow worse over time. (NINDS)
Four Main Symptoms of PD• Tremor— trembling in hands, arms, legs, jaw, or head.• Rigidity— stiffness of the limbs and trunk.• Bradykinesia— slowness of movement.• Postural instability—impaired balance. (NINDS)
Other Symptoms of PD• Depression• Emotional changes• Difficulty with swallowing and chewing• Speech changes• Urinary problems or constipation• Skin problems• Sleep problems (NINDS)
Other Symptoms of PD• Dementia or other cognitive problems• Orthostatic hypotension• Muscle cramps and dystonia• Pain• Fatigue and loss of energy• Sexual dysfunction (NINDS)
Causes of PD• It is not contagious.• Some PD cases appear to be hereditary.• Few can be traced to specific genetic mutation.• Most cases are sporadic.• Studies have shown that most Parkinsons patients have lost 60 to 80 percent or more of the dopamine and norepinephrine, which results in abnormal nerve firing patterns within the brain, that cause impaired movement. (NINDS)
Who Gets PD• About 50,000 Americans are diagnosed with PD each year.• PD strikes about 50 percent more men than women.• The average age of onset is 60 years.• 5 to 10 percent of people with PD have "early-onset" disease that begins before the age of 50. Early-onset forms of the disease are often inherited—specific gene mutations.• In very rare cases, parkinsonian symptoms may appear in people before the age of 20. This condition is called juvenile parkinsonism. (NINDS)
PD in Rehabilitation• Multiple-Task Training Multiple-task training— walking task and cognition task are feasible in people with mild to moderate PD. It is sustained benefits on walking velocity and body movement are possible(Canning, Ada, & Woodhouse, 2008; Schenkman, Hall, Kumar, Kohrt, 2008).
PD in Rehabilitation• Exercise Training Constraint-focused agility exercise program, tai chi, kayaking, boxing, lunges, agility exercise, and Pilates exercise, can improve delay mobility disability in people with PD(King & Horak, 2009). The exercise training under physiotherapist supervision was found to be more effective at improving activities of daily living, motor, mental, emotional functions and general health quality in people with PD(Elif & Yalima, 2009; Ellis, Katz, White, DePiero, Hohler, & Saint-Hilaire, 2008).
PD in Rehabilitation• Self-Vocalization Training Self-vocalization of a positive reinforcing word enabled people with PD to perform a daily upper extremity task faster and more smoothly. (Maitra, 2007)• Speech Therapy The telerehabilitation application as the delivery of online assessment for the dysarthric speech disorder associated with Parkinsons disease. (Constantinescu, Theodoros, Russell, Ward, Wilson, & Wootton, 2010)
PD in Rehabilitation• Occupational Therapy Occupational therapy is to support people with PD and help them maintain their usual level of self- care, work, and leisure activities for as long as possible(Dixon, Duncan, Johnson, Kirkby, O’Connel l, &Taylor, 2009).
Key Points for VR Professionals• Consider what access to specialist services is available.• Ensure early referral for assessment and/or treatment.• Get access to treatment with an appropriate neuropsychological rehabilitation service.• Work in a multi-disciplinary partnership. (Conradie & Stewart, 2008)
Key Points for VR Professionals• Provide education and information for the employee affect, their family, managers, appropriate work colleagues.• Be aware of needs and challenges that the PD employee may face in their social and home life, and how these can impact on their performance at work• Provide long-term support.• Play a part in ensuring ongoing and good communication with all involved (Conradie & Stewart, 2008)