This document discusses Parkinsonism and Parkinson's disease. It begins by defining Parkinsonism as a movement disorder resulting from dysfunction of the basal ganglia, characterized by tremors, rigidity, hypokinesia, and impaired postural reflex. It then discusses the various causes of Parkinsonism including idiopathic Parkinson's disease, infectious, toxic, pharmacological, atypical, metabolic, vascular, and traumatic causes. The pathophysiology involves degeneration of the substantia nigra and depletion of dopaminergic neurons. Clinical features include rigidity, bradykinesia, tremors, and impaired postural reactions. Treatment involves medication, surgery, and physiotherapy focused on improving posture, range of motion, walking,

1. Parkinsonism and
Parkinson's disease
By.DR.Adyata dave

2. Definition
• It is a movement disorder resulting from the dysfunction of the
extrapyramidal system , particularly basal ganglia and it is
characterized by,
• tremors,
• rigidity,
• hypokinesia/akinesia,
• impaired postural reflex.

3. cont..
• Described by James Parkinson(1817) in, “an
essay on shaking palsy”.
• James Parkinson termed it as “paralysis
agitence”
• Recognized as an extrapyramidal disorder by
KINNIER WILSON(1912)

4. ETIOLOGY
• 1. IDIOPATHIC PARKINSONISM
(Parkinson's disease)
 etiology unknown.
most commonly occurs in middle age or
elderly person.

5. • 2.INFECTIOUS PARKINSONISM
 Results from infection or post infection
cause.
 for e.g.- encephalitis, this type of
parkinsonism is called as ‘encephalic
lithargea’

6. • 3. TOXIC PARKINSONISM
 occurs in the individual exposed to certain
industrial poison and chemicals like (MPTP-
(methyl phenyl tetrohydro
pyridine),co,cs2,Mg.

7. • 4. PHARMACOLOGICAL
PARKINSONISM-
various drugs can produce parkinsonism as a
side effect such as neuroleptic tranquilizer
e.g.-chlorpromazine.
withdrawal of the drugs mostly reverse the
symptoms but sometimes they are long lasting.

8. 5. ATYPICAL PARKINSONISM(multiple
system atrophy)
degenerative disease of nervous system can
affects the substantia nigra and produce
parkinsonism along with the other neurological
signs.

9. • 6. METABOLIC CAUSE
 willson’s disease-disorder of the copper
metabolism that result in basal ganglia copper
deposition.

10. • 7. VASCULAR CAUSE
 CVA

11. • 8. TRAUMATIC CAUSE-
 PUNCH-DRUNK SYNDROME e.g.
hypothyroidism

12. Pathophysiology
• Degeneration of substantia nigra.
• Depletion of dopaminergic neuron.
• Decrease dopamine neurotransmitter.
• Degeneration of nigro-striate pathway.

13. Degeneration of s.g.

14. Depletion of dopaminergic neuron

15. Decrease dopamine neurotransmitter.

16. Degeneration of nigro-striate pathway

17. CLINICAL FEATURES
• RIGIDITY
• BRADYKINESIA
• TREMORS
• IMPAIRED POSTURAL REACTION

18. BRADYKINESIA
• Slowness in movement
• Difficulty initiating movement
• Lack of spontaneous movement
• Lack of associated movements
• Difficulty with repetitive movements
• Difficulty with two simultaneous movements
• Increased effort and concentration to achieve norm
• Two handed tasks more difficult
• Slowness of speech; difficulty raising voice

19. • Main areas of Difficulty
• Posture
• Balance
• Gait
• Fine movements – handwriting, buttons
• Automatic movements – blinking, swallowing, coughing,
swinging arms

20. OTHERS
• AUTOMATIC OR UNCONSCIOUS
MOVEMENT ARE LOST OR IMPAIRED
e.g.-loss of reciprocal arm swing during gait.
• Fatigue is the common symptoms.

21. • Gait
• Difficulty initiating walk
• Petit pas (small steps)
• Festination
• Freezing
• Difficulty turning
• Heel-toe gait

22. • Festinating gait pattern
-stooped posture
-short stepping
-rapid steps( tendency to run)
-reduce arm swing
-decrease balance on turning.

23. Posture
• Excessive flexion (bending) of neck, trunk, hips, knees;
• Contractures (muscle shortening)
• Reduced rotation – difficulty turning, to sit in chair, tight
corners
• Reduced arm swing
• Slumping in chair

24. Balance
• Reduced rotation
• Increased flexion (stooping) leading to decreased balance and
falls

25. • Face-
-mask like face or expression less face
-dysphagia
-dysarthria
-hypophonia- decrease volume of speech due to rigidity and
bradykinesia of speech muscle

26. ANS dysfunction also may occur
• Excessive respiration
• Grasy skin
• Increase salivation
• Bladder dysfunction
• Decrease appetite
• Decrease GIT mobility
• Constipation
• ANS orthostatic hypotension

27. Visual difficulties
• Difficulty in identifying different objects ,their colours by
seeing or difficulty in identifying distance.
Mental changes
• Dementia
• restlessness

28. SECONDARY IMPAIRMENT/COMPLICATION
• Muscle atrophy due to disuse
• Loss of flexibility & development of contracture
• Kyphosis
• Osteoporosis due to prolonged immobility
• Circulatory changes like edema over feet
• Decubitus ulcer

29. Treatment
• Medical RX. –
 L-dopa synthatase-levodopa
-carbidopa
 mono-amino oxidose(MAO)inhalator
selegilline
 anti-cholinergic drug
 amantadine(dopa. Agonist)

30. Surgical Rx.
• Thalamotomy
• Pallidotomy
• Foetal adrenal transplant

31. The main areas in which physiotherapists help people with
Parkinson's Disease are:
• posture,
• range of movement,
• walking and turning,
• balance and
• transfers

32. Physiotherapy RX.
• AIMS AND GOALS.
 Promote full functional ROM in all joints.
 Prevent contracture & correct faulty posture.
 Prevent or minimize the disuse atrophy.
 Awareness of the posture & balance.
 Promote the functional gait.
 Maintain or increase the vital capacity, chest expansion, and
speech.
 Functional independence
 Psychological support to come out from depression.

33. • The MAIN aim of physiotherapy in Parkinson’s
• Maximise independence and functional potential
• Minimise secondary complications.

34. The processes
• Assessment
• Treatment
• Education
• Liaising with carers
• Multidisciplinary team approach

35. General
• Break movement consciously into component parts
• Do one task at a time
• Use cues
• Stay active and involved and keep moving!
• As time goes on move with progression.
• Advise family/carer FOR cues, handling, positioning
• Avail of community physiotherapy in own home
• Avoid the problem of hypo mobility
• Encourage independence for as long as possible

36. Exercise should given are..
• 1.relaxation
• Gentle rhythmic technique that emphasis slow vestibular
stimulation can be used during therapy to produce generalized
relaxation of the total body musculature.

37. Cont.
• PNF technique named rhythmic initiation in which movement
progress from passive to active assisted to
active in small range was designed to relax the patient.
• Self relaxation technique of Benson and Jacobson,
progressive relaxation & deep breathing, slow gradual
stretching of all body parts.

38. Cues or Prompts
• Verbal
• Visual
• Vestibular/proprioceptive

39. Common problems with walking
?
• To help overcome these difficulties, focus only on walking:
• Try to concentrate on taking long steps, placing heels down
first (saying to yourself – HEEL – HEEL with each step can
help).
• Eliminate sharp turns in the environment. When you have to
turn, keep the feet apart and turn in a semicircle, always
moving in a forwards direction.

40. • The use of rhythm (a tape or CD with a catchy beat, or a
metronome) can help you get started and to keep going.
• Visual cues such as lines or tiles on the floor, or a strip of tape
at a doorway can help prevent freezing.
• A laser pointer aimed at the ground a few feet ahead of you
can also help you to keep moving, or point it at the ground just
in front of you and try stepping over it if you get stuck.

41. • If you feel yourself starting to freeze, stop walking, put your
heels to the ground (don't lean backwards), straighten your
knees, stand tall and when you're ready start off again.
• If you can't get started try rocking gently side to side, march in
place first or take a step backwards followed by a quick step
forwards

42. Gait management
• Visual clues – step over cracks, cue-cards
• Verbal cues – one/two, heel/toe, metronome, music, rhythm
• Proprioceptive clues – for freezing, heel down, rock
backwards/forwards, take step back
• Turn in wide arc, forward

43. • 2.ROM
 active and passive ROM ex.
 Suspension
 Active ex.-should be done to strengthen the muscle.
 Stretching to prevent contracture
 ROM ex. Combined with other ex. using with functional
pattern.
 Joint mobilization technique.

45. Safe and effective performance in these areas is a basis
for all activities in daily life
• To check or correct a stooped posture, try standing with your
back against a wall, heels touching the wall then try to get your
shoulder blades back against the wall and tuck your chin in so
that the back of your head touches the wall.
• Or try facing the wall, with your feet a few inches back from
the wall, place hands overhead , palms on the wall and lean
into it – hold the stretch for 20 to 30 seconds.

46. Break the movement sequence down into simple parts
and try to memorise these parts,
e.g.
TO SIT DOWN IN A CHAIR
• first walk right up to the chair,
• turn around,
• place hands on arms of chair,
• lean forwards,
• and then sit down ;

47. TO MOVE OVER IN BED
• first bend both knees,
• then raise your hips,
• and then move across.

48. • Doing only one task at a time, and visualizing the ideal
movement, can also help. Cue cards (pieces of card with
simple instructions e.g. 1-2-3 UP) placed on walls or furniture
at eye level or higher can act as a visual cue.

49. Home exercise programme
• Lying supine/prone
• Standing back to wall
• General exercises – promoting extension/rotation
• Postural advice – in sitting position
• Breathing exercises
• Relaxation

50. Thank you