Parkinson's disease is a progressive nervous system disorder that affects movement. It occurs when certain nerve cells in the brain don't produce enough of the chemical dopamine. The main symptoms include tremors, stiffness, slow movement, and impaired balance and coordination. It is treated mainly with medications to replace dopamine like levodopa, but physiotherapy can help maintain mobility and flexibility as the disease progresses through its stages.

1. PARKINSON
Submitted By : Sakshi Upadhyay
MPT Sports

2. Introduction
Parkinson’s disease (PD) is a progressive sickness of the
relevant fearful machine (CNS) with each motor and
nonmotor signs and symptoms.
It is an extended-term degenerative disease of the central
anxious machine that specifically affects the motor device.
It occurs while nerve cells inside the brain do not produce
enough of a brain chemical referred to as dopamine.
With much less and less dopamine, a person has much less
and much less potential to alter their actions, frame and
feelings.

3. Symptoms of Parkinson's disease
• Resting Tremor
• Bradykinesia
• Rigidity
• Postural Instability
Primary Motor Symptoms
•Freezing
•Micrographia
•Mask-like Expression
•Unwanted Accelerations
•Impaired gross motor coordination
•Poverty of movement (decreased arm swing)
•Speech problems
Secondary Motor Symptoms
•Loss of sense of smell, constipation
•REM behavior disorder (a sleep disorder)
•Mood disorders
•Depression
•Fear and anxiety
•Vision and dental problems
•Weight loss or gain
•Skin problems
Nonmotor Symptoms

4. Stages of Parkinson's Disease
Stage one
During this initial phase of the disease, a
person usually experiences mild
symptoms, such as tremors or shaking
in a limb. During this stage, changes
caused by Parkinson's, such as poor
posture, loss of balance, and abnormal
facial expressions.
Stage two
In the second stage of Parkinson's
disease, the person's symptoms are
bilateral, affecting both limbs and both
sides of the body.
Stage three
Stage three symptoms of Parkinson's
disease can be rather severe and include
the inability to walk straight or to stand.
There is a noticeable slowing of physical
movements in stage three
Stage four
This stage of the disease is accompanied
by severe symptoms of Parkinson's.
Walking may still occur, but it is often
limited, and rigidity and bradykinesia (a
slowing of movement) are often visible.
Stage five
In the last or final stage of Parkinson's
disease, the person is usually unable to
take care of himself or herself and may
not be able to stand or walk. A person
at stage five usually requires constant
one-on-one nursing care.

5. Complications of Parkinson's
disease
• Cognitive problems.
• Problems with swallowing .
• Sleep Problems and sleep disorders .
• Constipation and bladder problems .
• Smell dysfunction
• Pain
• Depression and emotional changes
• Sexual dysfunction

6. Pathophysiology
Due to etiological
factor
Affects the
substantia nigra
Destruction of
dopamine
producing neurons
within the basal
ganglia
Reduces the amount of
available striatal
dopamine(inhibitory
affect)
There is increase in
Acetylcholine
(excitatory effects)
Excitatory activity
of Ach is
inadequately
balanced
Difficulty in controlling
and initiating voluntary
movements

7. PREVENTION
Since there is no known cause of this disease there are not
any prevention methods at this time. Beside this here is
some basic strategy to prevent Parkinson’s disease
• Regular physical check-ups by physicians
• Performing simple mental and aerobic exercises
• High fiber nutritious food
• Caffeine , Tea
• Antioxidants such as Vit C , Vit D
• Non steroidal anti – inflammatory drugs (NSAIDs)

8. Treatment OF Parkinson’s
Disease
• The main aim of treatment in Parkinson's Disease is to
minimize symptoms. In early stage Pharmacological
option for the treatment of PD is multiple.
• Current Treatment For PD
• Levodopa Drugs
• Dopamine Agonist
• MAO-B inhibitors
• Anticholinergics
• Amantidine

9. ANTI-PARKINSONISM MEDICATION
1. LEVEDOPA (L-Dopa)
It is the most effective agents and the mainstay of
treatment, for controlling the symptoms particularly
Bradykinesia and rigidity.
SINEMET: It is made up of Levodopa and carbidopa.
Levodopa enters the brain and is converted to Dopamine
while carbidopa increase its effectiveness and prevents
the side effects of levodopa such as nausea, vomiting.

10. 2. DOPAMINE RECEPTOR AGONISTS
This are the drugs that activate or stimulate the dopamine receptors
. They mimic or copy the function of Dopamine in the brain.
Dopamine agonists can be taken alone or in combination with
Levodopa/carbidopa.
Most commonly drugs used are
Ergot derivatives : Bromocriptine or pergolide.
Non-ergot Derivatives: Ropinirole ,pramipexole.
3. MONOAMINE OXIDIZED INHIBITORS
It blocks an enzymes that caused premature of levodopa and are
used primarily to treat motors fluctuation associated with levodopa
treatment .
Most commonly drugs used are
Seligiline
Rosaline.

11. 4. AMANTADINE
It is the most commonly used medication for early onset Parkinson’s disease to tract
tremor .It reduce dyskinesia’s that occur with Levodopa.
5. COMT INHIBITORS(Catechol-o-methyl-transferase)
Such is Tolcapone and entacapone response the newest class of Parkinson’s drugs .
 It does not have direct effect on Parkinson’s disease symptoms
 It prolong the effect of levodopa by blocking its metabolism.
6. ANTI-CHOLINERGIC
It is helpful in controlling tremors and rigidity.
It decrease the activity of acetylcholine, a neurotransmitter that regulates movement.
Most commonly used are:
 Benztropine mesylate
 Trihexyphenidyl HCL
7. ANTI-DEPRESSANT
 Amitriptyline is typically prescribe because of its Anticholinergic and Antidepressant
effect.
 Serotonins reuptake inhibitors; Fluoxetine Hydrochloride and Bupropion hydrochloride.
 Effective for treating depression in patients with Parkinson’s disease.

12. Physiotherapy for Parkinson’s
Disease
The aims of physiotherapy in Parkinson's are:
• To maintain and improve functional ability and independence
• To correct and improve posture and balance
• To minimize the risk of falls
• To allow strength and flexibility to be maintained
• To enhance daily activities (getting in and out of bed, rising from a chair)
• To maintain a safe walking pattern (with or without mobility aids)
• If freezing is evident, coping strategies such as auditory or visual cues may
be taught
• To improve manual activities (reaching and grasping)
• To maintain respiratory function through breathing exercises
• To teach relaxation techniques
• To educate careers.

13. How can a physiotherapist help
me?
Early
stage
•The key aim within the early degree of the condition is to prevent state of no activity and to improve bodily ability in terms
of cardio capability, muscle energy and joint mobility. Your physiotherapist might also offer an workout programmed that
you can comply with in your very own or in a collection, with recommendations and advice on maintaining your fitness
stages.
Mid
stage
•In this level physiotherapy will aim to enhance higher limb function, specially attaining and
grasping, in addition to improving posture, balance, gait and transfers. Your physiotherapist
might also endorse more than a few exercises to help with those sports, which includes hand
sporting events to assist with guide dexterity so that you can more without difficulty button
a blouse, for example. He or she may collaborate with an occupational therapist to make
sure that your property is safe and to reduce the chance of you falling.
Late
stage
•In this level, physiotherapy pursuits to save you
complications which can stand up due to using a
wheelchair or being bedridden. This consists of preserving
your breathing, stopping pressure sores and working with
carers to make certain that they position you efficiently
and keep away from injuring themselves when lifting.