Parkinson's disease is characterized by the loss of dopaminergic neurons in the substantia nigra region of the brain, which can lead to motor symptoms like bradykinesia, rigidity, tremors, and postural instability. It is usually classified as idiopathic or secondary/acquired. Diagnosis is based on the presence of motor symptoms and the absence of other conditions. Management involves medications to replace dopamine or stimulate receptors, as well as physical, occupational, and speech therapy to address mobility, activities of daily living, and communication difficulties.

1. Parkinson’s Disease Neuropathology Classification Diagnosis Management

2. NEUROPATHOLOGY

3. Neuropathology Loss of pigmented dopaminergic neurons in Substantia Nigra mostly in the ventral and lateral areas (pars Compacta) Presence of lewy bodies

4. Neuropathology Normal Parkinson’s

5. Neuropathology

6. CLASSIFICATION

7. Classification Idiopathic Secondary or ACCQUIRED Parkinson’s plus syndromes CLASSIFICATION

8. Idiopathic Most common form. 1% of population over age 50 yrs., Incidence 40,000/yr. Incidence increase with age, peak 60-80 yrs. Male = female. CLASSIFICATION

9. Secondary or Acquired Drugs( neuroleptics, metoclopramide, reserpine ) - Toxics( manganese, carbon monoxide, carbon disulfide ) - Stroke, postencephalitis, head injury, boxer's brain CLASSIFICATION

10. Parkinson’s PLUS Progressive supranuclear palsy Shy-Drager syndrome Normal pressure hydrocephalus Alzheimer disease Wilson's disease CLASSIFICATION

11. DIAGNOSIS

12. Diagnosis Presence of at least three of bradykinesia Rigidity 4-6 Hz resting tremor Postural instability( primary visual, vestibular, cerebellar or proprioceptive dysfunction excluded ) Unilateral onset DIAGNOSIS

13. Diagnosis Persistent asymmetry Absence of clinical exclusion criteria Excellent response to l-Dopa Clinical course of 10 years or more DIAGNOSIS

14. MANAGEMENT

15. Management Medications Medical and nursing care Physical therapy Occupational therapy Speech therapy Psychological therapy MANAGEMENT

16. MEDICATIONS

17. Medications Neurotransmitter replacement( l-dopa, carbidopa with l-dopa ) Anticholinergic( trihexyphenidyl, benztropine mesylate, procyclidrin ) Receptor agonist( amantadine, bromociptine, pergolide mesylate) Other( selegiline ) MANAGEMENT

18. SURGICAL

19. Surgical Thalamotomy Pallidotomy Deep brain stimulation Striatal grafting of Dopaminergic fetal tissue MANAGEMENT

20. MEDICAL AND NURSING

21. Medical and Nursing Firm bed - Monitor for orthostatic hypotension - Regular meal with low protein - Measure vital capacity - Bowel program for hypomobility - Bladder evaluation and urodynamic study - Artificial tears for lack of blinking - anticholinergic for excessive drooling - Administration of medications prior a mealtime MANAGEMENT

22. PHYSIOTHERAPY

23. PHYSIOTHERAPY Requires Prior Assessment: Can be based on Specific Scales Eg: UPDRS Can be Based on General Scales Eg: Barthel Index Treatment Symptomatic Problem Based Approach Holistic

24. Physiotherapy Relaxation technique to decrease rigidity - Slow rhythmic rotational movement - ROM exercise, stretching and preventing contracture, pectoralis stretching, hip extensor and quadriceps isometric exercise - Back flexion-extension exercise and pelvic tilting MANAGEMENT

25. Physiotherapy - Proper sitting and postural control - Mat activities May be tilt table - Functional mobility training, rocking chair or chair lift - Stationary bicycling for reciprocal training MANAGEMENT

26. Physiotherapy - PNF, NDT and biofeedback to facilitate the slow movement - Auditory and rhythmic cueing in alternating movement - Standing balance - Progressive ambulation training, blocking, proper heel-toe gait, feet 12-15 in apart, arm swing MANAGEMENT

27. Physiotherapy - Use of assistive devices( weight walker or wheel walker ) - Aerobic conditioning exercise( walking, swimming ) MANAGEMENT

28. Physiotherapy - Frequent rest period - Frenkel's exercise - Family training and home program MANAGEMENT

29. Occupational Therapy ROM activities and stretching of upper extremity - Fine motor coordination skills - ADL training - Hand cycling for reciprocal training MANAGEMENT

30. Occupational Therapy - Rocking chair for mobilization - Handwriting skills MANAGEMENT

31. Occupational Therapy - Adaptive devices - Position and posture training - Family training and home program MANAGEMENT

32. SPEECH THERAPY

33. Speech Therapy Diaphragmatic breathing exercise and deep breathing before talking - Swallowing training - dysarthria training - Facial, oral and lingual muscle exercise MANAGEMENT

34. PSYCHOLOGY

35. Psychology Psychological support Patient and family counseling Antidepressant as indicated Cognitive remediation Group therapy MANAGEMENT

36. Bibliography Required Reading Rehabilitation: O’Sullivan Therapeutic Exercises: Kisner, Neurological Rehabilitation: Umphred Darcy Further Reading Neurological Rehabilitation: Dobkins Neurological Physiotherapy: Carr and Shepherd