Parkinson’s Disease is a condition which disturbs the function of two centres within the brain which are associated with the co-ordination of movement.

One of the chemical messengers (neurotransmitter) within the brain that helps to carry electrical messages from one nerve cell (neurone) to the next is called dopamine. In Parkinson’s Disease, there is a specific reduction of dopamine concentration at the point where one neurone meets the next (the synapse). This is the result of a degeneration of neurones associated with the disease process.

The cause of this degeneration is unknown, but it is a progressive process with a time course from onset of between 10 and 15 years. Some cases progress more rapidly, others so slowly that the degeneration may be undetectable.

Diagnosis of Parkinson’s Disease: As the onset of symptoms in Parkinson’s Disease is gradual, it may take months or even years for signs and symptoms to develop. Parkinson’s Disease is difficult to diagnose, because there are no specific tests that can be carried out to show that an individual has the disease. Diagnosis is therefore based upon a detailed history and an examination of the individual and their symptoms.

Once a diagnosis has been made, it is advisable to be reviewed regularly (every 6-12 months) to check the progress of the condition.

Clinical Signs and Symptoms: The clinical features of Parkinson’s Disease can be classified into motor (affecting movement) and non-motor symptoms:

Common motor symptoms include:

Tremor Often begins in one hand and may be the first symptom for people with Parkinson’s Disease. It usually occurs on one side of the body and affects the arm more frequently than the leg. It doesn’t necessarily prove a handicap to function as it is maximally present at rest, and reduces or can even disappear with voluntary movement.

Slowness of Movement All movements become reduced in range and speed. In walking, steps become smaller and pace is slower. Speech can also become slower and softer. Handwriting can get smaller and can become increasingly untidy after writing a few words. Functional activities such as cutting up food, fastening buttons or shoelaces, and repetitive movements such as stirring or polishing can be particularly affected. In general, it may become harder to initiate movements and performing these movements and activities takes longer.

Stiffness/Rigidity of Movement Muscle tone is increased but the resistance to movement at a joint is usually the same throughout the movement (as opposed to spastic high tone). This stiffness can contribute to difficulties with activities such as rising from a chair, or turning over in bed. It may be asymmetrical or even just affect one side of the body or one particular group of muscles. It can also be worse with nervous tension or a cold environment.

Postural Changes As Parkinson’s Disease progresses, postural disturbance can be seen. In standing, all joints become more flexed, leading to a stooped/rounded posture with the head held forward of the body. In sitting, there is a tendency to slump, often sliding sideways until supported by the arm of the chair. These postures can be voluntarily corrected, but this requires great concentration and effort and is usually only temporary.

Balance Disorders The combination of altered posture and changes to muscle tone and speed of movement characteristically affects balance in an individual with Parkinson’s Disease. There is a tendency to topple forwards and as it is more difficult to make the quick compensatory movements required to regain balance, the risk of falling is increased.

Gait is increasingly disturbed: a short shuffling pattern develops and it is hard for the individual to transfer their centre of gravity from one foot to the other. Arm swing becomes more rigid, and the overall posture stooped as described above. On occasion it may be difficult to initiate gait or turning around, almost as if the feet are ‘glued’ to the floor.

Getting out of a chair can also be problematic as it is harder to judge how to place the centre of gravity over the feet. Typically the individual’s weight will be too far back and there will be a tendency to fall backwards into the chair with each attempt to rise to a standing position.

Automatic Movements Automatic movements such as blinking can be specifically reduced or lost, and a characteristic ‘mask-like’, expressionless face may be seen in individuals with Parkinson’s Disease. Automatic swallowing of saliva may be impaired so there can be a tendency to dribble if the head is held flexed onto the chest. The coughing reflex as a response to clear the airways may also be disturbed, so there can be an increased risk of developing chest infections.

Non-motor symptoms may also be experienced and may include:

Memory problems

Fatigue Sleep disturbance

Depression

Urinary/bowel disturbances

Management/Treatment of Parkinson’s Disease: The management of Parkinson’s Disease needs to be multi-disciplinary and should be designed to meet the needs of each individual case.

Medical Management

Whilst there is no cure for Parkinson’s Disease, medication may be used to try and control the symptoms and, considerable improvements can be achieved. The stage at which medication is introduced depends on the individual and the severity of their symptoms, and not all medication will be considered suitable for everyone.

Some common medication used includes:

Levodopa Dopamine agonists

MAO-B inhibitors

Glutamate antagonists

Anticholinergics

Treating the motor symptoms using surgical techniques was once commonplace, however nowadays (particularly since the introduction of Levodopa), the number of cases of surgical intervention has reduced. Deep brain stimulation (DBS) is the most common technique used – this involves implanting a ‘brain pacemaker’ which sends electrical impulses to parts of the brain. This can be helpful if symptoms such as tremor are uncontrolled by drug therapy or perhaps, the individual is intolerant to the medication.

Physiotherapy Management

Physiotherapy plays a very important part in the management process as people suffering with Parkinson’s Disease usually experience problems with mobility, movement and function.

A thorough assessment of posture, balance, and mobility is undertaken, together with a full functional assessment, including gait. Our specialist neurophysiotherapist, Karen Wood can provide an assessment and/or treatment within the comfort of your own home, so she will be well placed to advise on increasing safety and independence, together with any aids or adaptations that may be recommended to assist with day-to-day functional activities.

Goal-orientated treatment and advice will be provided aiming to improve balance, muscle tone and flexibility, functional strength, gait, and to reduce the risk of falling. We work closely with the individual’s family and carers, to teach strategies and handling techniques to help cope with the symptoms and problems associated with Parkinson’s Disease. This can be particularly useful in dealing with routine day-to-day activities such as getting out of bed or the chair, walking (overcoming ‘freezing’ of gait), and going up and down stairs.

It is important to encourage the individual to remain as functionally independent as possible for as long as possible, even if tasks take longer to complete, or the daily routine has to be altered.

As Parkinson’s Disease is progressive, our therapy approach is designed to help the individual maximise their physical potential so that their quality of life is optimised at that particular time. The problems and difficulties encountered, and the goals of treatment/management will change as the disease process progresses, but the prolongation of functional independence is essential throughout.

For further information about our Neuro-Physiotherapy service (Iveridge Hall), please click here. Alternatively, or to arrange an appointment, please telephone either Cathy Preston on 07908 684441 or Sarah Joice on 07908 684441, or click here to send us an e-mail.

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