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PHYSDYS
NEURODEGENERATIVE DISORDERS (PARKINSON’S DISEASE)
| Term | Definition |
|---|---|
| PARKINSON’S DISEASE | ● Chronic, progressive, neurological disease, which at various stages and manifestations affects all aspects of a patient's functional state." (Hirschberg et al., 2010) ● Progressive neurodegenerative disorder ● Chronic and progressive in nature |
| PARKINSON’S DISEASE AFFECTS THE: | movement, coordination, and cognition |
| PARKINSON’S DISEASE CAUSED BY: | loss of dopamine-producing neurons in the substantia nigra |
| PARKINSON’S DISEASE APPROACH: | Rehabilitation / Top-down approach |
| TYPES OF PARKINSON'S DISEASE | ● PRIMARY PARKINSON'S DISEASE (IDIOPATHIC) ● SECONDARY (ATYPICAL) PARKINSONISM ● PARKINSON’S PLUS SYNDROMES (ATYPICAL) ● JUVENILE PARKINSON’S DISEASE ● YOUNG-ONSET PARKINSON’S DISEASE (YOPD) |
| PRIMARY PARKINSON'S DISEASE (IDIOPATHIC) | ● Most common form (85-90% of cases) ● No known cause, linked to genetic and environmental factors ● Progressive loss of dopamine producing neurons ● Responsive to dopaminergic medications (ex. Levodopa) ○ Likely to have these medications when asked |
| SECONDARY (ATYPICAL) PARKINSONISM | ● Caused by external factors ○ Medications ○ Brain injuries ○ Toxins ○ Metabolic disorders ● May not respond well to dopamine-based treatments |
| PARKINSON’S PLUS SYNDROMES (ATYPICAL) | ● More severe and faster progression ● Poor response to dopamine medications |
| TYPES OF PARKINSON’S PLUS SYNDROMES (ATYPICAL) | ○ Multiple System Atrophy (MSA) ○ Progressive Supranuclear Palsy (PSP) ○ Corticobasal Degeneration (CBD) ○ Dementia with Lewy Bodies (DLB) |
| JUVENILE PARKINSON’S DISEASE | ● Uncommon ● Onset before age 21 (rare) ● Linked to genetic mutations (eg, PARK2 gene) ● Slower progression compared to adult-onset Parkinson's |
| YOUNG-ONSET PARKINSON’S DISEASE (YOPD) | ● Onset before age 21 (rare) ● Linked to genetic mutations (eg, PARK2 gene) ● Slower progression compared to adult-onset Parkinson's |
| SIGNS AND SYMPTOMS OF PD (1) | POSITIVE (ADDED/”NADAGDAG”) ● TREMORS ● RIGIDITY ● Flexed posture |
| SIGNS AND SYMPTOMS OF PD (2) | NEGATIVE (REMOVED/“NATANGGAL”) ● BRADYKINESIA ● (-)postural reflexes ● Freezing phenomenon ● Cognitive decline, depression, sleep disturbances |
| Tremors: | most common symptom, suppressed by sleep and activity, increased by fatigue and stress |
| Rigidity: | increased tone during passive movement through ROM |
| Flexed posture: | bowed head, chin toward chest, kyphotic thorax, protracted shoulders, internally rotated arms, flexed elbows, knees, and hips |
| Bradykinesia: | slowness of movement, masked facies, decreased eye blinking, inability to move |
| (-)postural reflexes: | tendency to fall to the side or backward, sitting en bloc |
| Freezing phenomenon: | difficulty with transitional movements |
| COURSE AND PROGNOSIS OF PD (1) | ● To know rehab potential, timeline, intervention, and approach to use ● Progressive and varies among individuals ● Initial mild symptoms that worsen over time ● Managed with medication, therapy, and lifestyle changes |
| COURSE AND PROGNOSIS OF PD (2) | ● To determine what type of intervention we should do ● What are the changes after that they were diagnosed ○ Outcome of OT, diagnosis, premorbid |
| 5 STAGES OF PARKINSON’S DISEASE (HOEHN & YAHR SCALE) ● 1 | - Mild symptoms - Unilateral tremor - Minimal functional impairment |
| 5 STAGES OF PARKINSON’S DISEASE (HOEHN & YAHR SCALE) ● 2 | - Bilateral symptoms - Mild balance issues - Independent ADLs |
| 5 STAGES OF PARKINSON’S DISEASE (HOEHN & YAHR SCALE) ● 3 | - Postural instability - Increased falls - Moderate functional limitations |
| 5 STAGES OF PARKINSON’S DISEASE (HOEHN & YAHR SCALE) ● 4 | - Severe disability - Requires assistance with ADLs - Postural instability increasing, though able to walk - Decreased manipulation and dexterity |
| 5 STAGES OF PARKINSON’S DISEASE (HOEHN & YAHR SCALE) ● 5 | Complete dependence, wheelchair or bedridden |
| OT EVALUATIONS FOR PARKINSON’S (1) | SKILLS ● Motor Skills Evaluation ● Cognitive & Psychosocial Assessments |
| OT EVALUATIONS FOR PARKINSON’S (2) | OCCUPATIONS ● Assess ADLS & IADLS ● Home & Environmental Assessment |
| Motor Skills Evaluation | ○ Coordination, balance, fine a gross motor control ○ Coordination - we assess using finger to nose test, Purdue, MRMT, Jebsen |
| Cognitive & Psychosocial Assessment | ○ Memory (types of memory assessed), executive function, emotional well-being ○ MOCA ○ MMSE ○ Memory - asking questions |
| Assess ADLS & IADLS | ○ Self-care, work, leisure ○ COPM ○ FIM (level of assistance) ○ DPA |
| Home & Environmental Assessment | ○ Safety, accessibility, modifications needed ○ Home Safety checklist ■ Checking environment of client |
| OT INTERVENTIONS FOR PARKINSON’S | ● Task-Specific Training for ADLS ● Energy Conservation & Pacing ● Assistive Devices |
| Task-Specific Training for ADLS | ○ Focus on repetitive, meaningful activities to improve function ○ To make sure it’s meaningful, we ask it to the client, and to confirm it, we use COPM |
| Energy Conservation & Pacing | ○ Strategies to reduce fatigue, plan activities effectively ○ ECT: Position, Planning, Pacing, Prioritizing ■ Specifically telling them the 4Ps |
| 4Ps | - Position, Planning, Pacing, Prioritizing |
| Assistive Devices | ○ Use of mobility aids (walkers, canes), adaptive utensils for eating, dressing aids ■ Festinating gait ○ Swivel utensil ○ Weighted utensils |
| Festinating gait | - unable to control or stop |
| Swivel utensils | - better for tremors |
| Weighted utensils | - little literature about effectiveness (can improve, but after using, tremors worsen) |
| MANAGING IMPAIRMENTS - EARLY STAGE | ● Maintaining neuromuscular functions ● Work on posture ● Education of the patient and family ● Practice of gross and fine motor skills ● Focus on health and well-being |
| Education of the patient and family | ○ Be careful in telling them about their rehabilitation (hindi gagaling but will be helped by OTs) |
| Practice of gross and fine motor skills | ○ Provide RGR activities, arts and crafts (ex: painting) ○ To make sure skills are maintained |
| Focus on health and well-being | ○ Cx is happy with their life and the occupations they are doing despite their condition |
| MANAGING IMPAIRMENTS - PROGRESSION TO LATER STAGES | ● Maintain range of motion ● Maintain voluntary movement ● Work on coordination and balance ● Cognitive stimulation ● Dysphagia ● Introduce compensatory strategies ● Maintain quality of life |
| Maintain range of motion | ○ Through exercises, stretching activities to prevent contractures |
| Maintain voluntary movement | ○ Sensory and motor approaches |
| Medication | - Levodopa: for tremors and rigidity. - chronic use leads to motor problems (dyskinesia) |
Created by:
avemaria