More and more clients are walking through the door with Parkinson’s disease (PD). Parkinson’s Disease is not uncommon; in fact, it is the second most common neurodegenerative disorder after Alzheimer’s disease.
Parkinson’s disease is a complex neurodegenerative disorder with wide reaching implications for patients. Although disability can occur at all stages of the disease, PD is progressive in nature, so patients face increased demands and difficulties with activities of daily living and various aspects of mobility such as gait impairments, transfers, balance, and posture. In addition, significant disability can occur in the early stages of the disease, with patients becoming dependent for washing, eating and other activities of daily living, as severity usually increases with disease duration. Eventually, this leads to decreased independence, inactivity, and potential social isolation, resulting in reduced quality of life.
Neuro-chemically, Parkinson’s disease is characterized by an accelerated degeneration of dopaminergic neurons. Dopaminergic neurons continue to be lost through the course of PD. The rate of loss in the substantia nigra (part of the brain) has been calculated at about 1% per year (10 neurons per day), instead of 0.5% per year in healthy populations. However it must be understood that the rate of dopamine loss differs between patients, and it is unclear whether loss is linear or exponential. Approximately 70-80% of nigrostriatal dopamingeric neurons are lost before symptoms become noticeable. This is also known as the pre-symptomatic threshold.
Parkinson’s symptoms are characterized by:
• Tremors; that occur at rest but decrease with voluntary movement
• Rigidity; increase resistance to passive movement of a patient limbs
• Bradykinesia; slowness of movement
• Akinesia; absence of normal movement unconscious movement such as arm swing while walking
• Freezing; inability to move during execution of a movement sequence
• Impaired balance and postural instability
• Dyskinesia; over activity of muscles
• Hypomimia; paucity of normal facial expression
• Hypophonia; decreased voice volume
• Drooling; failure to swallow without thinking about it
• Reduced activity, reduced stride length, muscle weakness, reduced muscle length, contractures, deformity, reduced aerobic capacity
Management of PD
The modern management of PD has traditionally centred on pharmacological therapy. However, even with optimal medical management, patients with PD experience deterioration of body function such as mobility, muscle atrophy, cardio respiratory fitness, and cognitive processing. It has recently been demonstrated in literature to show that the onset of symptoms can be significantly slowed down. The aim of clinical Exercise Physiologists (EPs) is to enable PD patients to maintain their maximum level of mobility, activity and independence. This outcome can be attained through monitoring of the patient’s condition, and prognosis of the disease, implementation of appropriate physical treatments for movement, rehabilitation and enhancement of neuroplasticity to promote dopamine synthesis and survival. Here at Optimum, we use both our rehabilitation gyms and hydrotherapy pools to provide an appropriate environment for our Parkinson s clients to exercise.
Firstly, activity-dependent neuroplasticity is defined as alterations to the central nervous system (CNS) in response to physical activity that include processes such as, neurogenesis, synaptogenesis and molecular adaptations. Clinical studies suggest that high intensity exercise (ie. high repetition, high velocity, complexity) allows the body to self-repair due to the release of neurotrophic factors, and greater cerebral oxygenation, which together promote new cell growth and cell survival. In PD, it has been found that exercise stimulates dopamine synthesis in remaining dopaminergic cells, thus reducing symptoms.
Moreover, an array of exercise testing protocols can be used to gain understanding of a patient’s health status, deconditioning and degree of symptoms, as follows:
• Patient was categorized into Heohn and Yarh scale and Webster Scale to distinguish the progression of PD.
• Manual muscle testing can be used for strength evaluation and examination of muscle performance and weaknesses.
• Flexibility can be measured by using the sit and reach test to measure range of motion of particular limbs.
• To measure functional mobility and transfers, utilisation of sit-to-stand and timed up and go test.Static balance evaluation can examined through tandem stance and single leg stance, evaluation of dynamic balance was performed by timed up and go test.
• Cardio respiratory fitness or Aerobic capacity was tested through a submaximal treadmill Astrand test.
• Gait observations were performed at the patient’s comfortable walking speed.
• Postural assessment, and bio-mechanical compensatory pattern evaluation.
Pharmacological medications play their part, but rehabilitative exercise treatment provides a scientifically proven strategy to slow down the onset of this disease. The key is that PD requires precise dosage and prescription to meet the health needs of the patient. To manage your disease or any other chronic musculoskeletal injury, make a booking to see one of the Exercise Physiologists at Optimum Health Solutions.
