o PARKINSON’S DISEASE (PD)
Presented by:Trcoski Boge
What Is Parkinson's Disease?
 Parkinson's disease is a brain disorder that
causes a gradual loss of muscle control. The
s...
Early Signs of Parkinson's
 The early signs of Parkinson's may be subtle and
can be confused with other conditions. They
...
SYMPTOMS
 Tremor
 Tremor is an early symptom for about 70% of
people with Parkinson's. It usually occurs in a finger
or ...
POSTURAL INSTABILITY
 People with Parkinson's
tend to develop a stooped
posture, with drooping
shoulders and their head
...
 RIGIDITY
 Stiffness or rigidity of the muscles, resulting in
decreased ability to move. When a joint of a
Parkinson's p...
 OTHER SYMTOMS :
 Weakness of face and throat muscles
It may get harder to talk and swallow. Speech
becomes softer and m...
 Who Gets PD?
 The average age of
onset is 62, but people
over 60 still have only a
2% to 4% likelihood of
developing th...
 Surgeries used:
 Deep Brain Stimulation
 Electrodes can be implanted
into one of three areas of the
brain(VIN of the t...
 Treatment (drugs)
Dopamine Agonists
 Drugs that mimic dopamine,
called dopamine agonists,
may be used to delay the
move...
Parkinson's and Exercise
 Exercise may actually have a protective effect by
enabling the brain to use dopamine more effec...
 Most PD patients face mobility deficits
 Difficulties with transfers
 Posture
 Balance
 Walking
 Fear of falls
 Lo...
ASSESMENT OF THE PATIENT
 Şükriye Arslan is a 68-years-old
woman,1,57 hight and 68kg weight.She
was a cook for the last 12 years and she
finished ...
 Pre-operation PT assesment wasn’t made.
 Post-operation PT assesment was porformed
with couple of tests and meassurment...
RESPIRATORY ASSESMENT
Breath type: Abdominal
Breath frequency: 28/min
Breathing : Superficial
CHEST MEASUREMENT
NORMAL DEEP
INSPIRATION
DEEP
EXPIRATION
DIFFERENCE
AXILAR 92 94 92 2
EPIGASTRIC 95 96,5 94 2,5
SUBCOSTAL...
DTR RIGHT LEFT
ACHILLES REFLEX ++ ++
PATELLA REFLEX + +++
BICEPS REFLEXES + +++
TRICEPS REFLEXIS ++ ++
BRACHIORADIALIS
REF...
PATHOLOGICAL REFLEXES
 Glabellar = -
 Snout = -
 Hoffman = -
 Palmomental = -
 DRUGS USED :
 Modapin
 Azidect
 Pramipex
 Medsil
SENSATION :
 Is intanct for light touch,pain,temperature,
deep pressure ,and kinesthesia.
BED MOBILITY AND TRANSFER
 Independent rolling on bed with low axial
rotation,difficult independent sitting from
supine p...
GAIT AND POSTURE
 At this time patient is walking without any
assistive device ,without freezing,with
minimal forward fle...
 Time up & go test (3m) = 13,81 sec.
 12 metere walking = 17,45 sec.
 sit – stand /14 times = 30 sec.
 Posture analysis:
 kifosis(toracal)
 head anterior
 chest inside
 shoulder contraction
 PRESENT SYMPTOMS :
 Disarthrya
 Bradikinesy
 Rigidity (more in left arm)
 Incontinence
 Tiredness
 Cognition
 Con...
 Schwab & England Activities of Daily Living
scale
• She is estimate on 90 % - completely
independent. Able to do all cho...
MUSCLE AND ROM EXAMINATION
 Moderate dicrease of muscles power on neck
and trunk muscles.
 PROM without dicrease .
 Mod...
Physical Therapy
Physical Therapy Pogram
of the patient
 Relaxation tehniques to dicrease rigidity
 Slow lhytmic rotational movements
 G...
 Functional mobility training including bed
mobility,transfer training
 Training in rhytmic pattern to music such as
cla...
 Large steps progresssive training using
blocks to lift legs,teaching proper heel –
floor strike.
 Arm swing exercises
Motor Fluctuations
 The on – off respons:
 On and Off periods
occur wuthout warning
as a result of fluctuating
dopamine ...
 During ON times, patients report they feel
relatively fluid, clear, and in control of their
movements. Often, symptoms o...
 In the “off” period , we need to prefer
approaches that does not require the
patiant to actively participate that much,s...
THANK YOU 
Parkinson study case
Parkinson study case
Parkinson study case
Parkinson study case
Parkinson study case
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Parkinson study case

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Parkinson's disease

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Parkinson study case

  1. 1. o PARKINSON’S DISEASE (PD) Presented by:Trcoski Boge
  2. 2. What Is Parkinson's Disease?  Parkinson's disease is a brain disorder that causes a gradual loss of muscle control. The symptoms of Parkinson's tend to be mild at first and can sometimes be overlooked.  Distinctive signs of the disease include:tremors, stiffness, slowed body movements, and poor balance.
  3. 3. Early Signs of Parkinson's  The early signs of Parkinson's may be subtle and can be confused with other conditions. They include: • Slight shaking of a finger, hand, leg, or lip • Stiffness or difficulty walking • Difficulty getting out of a chair • Small, crowded handwriting • Stooped posture • A 'masked' face, frozen in a serious expression
  4. 4. SYMPTOMS  Tremor  Tremor is an early symptom for about 70% of people with Parkinson's. It usually occurs in a finger or hand when the hand is at rest but not when the hand is in use. It will shake rhythmically, usually four to six beats per second, or in a "pill-rolling" manner, as if rolling a pill between the thumb and index finger. Tremor also can be a symptom of other conditions, so by itself it does not indicate Parkinson disease.  Bradykinesia (slowness of movements)
  5. 5. POSTURAL INSTABILITY  People with Parkinson's tend to develop a stooped posture, with drooping shoulders and their head jutted forward. Along with their other movement issues, they may have a problem with balance. This increases the risk of falling.
  6. 6.  RIGIDITY  Stiffness or rigidity of the muscles, resulting in decreased ability to move. When a joint of a Parkinson's patient is moved, there is resistance to the movement. "Lead pipe" rigidity is a form of increased tone that is particularly prominent in Parkinson's and can result in muscle stiffness, fatigue, and weakness. "Cogwheel" rigidity occurs when there is also a tremor and is characterized by a "stop and go" effect during a range of motion maneuver.
  7. 7.  OTHER SYMTOMS :  Weakness of face and throat muscles It may get harder to talk and swallow. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the "Parkinson's mask.“  Constipation  Sleep problems  Depression
  8. 8.  Who Gets PD?  The average age of onset is 62, but people over 60 still have only a 2% to 4% likelihood of developing the disease. Having a family member with PD slightly increases the risk. Men are one-and- a-half times more likely to have Parkinson's than women.
  9. 9.  Surgeries used:  Deep Brain Stimulation  Electrodes can be implanted into one of three areas of the brain(VIN of the talamus)A pulse generator(pacemaker) goes in the chest near the collarbone. Electric pulses stimulate the brain to help reduce a patient's rigidity, tremors, and bradykinesia. It doesn’t stop the progression of PD or affect other symptoms. Not everyone is a good candidate for this surgery.  Phlebotomy and Thalamotomy • These surgical procedures use radio-frequency to destroy a pea –sized area in the globus pallidus of the tallamus
  10. 10.  Treatment (drugs) Dopamine Agonists  Drugs that mimic dopamine, called dopamine agonists, may be used to delay the movement-related symptoms of Parkinson's. They include Levadopa, Apokyn, Mirapex, Parlodel. Side effects may include nausea and vomiting, drowsiness, fluid retention, and psychosis.
  11. 11. Parkinson's and Exercise  Exercise may actually have a protective effect by enabling the brain to use dopamine more effectively. It also helps improve motor coordination, balance, gait, and tremor. For the best effect exercises should be done consistently and as intensely.Preferably three to four times a week. Working out on a treadmill or biking have been shown to have a benefit.
  12. 12.  Most PD patients face mobility deficits  Difficulties with transfers  Posture  Balance  Walking  Fear of falls  Loss of independence  Inactivity
  13. 13. ASSESMENT OF THE PATIENT
  14. 14.  Şükriye Arslan is a 68-years-old woman,1,57 hight and 68kg weight.She was a cook for the last 12 years and she finished just primiry school.She came to the PAU hospital for consult and she obteined schedule for deep brain stimulation surgery and she was operated on 13.03.2014
  15. 15.  Pre-operation PT assesment wasn’t made.  Post-operation PT assesment was porformed with couple of tests and meassurments.
  16. 16. RESPIRATORY ASSESMENT Breath type: Abdominal Breath frequency: 28/min Breathing : Superficial
  17. 17. CHEST MEASUREMENT NORMAL DEEP INSPIRATION DEEP EXPIRATION DIFFERENCE AXILAR 92 94 92 2 EPIGASTRIC 95 96,5 94 2,5 SUBCOSTAL 94,5 96,5 94,5 2
  18. 18. DTR RIGHT LEFT ACHILLES REFLEX ++ ++ PATELLA REFLEX + +++ BICEPS REFLEXES + +++ TRICEPS REFLEXIS ++ ++ BRACHIORADIALIS REFLEX + ++ 0=LOSS OR RECIVED; +=DECREASE; ++=NORMAL; +++=INCREASE
  19. 19. PATHOLOGICAL REFLEXES  Glabellar = -  Snout = -  Hoffman = -  Palmomental = -
  20. 20.  DRUGS USED :  Modapin  Azidect  Pramipex  Medsil
  21. 21. SENSATION :  Is intanct for light touch,pain,temperature, deep pressure ,and kinesthesia.
  22. 22. BED MOBILITY AND TRANSFER  Independent rolling on bed with low axial rotation,difficult independent sitting from supine position.  Sit transfer :  sit – stand = independent  bed –chair =independent
  23. 23. GAIT AND POSTURE  At this time patient is walking without any assistive device ,without freezing,with minimal forward flexed posture.While walking there is swinging of her arms with no cerebellar signs.  Balance test is positiv in static and dinamic position,without retropulsion or propulsion.
  24. 24.  Time up & go test (3m) = 13,81 sec.  12 metere walking = 17,45 sec.  sit – stand /14 times = 30 sec.
  25. 25.  Posture analysis:  kifosis(toracal)  head anterior  chest inside  shoulder contraction
  26. 26.  PRESENT SYMPTOMS :  Disarthrya  Bradikinesy  Rigidity (more in left arm)  Incontinence  Tiredness  Cognition  Concentration : difficult  Memory : intact
  27. 27.  Schwab & England Activities of Daily Living scale • She is estimate on 90 % - completely independent. Able to do all chores with some slowness, difficulty, and impairment. Might take twice as long. Beginning to be aware of difficulty.  Hoehn – Yahr scale (stages of PD) • Stage 1.5 -Unilateral and axial involvement
  28. 28. MUSCLE AND ROM EXAMINATION  Moderate dicrease of muscles power on neck and trunk muscles.  PROM without dicrease .  Moderate dicrease in AROM on neck and trunk muscles.
  29. 29. Physical Therapy
  30. 30. Physical Therapy Pogram of the patient  Relaxation tehniques to dicrease rigidity  Slow lhytmic rotational movements  Gentle ROM and streching exercises to prevent contractures,quadriceps and hip isometric exercises.  Neck and trunk rotation exercises  Back extension exercises and pelvic tilt  Breathing exercises
  31. 31.  Functional mobility training including bed mobility,transfer training  Training in rhytmic pattern to music such as clapping may help in alternating movements,standing and balancing in parallel bars(static and dynamic)with weight shifting,ball throwing  Stationary bicycle to help train reciprocal movements.
  32. 32.  Large steps progresssive training using blocks to lift legs,teaching proper heel – floor strike.  Arm swing exercises
  33. 33. Motor Fluctuations  The on – off respons:  On and Off periods occur wuthout warning as a result of fluctuating dopamine levels in the brain.
  34. 34.  During ON times, patients report they feel relatively fluid, clear, and in control of their movements. Often, symptoms of PD may be invisible to all but professionals.  During OFF periods, patients experience stiffness, lack of muscular coordination, pain, difficult handwriting — the full range of classic PD symptoms. Most patients have visible symptoms. Typically, patients will cycle between ON and OFF periods three to four times every day, although everyone’s experience is unique.
  35. 35.  In the “off” period , we need to prefer approaches that does not require the patiant to actively participate that much,such as respiratory therapy ,inhibation for pain and rigidity  In the “on” period , balance, coordonation,posture,walking exercises and gait training should be preferred.
  36. 36. THANK YOU 

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