PREFERRED PRACTICE PATTERN
A 75-year-old male with a 7-year history of Parkinson’s disease (PD) was admitted to the hospital following a fall. He did not suffer any fractures, but reports pain in his back when he exerts himself. He has been admitted to in-patient rehabilitation for mobility retraining. He has a festinating gait pattern with poor disassociation in his trunk and no arm swing. He demonstrates bilateral upper-extremity (UE) tremors that increase in amplitude when he is under physical, mental, or emotional stress. He struggles both to initiate a movement and to control the movement once it is initiated. His wife reports that he walks better when he holds on to her arm and they walk together, but that walking seems more effortful for him over the past several months.2
Progressive degenerative disorder of the central nervous system
Death of dopamine-producing cells in the substantia nigra
Named after English MD, James Parkinson
Parkinsonian syndromes (4 types)
Primary or idiopathic, no known cause
Secondary or acquired
Parkinson plus syndrome or multiple system degeneration
Core features include a tetrad of hypo- or bradykinesia, resting tremor, postural instability, and rigidity
Some people have a rigidity-dominant presentation; others have a dyskinesia-dominant presentation (predominantly those with onset at a young age)
Classification of drugs used in the treatment of Parkinson’s disease. (From Panus PT, Katzung B, Jobst E, Tinsley S, Masters S, Trevor A. Pharmacology for the Physical Therapist. New York, NY: McGraw-Hill; 2009: p. 228.)
Onset generally between 45 to 70 years of age
More common in men
Impacts all ethnic groups and socioeconomic classes
Most cases are idiopathic; genetic variants exist, but are rare
Schematic representation of the sequences of neurons involved in Parkinson’s disease and Huntington’s chorea. Top. Dopaminergic neurons (light gray) originating in the substantia nigra normally inhibit the GABAergic output from the striatum, whereas cholinergic neurons (gray) exert an excitatory effect. Middle. Neurons in Parkinson’s disease. The dopaminergic neuron (dashed, light gray) is lost with a relative increase in cholinergic activity. Bottom. Neurons in Huntington’s disease. The cholinergic neurons may be lost (gray), but even more GABAergic neurons (dashed black) degenerate. (From Panus PT, Katzung ...
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