Overview of Parkinson's Disease
This is a chronic progressive disease involving the subcortical gray matter of the basal ganglia. Most cases are due to a genetic defect, with toxic and infectious exposures being risk factors. The disease progresses as the substantia nigra of the basal ganglia loses its ability to produce dopamine.1 Because the basal ganglia is important for the initiation and control of motor behaviors, the progression of the disease significantly alters how movements occur, resulting in slowing of movement and loss of coordination. A decrease in daily activities and social participation results in deconditioning and a decrease in cardiovascular functions. The Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr Classification of Disability are used to determine disease progression.1
Hoehn and Yahr Classification of Disability
Stage 1: Minimal disability, unilateral involvement
Stage 2: Minimal bilateral involvement, balance not impaired
Stage 3: Impaired righting reflexes, unsteadiness but lives independently
Stage 4: Severe symptoms, standing and walking possible with assistance
Stage 5: Confined to bed or wheelchair
Comorbidities to Consider
Clients may develop depression and dementia that limit activities, and they may have dyspnea, rapid heart rate, and sweating with physical activities.
Keys to Examination of Clients
This condition is diagnosed based on the presentation of tremor, rigidity, bradykinesia, and akinesia. The concentration of dopamine transporters can be measured through computed tomography scans.
Screen the client's ability to move in a safe manner and for risk of falling with sitting and standing activities.
Recommended Baseline Testing of Fitness Levels
Aerobic fitness can be assessed with the 2- or 6-minute walk tests.2
Assess for strength, mobility, and balance based on the client's status and disease progression.
Type: Walking, treadmill walking, stationary bicyling3,4
Intensity: Low to moderate intensities
Frequency: Four times per week
Aerobic exercises performed for 6 weeks have resulted in significant changes in gait and quality of life measures and improved the efficacy of the medication levodopa.5,6 The intensity of the exercise should be prescribed for each client, with a goal of exercising at 60% to 80% of maximum heart rate. Balance and sensorimotor agility activities can be incorporated into a client's daily activities and recreational pursuits.7 Exercise and therapies that provide for sensorimotor agility, such as tai chi, kayaking, and Pilates, have also been advocated for these clients.7,8 Clients may need to time the use of their medications to diminish their rigidity, tremor, and ...