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LEARNING OBJECTIVES

LEARNING OBJECTIVES

  1. Describe the etiology, pathophysiology, clinical manifestations, and sequelae of Parkinson’s disease.

  2. Identify and describe the examination procedures used to evaluate people with Parkinson’s disease to establish a diagnosis, prognosis, and plan of care.

  3. Describe the role of the physical therapist in assisting a person with Parkinson’s disease in terms of direct interventions to maximize function, and in education to client, family/caregiver, community program instructors, and health care team to optimize outcomes and participation.

  4. Describe appropriate elements of the exercise prescription for individuals with Parkinson’s disease.

  5. Identify the neuropsychological effects and social impact of Parkinson’s disease and describe appropriate interventions to maximize function, participation and quality of life.

  6. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

INTRODUCTION

Parkinson’s disease (PD) is a progressive disorder of the central nervous system (CNS) with both motor and nonmotor symptoms. Motor symptoms include the cardinal features of rigidity, bradykinesia, tremor, and postural instability. Nonmotor symptoms (NMSs) may precede the onset of motor symptoms by several years. These early premotor symptoms can include loss of sense of smell (anosmia), constipation, rapid eye movement (REM) sleep behavior disorder, depression, anxiety and orthostatic hypotension. Other nonmotor symptoms include excessive daytime sleepiness, fatigue (a sense of exhaustion rather than sleepiness), pain (often unilateral and in affected limb), altered bladder function, erectile dysfunction, excessive saliva, integumentary changes, difficulty speaking and swallowing, apathy, and cognitive problems (reduced concentration and attention, slowed thinking, confusion, and in some cases dementia). Onset is insidious with a slow rate of progression. Disruptions in daily functions, roles, and activities are common in individuals with PD.1,2

INCIDENCE

PD is the second most common neurodegenerative disorder and affects an estimated 1 million Americans and an estimated 7 to 10 million people worldwide. More than 2% of people older than 65 years of age have PD, second only to Alzheimer’s disease among neurodegenerative disorders. The prevalence of the disease is expected to increase substantially in the coming years due to the aging of the population. The average age of onset is 50 to 60 years. Only 4% to 10% of patients are diagnosed with early-onset PD (less than 50 years of age). Young-onset PD is classified as beginning between 21 and 50 years of age, and juvenile-onset PD affects individuals less than 21 years of age. Men are affected 1.2 to 1.5 times more frequently than women, but this varies across the globe.3,4

ETIOLOGY

The term parkinsonism is a generic term used to describe a group of bradykinetic syndromes with primary disturbances in the dopamine systems of basal ganglia (BG). Both genetic and environmental influences have been identified. Parkinson’s disease, or idiopathic parkinsonism, is the most common form, affecting approximately 78% of patients. Secondary parkinsonism results ...

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