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LEARNING OBJECTIVES
Describe the etiology, pathophysiology, clinical manifestations, and sequelae of Parkinson disease.
Identify and describe the examination procedures used to evaluate people with Parkinson disease to establish a diagnosis, prognosis, and plan of care.
Describe the role of the physical therapist in assisting a person with Parkinson 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.
Describe appropriate elements of the exercise prescription for individuals with Parkinson disease.
Identify the neuropsychological effects and social impact of Parkinson disease and describe appropriate interventions to maximize function, participation, and quality of life.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
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Parkinson 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 bradykinesia, tremor, rigidity, and postural instability. Nonmotor symptoms (NMSs) may precede the onset of motor symptoms by an average of 10 years. These early premotor (prodromal) symptoms most commonly include constipation, rapid eye movement (REM) sleep behavior disorder, depression, anxiety, loss of sense of smell (anosmia), and orthostatic hypotension. Other NMSs include excessive daytime sleepiness, fatigue (a sense of exhaustion rather than sleepiness), pain, 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
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PD is the second most common neurodegenerative disorder (the first is Alzheimer disease [AD]), and it affects an estimated 1 million Americans and 7 to 10 million people worldwide. The incidence increases by 5 to 10 times from the sixth to the ninth decades of life, ranging from 5 to over 35 in 100,000 new cases annually. The prevalence also increases from under 1% in people aged 45 to 54 years to 4% of men and 2% of women aged 85 years and older. Prevalence is expected to more than double by the year 2040. The average age of onset is 60 years with only 4% to 10% of patients diagnosed before the age of 50 years. This early-onset PD, often called young-onset PD (YOPD), 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.2,3
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Parkinson disease, or idiopathic parkinsonism, is a generic term used to describe a group of neurologic disorders with PD-like movement problems (rigidity, slowness, tremor) ...