Parkinsonism definition treatment, physiotherapy treatment

               Parkinsonism

Parkinsonism is one of the disorders of the extra pyramidal system caused by damage to the basal ganglia, usually as a result of a deficiency of the neurotransmitter dopamine in old age. 
It is a name given to a clinical syndrome comprising of:
  • Impairment of movement
  • Rigidity
  • Tremors
Treatment
The three methods of management include:-
  • Pharmacology
  • Rehabilitation, and
  • Neurosurgical procedures. 
Pharmacological Management
  • Neurotransmitter replacement L-dopa, Carbidope with L-dopa
  • Anticholinergic drugs, like trihexyphenidyl, benztropine, procyclidine
  • Receptor agonists like amantadine
  • Bromocriptine
Rehabilitation
Medical and nursing
  • Firm bed to decrease contractures and improve bed mobility. 
  • Regular meals with low protein diet
  • Incentive spirometry to prevent atelectasis and pneumonia
  • Artificial tears for lack of blinking
  • Anticholinergic medications for excessive drooling. 
Physical Therapy
  • Relaxation techniques to decrease rigidity
  • PNF technique of rhythmic initiation, progresses from passive to active assisted exercise and progression from small range to maximum range. This overcome s the crippling effects of bradykinesia. 
  • ROM exercises, stretching and preventing contractures pectoralis stretching, isotonic and isometric exercises to quadriceps and hip extensors. 
  • Back flexion- extension exercises, and pelvic tilt
  • Proper sitting and postural control
  • Mat activities
  • Tilt table if needed
  • Functional mobility training, including bed mobility, transfer training and learning to rise out of a chair by rocking the body forwards and backward. The patient may require a chair lift
  • Stationary cycling to help train reciprocal movement. Training to music or with auditory cues such as clapping may help in alternating movement
  • PNF, biofeedback, and NDT training to facilitate slow movement. 
  • Standing or balancing in parallel bars with weight shift. 
  • Progressive walking
  • Use of assistive devices (Walker) 
  • General cardiovascular fitness exercises for aerobic conditioning (swimming, walking) 
  • Deep breathing exercises for the diaphragm
  • Family training and home exercises program

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