Parkinson’s disease

MedlinePlus Topics

Parkinson's disease is a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination.

Causes

Parkinson's disease was first described in England in 1817 by Dr. James Parkinson. The disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly. Sometimes Parkinson's disease occurs in younger adults, but is rarely seen in children. It affects both men and women.

In some cases, Parkinson's disease occurs in families. When a young person is affected, it is usually because of a form of the disease that runs in families.

Nerve cells use a brain chemical called dopamine to help control muscle movement. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why the brain cells waste away is unknown. Parkinson's in children may occur because the nerves are not as sensitive to dopamine. Parkinson's is rare in children.

The term "parkinsonism" refers to any condition that involves the types of movement changes seen in Parkinson's disease. Parkinsonism may be caused by other disorders (such as secondary parkinsonism) or certain medications.

Symptoms

The disorder may affect one or both sides of the body. How much function is lost can vary.

Symptoms may be mild at first. For instance, the patient may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging.

Symptoms include:

• Automatic movements (such as blinking) slow or stop
• Constipation
• Difficulty swallowing
• Drooling
• Impaired balance and walking
• Lack of expression in the face (mask-like appearance)
• Muscle aches and pains (myalgia)
• Problems with movement
• Difficulty starting or continuing movement, such as starting to walk or getting out of a chair
• Loss of small or fine hand movements (writing may become small and difficult to read, and eating becomes harder)
• Shuffling gait
• Slowed movements
• Rigid or stiff muscles (often beginning in the legs)
• Shaking, tremors
• Tremors usually occur in the limbs at rest, or when the arm or leg is held out
• Tremors go away during movement
• Over time, tremor can be seen in the head, lips, tongue, and feet
• May be worse when tired, excited, or stressed
• Finger-thumb rubbing (pill-rolling tremor) may be present
• Slowed, quieter speech and monotone voice
• Stooped position

Other symptoms:

• Anxiety, stress, and tension
• Confusion
• Dementia
• Depression
• Fainting
• Hallucinations
• Memory loss
• Oily skin (seborrhea)

Exams and Tests

The health care provider may be able to diagnose Parkinson's disease based on your symptoms and a physical examination. However, the symptoms can be difficult to assess, particularly in the elderly. The signs (tremor, change in muscle tone, problems walking, unsteady posture) become more clear as the illness progresses.

An examination may show:

• Difficulty starting or finishing voluntary movements
• Jerky, stiff movements
• Muscle atrophy
• Parkinson's tremors
• Variation in heart rate

Reflexes should be normal.

Tests may be needed to rule out other disorders that cause similar symptoms.

Treatment

There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms.

Medications control symptoms, mostly by increasing the levels of dopamine in the brain. At certain points during the day, the helpful effects of the medication often wears off, and symptoms can return. Your doctor need to be change the:

• Type of medication
• Dose
• Amount of time between doses
• How the medications are taken

Work closely with your doctors and therapists to adjust the treatment program. Never change or stop taking any medications without talking with your doctor.

Many medications can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. Monitoring and follow-up by the health care provider is important.

Eventually, symptoms such as stooped posture, frozen movements, and speech difficulties may not respond very well to drug treatment.

Medications used to treat symptoms of Parkinson's disease are:

• Levodopa (L-dopa), Sinemet, levodopa and carbidopa (Atamet)
• Pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel)
• Selegiline (Eldepryl, Deprenyl), rasagiline (Azilect)
• Amantadine or anticholinergic medications -- to reduce early or mild tremors
• Entacapone -- to prevent the breakdown of levodopa

Lifestyle changes that may be helpful for Parkinson's disease:

• Good general nutrition and health
• Exercising, but adjusting the activity level to meet changing energy levels
• Regular rest periods and avoiding stress
• Physical therapy, speech therapy, and occupational therapy
• Railings or banisters placed in commonly used areas of the house
• Special eating utensils
• Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)

Less commonly, surgery may be an option for patients with very severe Parkinson's disease who no longer respond to many medications. These surgeries do not cure Parkinson's, but may help some patients:

• In deep brain stimulation (DBS), the surgeon implants electrical stimulators in specific areas of the brain to help with movement.
• Another type of surgery destroys brain tissues that cause Parkinson's symptoms.

Support Groups

Support groups may help you cope with the changes caused by the disease.

See: Parkinson's disease - support group

Outlook (Prognosis)

Untreated, the disorder will get worse until a person is totally disabled. Parkinson's may lead to a deterioration of all brain functions, and an early death.

Most people respond to medications. How much the medications relieve symptoms, and for how long can be very different in each person. The side effects of medications may be severe.

Possible Complications

• Difficulty performing daily activities
• Difficulty swallowing or eating
• Disability (differs from person to person)
• Injuries from falls
• Pneumonia from breathing in (aspirating) saliva
• Side effects of medications

When to Contact a Medical Professional

Call your health care provider if:

• You have symptoms of Parkinson's disease
• Symptoms get worse
• New symptoms occur

Also tell the health care provider about medication side effects, which may include:

• Changes in alertness, behavior or mood
• Delusional behavior
• Dizziness
• Hallucinations
• Involuntary movements
• Loss of mental functions
• Nausea and vomiting
• Severe confusion or disorientation

Also call your health care provider if the condition gets worse and home care is no longer possible.

Alternative Names

Paralysis agitans; Shaking palsy

References

Lang AE. When and how should treatment be started in Parkinson disease? Neurology. 2009;72(7 Suppl):S39-43.

Miyasaki JM, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, et al. Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson's disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66:996-1002.

Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H, et al. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66:983-995.

Suchowersky O, Reich S, Perlmutter J, Zesiewicz T, Gronseth G, Weiner WJ. Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006.66:968-975.

Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301(1):63-73.

Update Date: 7/4/2009

Updated by: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Exercises For The Parkinson Patient

Just as running water does not freeze, so moving muscles do not freeze.

---

Know the facts. The maintenance of normal muscle tone and function is an important aspect of the treatment of parkinsonism. In part, medication administered for your illness achieves this goal. However, to realize the full benefit of the medication daily exercise and activity are essential. This booklet outlines some of the exercises capable of maintaining muscle power and tone and preventing deformities of the limbs and spine. Their daily performance has proved most beneficial to patients with this illness.

TEN BASIC EXERCISES FOR THE PARKINSON PATIENT

1. Bring the toes up with every step you take. In Parkinson's disease, "you never make a move", without lifting the toes.

2. Spread the legs (10 inches) when walking or turning, to provide a wide base, a better stance, and to prevent falling. It may not look "beautiful," but neither does falling.

3. For greater safety in turning, use small steps, with feet widely separated. Never cross one leg over the other when turning. Practice walking a few yards and turn. Walk in the opposite direction and turn. Do so fifteen minutes a day.

4. Practice walking into tight corners of a room, to overcome fear of close places.

5. To insure good body balance, practice rapid excursions of the body. Backward, forward and to the right and left, five minutes, several times a day. Don't look for a wall when you think you are falling. It may not be there. Your body will always be there to protect you, if you will practice balance daily.

6. When the legs feel frozen or "glued" to the floor, a lift of the toes eliminates muscle spasm and the fear of falling. You are free to walk again.

7. Swing the arms freely when walking. It helps to take body weight off the legs, lessens fatigue, and loosens the arms and shoulders.

8. If getting out of a chair is difficult, rise with "lightning speed," to overcome the "pull of gravity." Sitting down should be done slow, with body bent sharply forward, until one touches the seat. Practice this at least a dozen times a day.

9. If the body lists to one side, carry a shopping bag loaded with books or other weights in the opposite hand to decrease the bend.

10. Any task that is difficult, such as buttoning a shirt. or getting out of bed, if practiced 20 times it day, becomes easier the 21st time.

FOR TIGHT MUSCLES AND POOR POSTURE

STANDING

1. Stand ln front of a wall, facing it about 8" away. Raise arms and reach as high as possible toward the top of the wall. Lean toward the wall and stretch.

2. With your back to the wall, alternate raising legs as high as possible by bending the knee as if marching in place.

3. Holding on to something secure, squat down as far as possible, bending knees; then come up.

SITTING

1. Sitting in straight-back chair, place your arms behind the chair and bring your shoulders back as far as possible; raise your head up and look at the ceiling.

2. Sitting In the same chair, grip the ends of a broom or mop stick with both hands, try to raise it over your head until you get it behind your head. Keep head and shoulders as erect as possible.

3. Sitting in same chair, place one leg at a time on another chair and press the knee straight. Keep it there 15 minutes. Try both legs together.

4. Sitting in a chair, raise legs up from the knee alternately, as if stamping your feet.

LYING ON A FIRM BED OR FLOOR

1. Lie on the floor or bed, flat on your back; try to press your body to the floor as flat as possible. Move your head from right to left as far as possible. Make sure your head, shoulders, back, and knees touch the surface.

2. Lie on the floor or bed on your abdomen. Do the following one by one:

1. Put your hands behind back and look up to ceiling, trying to raise your chest off the floor.
2. Kick your legs alternately, as if swimming.
3. Turn your head from right to left.

FOR BETTER BALANCE

1. Stand with hands on hips, feet spread apart:

1. Practice marching in place
2. Practice raising leg straight out to the rear.
3. Practice raising leg out to the side.
4. Practice drawing a circle with the leg.

2. Standing with hands at side, feet spread apart:

1. Lean forward and back
2. Lean to both sides
3. Lean in a circular motion and reverse the motion

FOR WALKING

1. When walking, REMEMBER:

1. Take as large a step as possible
2. Raise your toes as you step forward, hitting ground with your heels
3. Keep legs apart and posture straight
4. Swing arms and look straight ahead - your feet know where the floor is located.

2. Collect a dozen magazines; lay them out in a straight line. Space them so that you can take as long a step as possible. Practice walking over these magazines without stepping on them.

3. For a better swing to arms, walk holding a rolled magazine in each hand; keep elbows straight.

4. Practice walking sideways, backwards, and take big steps.

FOR TURNING

1. When practicing turning:

1. Keep feet spread-apart and head high
2. Use small steps; rock front side to side
3. Raise legs from the knees

2. If you feel glued to the floor:

1. Raise your head, relax back on your heels and raise your toes
2. Rock from side to side, bend knees slightly and straighten up and lift your toes
3. It sometimes helps if the arms are raised in a sudden short motion

FOR GETTING IN AND OUT OF A CHAIR

1. If you become glued a few steps before you reach the chair, try this: Don't aim for the chair but some object past it. Pass the chair as closely as possible and as you go by it sit down.

2. To sit down, bend forward as far as possible and sit down slowly. Get close to the chair. Do not fall into the chair.

3. To get up, move to the edge of the chair, bend forward and push up vigorously using your arms; try to count 1 2 3 GO! If you have a favorite armchair, raise the back legs with 4" blocks. This will help you to get up easily. Don't let people drag you up by your arms, but help you by pulling you under your arms, or with a slight push on your back.

FOR GETTING OUT OF BED

1. Place blocks under the legs of the head of the bed. This will elevate the head of the bed, & make it easier for you to sit up and swing the legs off the bed.

2. A knotted rope tied to the foot of the bed can help you to pull yourself up.

3. To get to a sitting position, shift the body down and rock yourself by vigorously, throwing your arms and legs toward the side of the bed.

FOR USING YOUR ARMS AND HANDS

1. Practice buttoning and unbuttoning your clothes; practice cutting food and writing. Squeeze a ball or work with "Silly Putty." Keep your fingers busy many times a day. Tear paper; take coins out of the pocket; play the piano.

2. Always try to dress yourself completely. Use shoehorns, elastic laces, or extra-long shoelaces to get a better grip. Dress in the most relaxed and comfortable position, sitting or standing, but make sure you are in a safe position.

3. To keep elbows straight and shoulders loose, install a pulley in doorway, place a chair under it or slightly in front. Stretch your arms and shoulders in all directions. By working the pulley when seated, you can get a more vigorous pull.

FOR GREATER SAFETY IN BATHTUB AND TOILET

If it is difficult to sit down in a bathtub, try the following:

1. Place a bench, stool or chair inside the tub; have the legs sawed off to tub height. Sit on the chair and soap yourself. Use shower to rinse, or rubber shower extension.

2. Bathtub grab bars are available. Purchase only those that attach securely.

3. Raised toilet seats are commercially available.

4. Toilet armrest for getting on and off the toilet are available.

FOR SPEECH, FACE AND CHEWING DIFFICULTIES

1. Practice singing and reading aloud with forceful lip movements. Talk into a tape recorder, if one is available.

2. Practice making faces in front of a mirror. Recite the alphabet and count numbers with exaggerated facial motions. Massage your face with vigor when washing and bathing.

3. When chewing food, chew hard and move the food around; avoid swallowing large lumps.

The previously outlined general exercises and suggestions are designed to help you. They are ancillary to medical treatment which should be carried out in consultation with your physician. In special instances where other diseases are associated with parkinsonism, your physician may wish to limit the intensity of your physical activity. Conversely, more intensive physical therapy may be indicated and in some instances should be done under the direction of a physical therapist.

All activities possible should be engaged in: work, walking, shopping, house chores, gardening, visiting, senior clubs, church organizations, travel, theater, swimming, sports, gymnasium, health clubs, "Y" activities, etc.

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Rehabilitation Strategy Points of Management in Thoracic Malignancy

Rehabilitation Strategy Points of Management in Thoracic Malignancy

Nury Nusdwinuringtyas

Pulmonary Rehabilitation Division, Department of Physical Medicine & Rehabilitation, Cipto Mangunkusumo Hospital, Jakarta

ABSTRACT

Rehabilitation has been described as the restoration of a patient to a person. The aim of rehabilitation with its holistic approach according to the World Health Organization is not only to train disabled and handicapped person to adopt environment and society as a whole, but also to facilitate the social integration where to live and they should be in the mainstream of community level.

Types of cancer rehabilitation, includes preventive, supportive, and palliative aspects. The goal of preventive rehabilitation therapy is to achieve maximal function considered to be cured or in remission. The goals of supportive rehabilitation therapy include providing adaptive self-care equipment in an attempt to offset what can be a steady decline in the patient’s functional skills. Palliative rehabilitation therapy goals are to improve or maintain comfort and function during the terminal stage of the disease. Palliative care rehabilitation at its best is the transformation of the dying into the living.

Patients with thoracic malignancies mostly suffer from respiratory symptoms (i.e. dyspnea) and pain. The World Health Organization estimates that 25% of all cancer patients die with unrelieved pain. Up to 60% of patients at all stages of the disease process experience significant pain. Most of this pain can be adequately relieved by analgesics. Cancer pain is managed by using opioid agonists and adjuvant drugs (i.e. antidepressants, anticonvulsants, benzodiazepines, neuroleptics, psychostimulants, antihistamines, corticosteroids, and calcitonin) which are chosen to supplement analgesics for their specific secondary effects or to treat side effects.

In addition to pain, the most common problems being dealt by patients with thoracic malignancies are dyspnea, excessive mucus secretion, and persistent cough. Weakness, lack of activity, and an inability to swallow saliva lead to chest infections, and these, aggravated by the inability to cough, and clear mucus, are distressing for patients and caregivers alike. To relief those symptoms, many approaches can be done including breathing exercise, postural drainage, inhalations, humidifiers, and nebulizers.

Dyspnea creates anxiety, and anxiety creates dyspnea. Breaking the cycle by a management strategy is necessary if any relief is to be provided. Patient can be taught to extend their activity range significantly if they follow a simple system involving breathing control, relaxation, organizing their activity into short periods with rest at regular intervals.

It is possible that oxygen supplementation could improve function in patients with cancer dyspnea, but such studies have not been conducted. The main objective of oxygen therapy in advanced cancer patients is symptomatic relief rather than prevention of long term complications; therefore, intermittent use can be acceptable and less psychologically burdensome in patients who present with intermittent exacerbation of dyspnea. Pulse oximetry is used to measure oxygen saturation, which will determine the effect of supplemental oxygen for patients with dyspnea.