A Research Paper on Parkinson’s Disease

Etiology

Parkinson’s Disease (PD) can happen due to genetics or environmental factors. There are six genes that have been classified that can be the cause of Parkinson’s Disease, “alpha-synuclein, parkin, UCHL1, DJ1, PINK1, and LRRK2”. An over expression of one or two of these can cause mitochondrial defects within the musculoskeletal system and can cause neurodegenerative. Parkinson’s Disease affects approximately 1 million persons in the United States. Synuclein, UCHL1, LRRK2; these three can be classified as an autosomal dominant parkinsonism. DJ1, PINK1, parkin; can be classified as an autosomal recessive. There are also environmental factors being a possible risk factor for PD.

Toxic and infection exposures can increase getting parkinson’s disease; for example toxic exposures like, “carbon monoxide and methanol can damage the basal ganglia and produce parkinsonian symptoms”. Infection exposures like, “measles virus, rubella virus, and herpes virus”, can increase the percentage of getting PD. It is also known that men are more likely to obtain the disorder more than women. That makes sense because men are exposed to more toxic environment due to their occupational work. Construction, miners, machine operators are just a few examples of toxins that are around these working environments that can lead to developing PD. One stunning study also shocked me that, “ There is a relatively well established relationship between PD and history of smoking… Individuals with a history of smoking seem to have a lower risk of developing PD”. It’s crazy to think smoking can lower the risk of developing PD, I would have thought it would increase the chances and probably worsen.

Pathology

Parkinson’s Disease is associated with degeneration of the, “nigrostriatal dopaminergic system”, with neuronal loss and reactive gliosis found in the autopsy. It is a heterogeneous with abnormalities in the presynaptic protein synuclein. “Alpha-synuclein accumulates in neuronal perikarya (Lewy bodies) and neuronal processes (Lewy neurites)”. The disease affects the central nervous system neurons and the peripheral autonomic nervous system neurons. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and they are responsible for relaying messages that plan and control body movement.

The dopamine producing nerve cells of the substantia nigra begin to die off for some individuals. When “ eighty percent of dopamine is lost”, that’s when Parkinson’s Disease signs start to show up within the patient. The body movement is a complex chain of inter-connected groups of nerve cells called ganglia. Information comes to the central area of the brain called the “striatum”; which works with the “substantia nigra” to send impulses back and forth from the spinal cord to the brain. Movement supposed to be smooth and in a fluid manner but incases of PD patients its the opposite, especially if the PD is severe. The signs and symptoms of parkinson’s disease appear when the body mechanics tries to compensate for the lack of dopamine within the body.

Clinical Signs/Symptoms

Parkinson’s Disease vary from patient to patient and also it depends on the rate of progression of the disorder. Some of the signs and symptoms that you see commonly are bradykinesia, tremor, rigidity, postural instability and even depression. “In particular, the subthalamic nucleus (STN) becomes overactive and acts as a brake on the globus pallidus interna (GPi)” (Mandybur), which means that it shutdowns the fluid motion and even causes rigidity. Rigidity or in other words also known as stiffness can be seen in the upper and lower body parts. For example, a PD patient can cause a person to not be able to swing their arms when walking which puts them in danger of their environment.

Another symptom that Parkinson’s Disease are tremors and its due to the fact when the, “GPi is overstimulated, it has an over-inhibitory effect on the thalamus, which in turn decreases thalamus output and causes tremor”. Tremor can also put the patient at danger because its an involuntary muscle contraction, and at relaxation it can cause a twitching movement. These twitching movement can affect the patient's arms, hands, eyes, face, trunk and legs. One of the signs that can be a potential of hinting toward parkinson’s disease is slow movement or also known as bradykinesia. “Slowness of movement, imparied dexterity, decreased blinking, drooling, expressionless face”. Just imagine not being able to move at a normal pace whether is walking or maybe just reaching for something. A disorder that slows your daily movements can be extremely difficult to accomplish any task. These patients are going to need a lot of assistance and guidance for them to complete their tasks. Slow movement can also lead to imbalance and poor posture when walking. Usually patients with Parkinson’s Disease they overcompensate by lowering their center of gravity, can result in shrinkage of the upper extremity muscles and over extended muscles on the back. Not to mention the person might feel anxious and depressed because these signs and symptoms.

Prognosis

There’s a few things a person can do to prevent it; I strongly believe PD won’t occur in people if they live a healthier lifestyle. For example, just having eating a balanced diet and staying active are some contributions that a person can do to stay healthy and more important for their well being. Parkinson’s disease can be managed with self-care, medication, and surgery. Self-care is pretty self explanatory which involves exercising and making sure you maintain flexibility; which improves balance and the patient’s range of motion. Another example is maybe joining some type of exercise dance class or group activity. Being in a group activity environment helps one another because you can push one another to achieve a short term goal.

Another method of helping a patient with PD is making sure he or she is taking the right medications. The drug “Amantadine (symmetrel), bloc the action of the neurotransmitter glutamate, which allows for an increase in dopamine release”. Increasing the dopamine release in a PD patient will increase the movements of the patient which can lead to a better therapy session. Other medications that helps a patient with PD are, “trihexyphenidyl (artane) and benztropine (Cogentin) which reduces the activity of the neurotransmitter acetylcholine and it reduces tremor”. The final thing a PD patient can consider is deep brain stimulation surgery. DBS is a surgical procedure to implant a pacemaker device that sends electrical signals to the brain responsible for movement. Before any surgery you have to take into consideration if the patient is in the right condition or mindset for it.

PT/PTA Implications

I think the PT and PTA relationship is extremely important when having a patient with Parkinson's Disease. The PT has to make sure the plan of care is appropriate for the patient and the PTA has to make sure he or she can execute the tasks that are given. With a PD patient you want to take into consideration that maybe you don’t want the patient to do explosive movements or crazy lifting at the beginning. First because its not suited for the patient; the patient may have bradykinesia and he or she won’t be able to do quick movements at all. A short term goal that a PTA can say to the PT is to work on the patients flexibility or maintain it. You wanna maintain flexibility to make sure the patient muscles aren’t getting tight. As PT and PTA they wanna make sure they are taking their medication before a session to increase mobility and productiveness. Another thing is giving the patient motivation because some PD patients may be depressed and guiding them can mean a lot for them. The environment needs to be safe for the patient to prevent injury and incase of injury what to do if it does happen. Most important you also want to document everything in a session to see the progression of the patients and for legal purposes.

References

1. Dickson, D. W. (2012, August). Parkinson's disease and parkinsonism: Neuropathology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405828/
2. Goodman, C,C & Fuller, K.S. (2017). Pathology for the physical therapist assistant, second edition. St. Louis: Elsevier
3. Mandybur, G. (2018, April). Parkinson's Disease (PD). Retrieved from https://mayfieldclinic.com/pe-pd.htm
4. Schapira, A. H. (2015, May). Glucocerebrosidase and Parkinson disease: Recent advances. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25802027