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Physical Therapy for Postural

Instability in Parkinsons Disease


Presented by : Chintya 2015061134
Reviewed by: dr. Rr. Josephine Retno W, Sp.S

INTRODUCTION

Background
Parkinson
is
a
progressive
neurologic disorder that causes
progressive disability that can be
slowed but not halted by any
adequate treatment.

Background
Parkinson affects approximately 1%
individuals older than 60 years
Incidence 4.5-21 cases/100.000
populations each year
Indonesia 876.665 persons each
year

Background

HOW TO TREAT?

Aim
To know the function of physical
therapy for postural instability in
Parkinson disease

LITERATURE REVIEW

Parkinson
Parkinson progressive neurological
disorder with the degeneration of
dopamine producing cells in the
substantia nigra decreased
dopamine production

Hoehn and Yahr Classification


Stage

Description

Stage 1

Unilateral involvement only usually with minimal or


no functional disability

Stage 2

Bilateral or midline involvement without impairment

Stage 3

of balance
Bilateral disease : mild to moderate disability with
impaired postural reflexes; physically independent

Stage 4

Severely disabling disease; still able to walk or stand

Stage 5

unassisted
Confinement to bed or wheelchair unless aided

Parkinson
Onset 60 years old or older
Men > women with ration 1.2:1 to
1.5:1
Mortality 37% from all patients

Risk Factors
Demograph
ic factors

Infectious
Agent

History of
past illness

Genetic
factors

Occupation

Enviroment

Diet

Parkinson
Mechanism :
Loss of pigmented dopaminergic neurons
of the substansia nigra pars compacta
The presence of Lewy bodies and Lewy
neurites not specific increase in
elderly

Clinical Manifestation
Manifestation :
Tremor predominant
Postural instability predominant

Clinical Manifestation

T R A P

Clinical Manifestation

Musculoskelet
al,
cardiovascular
, respiratory
system

Pain and
sensoric
function

Mental
Function

Diagnose

CLINICAL DIAGNOSIS
(differ from essential tremor,
parkinsonism vascular, drug-induced
parkinsonism, atypical parkinsonism)

Treatment
Pharmacology
Levodopa
Nonergot dopamine agonis
Monoamine oxidase-b inhibitor

Non-pharmacology
Deep brain stimulation
Physical therapy
Occupation therapy
Speaking therapy

Postural Instability
Loss of balance control or balance
dysfunction loss of mobility and
quality of life

Postural Instability
Postural instability affects balance control in
Parkinson Disease mainly in four domains :
Balance during quiet stance
Reactive
postural
adjustments
perturbations
Anticipatory postural adjustments
Dynamic balance

to

external

Physical Therapy
Physical Activity = any bodily
movement produced by skeletal
muscles that requires expenditure and
involve activities such as walking the
pets or any house chores.

Physical Therapy

Early
Phase

Mid
Phase

Late
Phase

Physical Therapy
Indications :

Limitations in activities and impairments in function especially with


respect to transfers, body posture, reaching and grasping, balance and
gait
Inactivity or a decreased physical capacity
Increased risk of falls or fear to fall
Increased liability to pressure sores
Impairments and limitations a result of neck and shoulder complaints
Need for information about the consequence of Parkinson disease,
especially regarding the limitations in activities concerning posture or
movement

Physical Therapy
Goals:
To stimulate the patients safety and independence in the
performance of activities with the emphasis on :
Transfers
Body posture
Reaching and grasping
Balance
Gait

To preserve or improve physical capacity


To prevent falling
To prevent pressure sores
To stimulate insight into impairments in function and limitations in
activities, especially of pasture and movement

Physical Therapy Classification


Strength and
flexibility
therapy

Balance
therapy

Neuromotor
Exercise
Training

Cardiorespirato
ry Exercise
Training

CONCLUSION
AND

Conclusion
Parkinson is a progressive neurologic
disorder that causes progressive disability
that can be slowed but not halted by any
adequate treatment.
Clinical manifestations of Parkinson are
tremor, rigidity, bradykinesia, and
postural instability.

Conclusion
Interventions for Parkinson can be classified into
pharmacology and non-pharmacology
Physical therapy consists of some therapy options
such as therapy for strength, flexibility, aerobic or
balance.
Every options has its different functions
To choose the most suitable therapy, patients
clinical manifestation need to be considered

Suggestion
Physical therapy in Parkinson is suggested
as soon as possible
To get the maximum result, therapy plan is
needed
Therapy plan for each patients is different
depends on degree of the disease, patients
desire, and the availability of therapist.

References
Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, JamesonJL, et al. Harrisons
Neurology n Medicine. California: Mc Graw Hill; 2010.
Choices NHS. Parkinsons disease - NHS Choices [Internet]. 2016 [cited 2016 Oct 12].
Available from: http://www.nhs.uk/conditions/parkinsons-disease/Pages/Introduction.aspx
Gallo PM, Garber CE. Parkinsons Disease : A Comprehensive Approach to Exercise
Prescription for the Health Fitness Professional. ACSMs Health and Fitness Journal. 2011. 15
(4).
Tan LC. Epidemiology of Parkinsons disease. Neurol Asia. 2013;18(3):231238.
Kim SD, Allen NE, Canning CG, Fung VSC. Postural Instability in Patients with Parkinsons
Disease: Epidemiology, Pathophysiology and Management. CNS Drugs. 2013 Feb;27(2):97
112.
Klamroth S, Steib S, Devan S, Pfeifer K. Effects of Exercise Therapy on Postural Instability in
Parkinson Disease: A Meta-analysis. J Neurol Phys Ther. 2016 Jan;40(1):314.
Royal Dutch Society for Physical Therapy. KNGF Guidelines for Physical Therapy in Patients
with Parkinsons Disease. Dutch Journal of Physiotherapy. 2004. 114 (3).

References
Yitayeh A, Teshome A. The effectiveness of physiotherapy treatment on balance
dysfunction and postural instability in persons with Parkinsons disease: a systematic
review and meta-analysis. BMC Sports Sci Med Rehabil [Internet]. 2016 Jun 6 [cited
2016 Oct 12];8. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895982/
DOS SANTOS LM, NUNES LDP, ALMEIDA AM, BATISTETTI CL, LIMA AC. CASE STUDY:
FUNCTIONAL EVALUATION AND PHYSICAL THERAPY IN PARKINSONS DISEASE. Simpsio
Int Neurocincias Gd Dourados [Internet]. 2016 [cited 2016 Oct 12];4. Available from:
http://www.cienciasecognicao.org/revista/index.php/SINGraD/article/download/1303/81
8
Gisbert R, Schenkman M. Physical therapist interventions for Parkinson disease. Phys
Ther. 2015;95(3):299305.
van der Kolk NM, King LA. Effects of exercise on mobility in people with Parkinsons
disease: Exercise in Parkinsons Disease. Mov Disord. 2013 Sep 15;28(11):158796.

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