It was first described as 'shaking paralysis' by the British physician James Parkinson in 1817. Parkinson's disease is a neurological disease with a progressive course and associated motor and non-motor symptoms. Although Parkinson's disease was initially treated pharmacologically, increasing evidence for non-pharmacological treatments has revealed the importance of physiotherapy and rehabilitation in the treatment of the disease.
This disease, which is diagnosed clinically, occurs between the ages of 40-75, often over the age of 60. starts. The onset may occur between the ages of 20 and 40 in 5% of all Parkinson's patients due to genetic reasons. The aim of the physiotherapy and rehabilitation program is; The aim is to minimize the problems caused by the disease, to ensure that the patient reaches maximum independence and to increase the quality of life as much as his/her own disability and environmental conditions allow.
Mechanism of the Disease: The substantia nigra (located in the upper brainstem region). It is due to the decrease in black nucleus) cells. These cells produce and store a substance called 'dopamine' and use it as a chemical transmitter in the connection between the nerve cells of the structures called 'striatum' located deep in the brain.
STRIATUM:With the movement coming from the brain cortex. It adds harmony and skill by processing relevant data. It contributes to balance and coordination, and the data is sent back to the muscles via the cerebral cortex, brainstem and spinal cord. In Parkinson's disease, substantia nigra cells cannot store dopamine and dopamine is depleted in the striatum. Depending on this loss and disrupted cycle, symptoms of the disease begin to appear in the body. At this point, we can start talking about the need for Physical Therapy and Rehabilitation in Parkinson's disease.
BASIC SYMPTOMS
The disease progresses insidiously and slowly. In general, the time of onset of the disease cannot be recorded precisely. Frequently, the first symptom is a tremor in a finger or a hand.
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Tremor:Finger, hand, foot It can be seen on the knees, chin and lips.
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Rigidity (Hardening of Muscles): Normally muscular While the bones should be soft and loose at rest, in the presence of rigidity, they are seen to be constant, tense and hard enough to be felt by hand even at rest.
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Bradykinesia (Slowness in movements):
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Bradykinesia (slowness in movements):Bradykinesia, one of the most basic symptoms, develops early or late in every patient. Although slowness of movement is evident, Muscle Strength is normal.
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Hypokinesis: Decrease in movements.
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Hypomimia: Decrease in facial expressions.
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Micrographia: Distortion of handwriting.
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Dysarthria: Speech Disorders
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Sialorrhea:Drawing due to difficulty in swallowing
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Postural Instability:Decrease in postural reflexes, rigidity and akinesia (lack of movement) cause postural instability.
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Posture and balance disorders.
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Tendency to fall forward
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Gait disorders (Festination gait)
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Locking and Freezing: Failure to start the movement, locking during movement
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Falling
POSTURE IN PATIENTS WITH PARKINSON'S:
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Forward bending (flexion) of the head
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Forward Leaning of the Trunk
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Pisa Syndrome: Leaning of the Trunk to the Side
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Thoracolumbar kyphosis
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Forward bending (flexion) at the hips and knees
Continuous forward bending posture causes mechanical tension of the back muscles and shortening of the front group muscles. . As a result, chronic pain occurs in the waist, neck, hip and knee joints. Poor posture may, over time, lead to feeling unsafe, loss of balance, and falls while standing, walking, turning left and right, or getting up from a chair and reaching forward.
PHYSICAL THERAPY AND REHABILITATION AT THIS POINT >
In addition to medical and surgical options against the disease, physical therapy and rehabilitation practices are of great importance for chronic and progressive, motor and non-motor symptoms. is. Physical therapy applications of the disease vary depending on the person's age, profession, symptoms of the disease, stage of the disease, psychiatric problems (hallucination, dementia, depression, etc.). There are periods when symptoms decrease) and off (symptoms increase towards the end of the dose). When evaluating Physical Therapy and Rehabilitation, it should be questioned in detail which drugs are used, at what hours and frequency the drugs are used, and whether the symptoms increase or decrease accordingly.
It is a known fact that physically fit patients cope better with the long course of the disease. . Exercise activities help protect muscles and joints that are subjected to constant stress. It also contributes to the functioning of the heart, blood circulation and ventilation of the lungs. Kidneys, urinary tract and bladder work better and constipation is minimized.
Physical activities are also important for mental activities. It helps the patient manage his/her anxiety, and the feeling of happiness, relaxation and comfort dominates the person. Family members should have a supportive and encouraging attitude in this regard, as much as the physician and physiotherapist.
Treatments are specific to the patients. With the doctor's diagnosis and physiotherapist evaluation, a special rehabilitation plan is drawn for the patient and our first goals are to adapt the exercises to life and inform the patient's relatives.
If we look at the Exercises in general;
There are exercise practices for every physical symptom we mentioned above.
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Stretching Exercises to be done face down, on your back or standing in bed
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Posture Exercises:This is of great importance for patients. A detailed evaluation should be made and an exercise program should be planned for impaired forward bending posture.
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Walking Exercises: Due to impaired posture and lack of movements. In-home arrangements to be made for the impaired walking pattern will both be good for the fear of falling and prevent walking disorders. It will help the patient to prevent the pain from progressing.
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Rotation Exercises:Due to lack of movement and rigidity in the muscles, the patient turns to the right and left. It may be difficult. Rotation exercises while lying, sitting or standing and exercise arrangements that can be done in daily life will be good for the patient.
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Balance and Coordination Training :Balance exercises in dynamic and static positions should definitely be included in the rehabilitation program.
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Breathing Exercises:Breathing Stiffness that may occur in the muscles (rigidity) may cause a decrease in respiratory capacity.
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Mimic Exercises:If hypomimia is present, it should be added to the exercise program. .
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Swallowing Rehabilitation:Patients with swallowing difficulties should be evaluated by specialist physicians and physiotherapists.
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Relaxation Exercises and Meditation
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