Physiotherapeutic theory for neurorehabilitation
of Parkinson’s disease
Crash course PD
Idiopathic PD
Multisystem disorder
Pathophysiology of striatum
Striatum (purple) = putamen + n. caudatus + n. accumbens (a6ective)
Striatal function
• Selective inhibition of self-generated
movements
• Parameters: speed & amplitude
Striatal neurons: MSN (inhibitory function via
GABA)
à Dopamine modulates action
,Disrupted BG circuit
D1 (direct pathway): facilitating movement
D2 (indirect pathway): inhibiting movement
Pathology in SNc à dysfunction of striatum
• Overexpression of indirect pathway
à Bradykinesia
2 types
Body-first PD (from gut via n.
vagus)
- RBD at onset
- More severe disease
Brain-first PD (from midbrain)
- No RBD at onset
- Tremor
- Milder disease
Progression
, Posterior regions
degenerate first à
automatic behavior
reduces à reliance on
anterior (cognitive)
networks
Goal PD rehab
1. Maintaining, regaining or improving generalized physical and mental health
2. Treating refractory motor problems a6ecting safety & ADL
• Refractory problems despite optimal pharmacotherapy
, Parkinson plus syndromes
Faster progression and higher mortality than idiopathic PD
• Actual basal ganglia itself are degenerated à levodopa doesn’t help
Lewy Body Dementia (LBD)
Signs and symptoms
• Dementia most prominent: development <1y post-diagnosis
o Short-term memory loss, problems with speech and finding words, visuospatial
deficits, attention disorders, inflexibility, problems with insight and judgement
• Motor characteristics of PD without tremor
• Visual hallucinations early and complex
• RBD
• Fluctuations of cognition and attention
• Falls and syncope (autonomic dysfunction)
Multiple System Atrophy (MSA)
• 30% of MSA patients initially have a good response to levodopa
Dysautonomia
• Orthostatic hypotension: repeatedly syncopes
• Urogenital dysfunction: urinary incontinence or retention, erectile dysfunction
• Anhidrosis: altered sweat response
• Sleep disorders: RBD, apnea, stridor, ataxic breathing
• Postural deformities: antecollis
Progressive supranuclear palsy (PSP)
Signs and symptoms
• Early postural instability and falls
• Gaze palsy: inability to move eyes
• Axial impairment and retropulsion
• Postural deformities: camptocormia, pisa syndrome, retrocollis)
• Pseudobulbar lesions: dysarthria, dysphagia, dysphonia (paresis of tongue and facial muscles)
of Parkinson’s disease
Crash course PD
Idiopathic PD
Multisystem disorder
Pathophysiology of striatum
Striatum (purple) = putamen + n. caudatus + n. accumbens (a6ective)
Striatal function
• Selective inhibition of self-generated
movements
• Parameters: speed & amplitude
Striatal neurons: MSN (inhibitory function via
GABA)
à Dopamine modulates action
,Disrupted BG circuit
D1 (direct pathway): facilitating movement
D2 (indirect pathway): inhibiting movement
Pathology in SNc à dysfunction of striatum
• Overexpression of indirect pathway
à Bradykinesia
2 types
Body-first PD (from gut via n.
vagus)
- RBD at onset
- More severe disease
Brain-first PD (from midbrain)
- No RBD at onset
- Tremor
- Milder disease
Progression
, Posterior regions
degenerate first à
automatic behavior
reduces à reliance on
anterior (cognitive)
networks
Goal PD rehab
1. Maintaining, regaining or improving generalized physical and mental health
2. Treating refractory motor problems a6ecting safety & ADL
• Refractory problems despite optimal pharmacotherapy
, Parkinson plus syndromes
Faster progression and higher mortality than idiopathic PD
• Actual basal ganglia itself are degenerated à levodopa doesn’t help
Lewy Body Dementia (LBD)
Signs and symptoms
• Dementia most prominent: development <1y post-diagnosis
o Short-term memory loss, problems with speech and finding words, visuospatial
deficits, attention disorders, inflexibility, problems with insight and judgement
• Motor characteristics of PD without tremor
• Visual hallucinations early and complex
• RBD
• Fluctuations of cognition and attention
• Falls and syncope (autonomic dysfunction)
Multiple System Atrophy (MSA)
• 30% of MSA patients initially have a good response to levodopa
Dysautonomia
• Orthostatic hypotension: repeatedly syncopes
• Urogenital dysfunction: urinary incontinence or retention, erectile dysfunction
• Anhidrosis: altered sweat response
• Sleep disorders: RBD, apnea, stridor, ataxic breathing
• Postural deformities: antecollis
Progressive supranuclear palsy (PSP)
Signs and symptoms
• Early postural instability and falls
• Gaze palsy: inability to move eyes
• Axial impairment and retropulsion
• Postural deformities: camptocormia, pisa syndrome, retrocollis)
• Pseudobulbar lesions: dysarthria, dysphagia, dysphonia (paresis of tongue and facial muscles)
