Q: Doctor my father is 48 and has Parkinson’s Disease, the symptoms are quite exaggerated, kindly guide about physiotherapy in this disease.
A: Parkinson's disease (PD), also referred to as Parkinson’s, is a complex and progressively worsening neurodegenerative disorder. It is primarily defined by the abnormal accumulation of a protein called alpha-synuclein in the brain, which places it in a category of disorders known as synucleinopathies. This protein build-up is thought to lead to neuronal dysfunction and, ultimately, the death of dopamine-producing neurons, especially in a region of the brain called the substantia nigra. Dopamine is a critical neurotransmitter responsible for regulating movement, emotion, and certain aspects of cognition. As the dopamine-producing cells degrade, PD manifests in various physical and psychological symptoms. This disorder predominantly affects older adults, usually developing after age 60, though early-onset cases are also reported. Among the first motor symptoms noticed is bradykinesia – a generalized slowing of voluntary movements, which significantly impacts daily activities and mobility. Bradykinesia is often accompanied by one or more of PD’s hallmark motor symptoms: resting tremor or muscular rigidity.

Resting tremor is frequently one of the earliest and most visible symptoms of PD. It generally starts on one side of the body, affecting an arm, hand, or even a leg. The tremor is most apparent when the affected limb is at rest, such as when a person is sitting or lying down. This tremor may temporarily lessen or disappear when the person voluntarily moves the limb, though it often returns as the movement stops. Over time, the tremor can become more prominent and affect both sides of the body, further complicating movement and coordination. Muscular rigidity is another defining feature of PD and manifests in two main forms: "lead pipe" rigidity and "cogwheel" rigidity. Lead pipe rigidity refers to a consistent, uniform resistance to passive movement, almost as if the limb is pushing against a stiff pipe. Cogwheel rigidity, on the other hand, is characterized by a ratcheting or jerky movement when the limb is moved, giving the sensation of small "catches" as it flexes and extends. These rigidities contribute to the overall stiffness, discomfort, and inflexibility experienced by people with PD, making everyday activities, such as dressing, writing, or walking, increasingly challenging.

In addition to motor symptoms, PD is associated with an array of non-motor symptoms that significantly affect the patient’s quality of life. These non-motor symptoms include anosmia, or loss of smell; sleep disturbances, such as REM sleep behavior disorder, which is often characterized by excessive limb movements during sleep; and mood disorders, including depression and anxiety. These symptoms are often early indicators of PD and may appear years or even decades before the first motor symptoms. Other non-motor symptoms may include excessive salivation and various gastrointestinal issues, such as constipation. These non-motor symptoms often provide early diagnostic clues and, in some cases, serve as red flags that warrant closer observation and potentially early intervention.

As Parkinson’s disease advances, gait disturbances become increasingly prominent. Patients frequently develop a shuffling gait, marked by short, slow steps and a tendency to stoop forward, which affects their posture and balance. Turning or pivoting without taking multiple small steps becomes difficult, and patients may experience challenges stopping suddenly, leading to a high risk of falls. These gait abnormalities are not only a safety concern but also contribute to the increased likelihood of injury, further complicating disease management and patient care.

PD is the second most common neurodegenerative disease globally, trailing only Alzheimer’s disease, and is the fastest-growing neurological condition worldwide. Its multifaceted nature, which affects multiple organ systems, presents a formidable challenge for effective management. Because Parkinson’s disease is progressive, symptoms tend to worsen over time, and new symptoms may appear as the condition advances. This evolution requires ongoing modifications to treatment strategies to best manage the wide range of symptoms, from motor to non-motor. Certain symptoms, such as depression, caregiver fatigue, and constipation, may emerge as direct consequences of PD or as side effects of medications. For instance, dopamine replacement therapies, often used to alleviate motor symptoms, can sometimes lead to mood fluctuations and gastrointestinal side effects, complicating the therapeutic process.

to be continued...