Parkinson | Fondazione Santa Lucia

Parkinson

Characteristics and Causes

Parkinson's disease is a neurodegenerative syndrome characterized primarily by neurobiological changes, which are associated with changes in motor skills and cognitive and behavioral functions. A reduction in the availability of dopamine in different cortico-subcortical circuits leads to the depletion of dopamine neurons, affecting some early neuronal populations of subcortical regions of the brain (substantia nigra). This causes alteration in motor and cognitive processes involved.

 

Symptoms

Clinical symptoms of Parkinson affects the proper functioning of the extrapyramidal motor system such as tremors at rest, muscular rigidity, bradykinesia and postural instability. A diagnosis of the disease is indicated by the response to levodopa treatment (a dopamine precursor).

People with Parkinson's disease present with very high frequency, during the course of the disease, not only motor disorders, but also affective and cognitive deficits, impaired swallowing and sleep, urinary disorders and issues in normal regulation of blood pressure and heart rate.

Rehabilitation

Inpatients with Parkinson's disease are managed by a multidisciplinary team, consisting of neurologists, physiatrists, psychologists, physiotherapists, speech therapists, nurses and social workers. A series of medical tests, including neurological, physiatric and neuropsychological examinations, are used to establish a tailored rehabilitation program. It generally relates to improving the motor and cognitive functions.

 

Balance and Walking Deficits

Physiotherapy with patients suffering from Parkinson's disease often deals with walking problems and balance issues. They are disorders often associated with an increased risk of falling, which can then lead to a significant worsening of and complications to the health of the patient. The rehabilitation approach in this case aims to support coordination and muscle strength of the patient. For these issues are often employed innovative technologies like the Wii Balance Board and the Gait Trainer.

 

Rehabilitation in Water

Movement therapy in water (hydrokinetic) is another method of rehabilitation that can be adopted in the treatment of movement disorders of patients with Parkinson's disease. The reduction of the weight of gravity in water facilitates the execution of active and passive mobilization exercises that improve posture, walking and the realignment of the center of gravity.

 

Rehabilitation of Cognitive Functions

The cognitive rehabilitation of patients with Parkinson's disease is managed by the neuropsychologist and the speech therapist. The patient with Parkinson's disease typically presents altered attention, memory deficit and loss of so-called executive functions, which require the implementation of strategies to carry out simple actions and perform tasks under the new conditions caused by the trauma. Recent research has also documented a close relationship between cognitive deficits – particularly of executive functions – and movement disorders. In this context, the rehabilitation strategies of the Santa Lucia Foundation also provide the use of IT tools and virtual reality.

 

Swallowing Difficulty

The alteration of muscle coordination frequently causes swallowing deficit in patients with advanced stage Parkinson's disease. Some of the associated symptoms, such as salivation (drooling or increased saliva in the mouth), are minimally annoying and can inhibit social interactions. Swallowing disorders also involve serious risks, such as choking as food may enter the trachea, pneumonia or tracheitis. The rehabilitative for swallowing issues typically involves the speech therapist.

 

Treatment of Neurological Bladder

Parkinson's disease can cause a lesion of the nerve centers that regulate the functioning of the bladder, causing incontinence or urinary retention. Urologists and nurses at the Santa Lucia Hospital provide rehabilitation pelviperineal treatments, designed to the strengthen the pelvic floor muscles that control urination.

 

Occupational therapy

The patient suffering from Parkinson's disease may have difficulty performing the routine activities of daily living, such as eating, clothing, bathing and personal hygiene. The intervention of the occupational therapist is aimed at improving the ability to independently manage these types of activities, through functional learning strategies. For example, the use of special cutlery and large handle toothbrushes to facilitate the grip can be recommended as well as special techniques for dressing by sitting.

 

The Hospital Discharge

The rehabilitation team, in collaboration with the Hospital Social Services, discuss with the patient and family the post discharge process. Provided is information on the continuity of care and possible home care, post discharge projects, integrated home care and, if necessary, may propose measures to physically change some features of the home.