Chapter 6: Examination and Management of the Client with Parkinson’s Disease, 2nd Edition 5 CCUs
By: Deborah Kegelmeyer, DPT, MS, GCS Learning objectives After completing this course, the learner will be able to: Describe the etiology and symptoms of Parkinson’s disease, including its four cardinal signs. Describe the clinical course of Parkinson’s disease, its classification, and differential diagnosis of parkinsonian syndromes. Course overview Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder (after Alzheimer’s disease [AD]), impacting approximately 1 million individuals in the United States, with 60,000 new cases diagnosed each year (Parkinson’s Disease Foundation, n.d.). Many physical therapists enter the field with a broad understanding of neurologic rehabilitation but lack specific training in the differential diagnosis, examination, and management of clients with PD. Currently, research in the physical therapy management of individuals with PD is quite robust, resulting in an ever-changing field of practice in response to new research findings. Therapists might lack information regarding the most valid diagnostic tests and measures and the most current evidence-based treatment techniques. Recent studies have developed new assessment techniques such as the Balance Evaluation Systems Test (BESTest) and shorter versions called the Mini-BESTest (Duncan et al., 2013) and the Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing Parkinson’s disease (PD) is the term most commonly used to describe a group of disorders that are poorly differentiated from one another. Neurologists differentially diagnose the parkinsonian syndromes based on whether there is a known cause for the disorder and whether there are symptoms present that do not fit within the standard definition of PD. When PD has no known cause or etiology but meets certain specified criteria (e.g., the presence of bradykinesia, tremors, postural instability, Anatomy and role of the basal ganglia Dopamine has many functions in the brain, including important roles in behavior and cognition, voluntary movement, motivation, punishment and reward, sleep, mood, attention, working memory, and learning. Dopaminergic neurons (i.e., neurons whose primary neurotransmitter is dopamine) are present primarily in the midbrain, the substantia nigra of the basal ganglia, and the hypothalamus (Juárez Olguín et al.,
Describe the medical management of Parkinson’s disease. Determine the optimal examination procedure, given the client’s individual presentation and current best evidence. Compare and contrast current best physical therapy interventions for the management of the client with Parkinson’s disease. Brief-BESTest (Padgett et al., 2012). Although it has been well established that physical therapy is beneficial for people with PD (Tomlinson et al., 2012), evidence on best treatments is still growing. This intermediate course is designed to provide physical therapists and physical therapist assistants with the information needed to appropriately examine and treat the client with PD, including differential diagnosis of individuals who exhibit signs and symptoms indicative of PD. In addition, the learner will be able to manage clients with PD by designing a comprehensive treatment program based on the use of appropriate outcome measures. Equipped with the most current evidence, the learner will be able to discuss and critically evaluate interventions directed at the specific body structure and function, activity, and participation deficits associated with PD. implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients
can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. EXAMINATION AND MANAGEMENT OF THE CLIENT WITH PARKINSON'S DISEASE Parkinson’s disease overview
and rigidity), it is identified as idiopathic PD, or primary PD. In contrast, when an individual exhibits these typical symptoms of PD, but also displays additional symptoms that do not fit the diagnostic criteria for idiopathic or primary PD, the individual is said to have parkinsonism or parkinsonian features. In general, all individuals who exhibit parkinsonian symptoms have dysfunction in the dopamine pathways of the basal ganglia. 2016). Lack of dopamine in the basal ganglia impacts the motor pathways, leading to symptoms such as bradykinesia and postural instability. Because of the widespread influence of dopamine in the brain, any disease that alters dopamine production or the administration of dopaminergic medications will impact many areas of the brain beyond the motor pathways.
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