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Lesson 35. Parkinson's Disease


a. Definition. Parkinson's disease is a progressive neurological disorder affecting the brain centers that are responsible for control of movement.

(1) Primary degenerative changes of the basal ganglia and their connections prevent motor transmission of automatic movements (blinking, facial expressions, muscle tone).
(2) The exact cause of Parkinson's is unknown. Suspected causes include genetic factors, viruses, chemical toxicity, encephalitis, and cerebrovascular disease.

b.  Signs and Symptoms.

(1) Bradykinesia, which usually becomes the most disabling symptom.
(2) Tremor which tends to decrease or disappear on purposeful movements.
(3) Rigidity, particularly of large joints.
(4) Classic shuffling gait.
(5) Muscle weakness which affects eating, chewing, swallowing, speaking, writing.
(6) Mask-like facial expression with unblinking eyes.   
(7) Depression.
(8) Dementia.

c.      Medical and Nursing Management.

(1) Treatment is based on a combination of the following:

(a) Drug therapy.
(b) Physical therapy.
(c) Rehabilitation techniques.
(d) Patient and family education.

(2) Encourage patient to participate in physical therapy and an exercise program to improve coordination and dexterity.

(a) Emphasize importance of a daily exercise program.
(b) Instruct patient in postural exercises and walking techniques to offset shuffling gait and tendency to lean forward.
(c) Encourage warm baths and showers to help relax muscles and relieve spasms.
(3) Instruct patient to establish a regular bowel routine with a high fiber diet and plenty of fluids. Constipation is a problem due to muscle weakness, lack of exercise, and drug effects.
(4) Eat a well-balanced diet. Nutritional problems develop from difficulty chewing and swallowing and dry mouth from medications.
(5) Encourage patient to be an active participant in his/her therapy and in social and recreational events, as Parkinsonism tends to lead to withdrawal and depression.
(6) Inform patient about American Parkinson's Disease Foundation for patient education and group support.

David L. Heiserman, Editor

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Revised: June 06, 2015