Parkinson Disease stage

Bismillahirahmanirahim..

Parkinson’sDisease

Definition Of Parkinson’s

A disorder of the brain characterized by shaking and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that controls muscle movement.

Definition Of Parkinson’s Disease In More Detail And More Info.

Parkinson’s disease is an age-related neurologic disease that affects movement, balance, speech swallowing, walking, and muscle tone. Parkinson’s disease affect a region of the brain known as the basil ganglia. One-half to one million persons in the United States are affected with this chronic debilitating disease. Parkinson’s disease was the first neurologic disease to be associated with the loss of a specific neurotransmitter, in this case, dopamine. The cardinal manifestations of Parkinson’s disease include: tremor that usually occurs at rest and can affect any part of the body, bradykinesia that is a slowness of movement, akinesia or obsence of certain movements, and increased muscle tone.

Alternative Names

·         Paralysis Agitans

·         Shaking Palsy

History

·         It appears both in female and male

·         Ages 50 - 79

·         This disease is more prominent on the Pacific Island of Guam and Thekii Peninsula of Japan than anywhere else in the world.(they are trying to find out why)

·         Caucasians get Parkinson’s disease just a little bit more than black people.(less pigment is suspected.

·         Parkinson’s disease reduces life expectancy due to increased incidence of infection associated with chronic immobility

Causes, incidence, and risk factors

·         Parkinson's disease was first described in England in 1817 by James Parkinson. The disease affects approximately 2 out of 1,000 people, and most often develops after age 50.

·         It affects both men and women and is one of the most common neurologic disorders of the elderly.

·         The term "parkinsonism" refers to any condition that involves a combination of the types of changes in movement seen in Parkinson's disease, which happens to be the most common condition causing this group of symptoms.

·         Parkinsonism may be caused by other disorders or by external factors Secondary Parkinsonism.

·         Parkinson's disease is caused by progressive deterioration of the nerve cells of the part of the brain that controls muscle movement (the basal ganglia and the extrapyramidal area).

·          Dopamine, which is one of the substances used by cells to transmit impulses (transmitters), is normally produced in this area. Deterioration of this area of the brain reduces the amount of dopamine available to the body.

·          Insufficient dopamine disturbs the balance between dopamine and other transmitters, such as acetylcholine. Without dopamine, the nerve cells cannot properly transmit messages, and this results in the loss of muscle function.

·         The exact reason that the cells of the brain deteriorate is unknown. The disorder may affect one or both sides of the body, with varying degrees of loss of function.

·         In addition to the loss of muscle control, some people with Parkinson's disease become severely depressed.

·          Although early loss of mental capacities is uncommon, with severe Parkinson's the person may exhibit overall mental deterioration (including dementia , hallucinations , and so on). Dementia can also be a side effect of some of the medications used to treat the disorder.

·         Parkinson's disease is rare in children. When present, it appears to be due to decreased sensitivity of the nerves (post-synaptic) to dopamine rather than deterioration of the area of the brain that produces dopamine.

Another Type Of Parkinsonism

Secondary Parkinsonism

·         There are different stages of Parkinson’s but Secondary is one of them.

·         Conditions which do not usually affect the midbrain that involve the substantia nigra

·         ex.-Trauma such as head injuries from boxing can damage the substantia nigra and lead to Parkinson’s Disease (this is what happen to Mohammed Ali).

·         Or trauma, Ischemia (stroke), Hemorrhage (stroke), Neoplasma (cancer), Neurosyphilis, Tuberculosis.

The Clinical Picture

Trap

Tremor (at rest)

Rigidity (cogwheel)

Akinesia

Postural Instability

Tremor

·         An involuntary movement which may affect the head, limbs, or entire body.

·         Most apparent when limb is related and supported

·         Increased with stress

·         Ceased during sleep

·         Decreased with intentional movements

·         ‘Pill rolling tremor’ if most prominent in fingers and hand

·         Most bothersome, yet least disabling of all symptoms

Rigidity

·         Muscular stiffness and increased muscle tone

·         Patients usually unaware of rigidity but troubled with slowness

·         More apparent to doctor than patient

·         Cogwheeling (affect when moving arms)

Bradykinesia/Akinesia

·         Akinesia: inability to move

·         Bradykinesia: slowness of movement

Most Disabling Feature

·         Decrease in:

·         eye blinking

·         facial expression

·         eating and chewing

·         walking speed

Postural Instability

·         Impaired righting ability

·         Toe-first walk develops

·         Decreased arm swing when walking

·         Posture stooped, knees flexed while walking

·         Unsteadiness while turning

·         Falls will occur

Stage 1

·         Mild one sided tremor or rigidity

·         Affected arm in semi flexed position with tremor

·         Patient leans to affected side

·         One sided disease plus axial (waist) involvement

Stage 2

·         Bilateral involvement

·         Early postural changes

·         Slow, shuffling gait

·         Decreased stride length

·         Mild bilateral involvement

·         Recovery on pull test

Stage 3

·         Pronounced gait disturbances

·         Moderate generalization disability

·         Balanced is a major problem

·         Server tremor, rigidity and/or brandykinesia

Stage 4

·         Significant disability

·         Limited ambulation with assistance

Stage 5

·         Loss of ability to function independently

·         Brandykinesia very severe

·         Independent mobility impossible

Treatments

·         There is no known cure for Parkinson's disease. Treatment is aimed at controlling the symptoms. Medications control symptoms primarily by controlling the imbalance between the transmitters.

·         The medications used vary, depending on the case. The type of medication, the dose, and the amount of time between doses, or the combination of medications used may need to be adjusted as symptoms change.

·         Many of the medications can cause severe side effects, so monitoring and follow-up by the health care provider is important.

·         Deprenyl may be started early in the disorder to slow progression of symptoms and reduce the need for other medications.

·          Amantadine and/or anticholinergic medications may be used to reduce early or mild tremors.

·         Levodopa is a medication that the body converts to dopamine. (It may be used to increase the body's supply of dopamine, which may improve movement and balance.)

·         Carbidopa is a medication that reduces the side effects of Levodopa and makes the Levodopa work better.

·         Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, bromocriptine, monoamine oxidase inhibitors, and others.

·         Good general nutrition and health are important, such as exercise, regular rest periods,avoid stress and tiredness because this can make symptoms worse.

·         Physical therapy, speech therapy, and occupational therapy may help promote functioning, positive attitude, and independence.

Complications

·         disability, varying degrees

·         difficulty swallowing/eating

·         difficulty performing daily activities

·         injuries from falls

·         side effects of medications

Additional Information

·         Experimental or less common treatments may be recommended. For example, surgery to destroy tissues responsible for tremors may reduce symptoms in some people. Transplantation of adrenal gland tissue (and fetal brain tissue) to the brain has been attempted, with variable results.

·         Untreated, the disorder progresses to total disability, often accompanied by general deterioration of all brain functions. It may result in an early death if untreated.
 

            wallahuaklam.

Best and effective Tips for Back Pain prevention

Back Pain (Guideline)

Back Pain Snippets

About 85% of Malaysians experience back trouble by age 50.

Back problems are the most frequent cause of activity limitations in working-age adults.

In the long run, surgery, chiropractic care, etc., are considered no more effective than no treatment in reducing low back pain.

The Spinal Column

The human spinal column is the center of postural control.

It is built to provide stability and at the same time allow flexibility. 

These two seemingly incompatible functions of support (inflexibility) and movement (flexibility) are at opposite ends of a spectrum of movement, and this fact is one reason the spine is so vulnerable to injury.

The Spine - Disk Nutrition

Located between the vertebrae in our backs are discs which act as the shock absorbers for the spine.

Discs begin losing blood supply by age 20. 

We feed our disks by moving fluids into and out of them through mechanical compression and decompression (one reason to move about while at work).

Forces Acting on the Spine

Compressive forces push bones and discs together.

Tensile forces act (pull) on ligaments, tendons and muscles.

Typically these forces occur simultaneously, for example, when lifting objects, or when “slouching.”

Back Injury Risk Factors – Acute

Acute (traumatic) back injury may occur due to:

slips, trips and falls;

auto accidents;

sedentary lifestyle (with occasional lifting);

heavy and/or awkward loads;

improper lifting technique.

Back Injury Risk Factors – Chronic

Chronic back injury may result from poor posture and/or improper lifting technique combined with repetitive lifting.

Additionally, genetics and overall physical fitness may affect spine health.

Back Injury Risk Factors – Chronic

Maintaining a neutral spinal posture is important when seated as well as during lifting tasks. 

If sitting without back support, rotate the hips forward until a neutral posture is achieved. 

If using the backrest, sit back in the chair to allow the backrest to help maintain a neutral posture and reduce muscle loading

Risk Reduction - Engineering/Design

You can design a safer lifting environment by: 

avoiding very high and very low object placement;

reducing object weight and size;

providing handles;

eliminating the need for twisting motions;

eliminating bending and stooped postures; and

by providing mechanical assistance.

Risk Reduction - Lifting Tips

When lifting, you can substantially reduce your risk of low back injury and pain by:

keeping the object close to you;

bending your knees;

maintaining your lumbar curve (bend knees and stick buttocks out);

not twisting or bending sideways;

avoiding rapid, jerky movements; and

asking for assistance with heavy and/or bulky loads.

Risk Reduction at Home

Maintaining a neutral spinal posture  when stooped (e.g., when shaving, brushing teeth, bathing children, repairing cars, shoveling, etc.) may reduce your risk of back injury and discomfort.

Planning your lifts, getting assistance, and using mechanical advantage are examples of risk reduction strategies.

Back Pain - When to Seek Help

For common back strain, give home remedies a try for 72 hours.

In rare cases, back pain can indicate a serious problem - seek medical attention if:

• you have weakness or numbness in either leg;
• you have a fever along with back pain;
• you notice new bladder or bowel control problems;
• your pain increases with lying down; or
• you have a history of significant chronic disease, such as osteoporosis, cancer or diabetes

Medical Intervention Snippets

Less than 5% of back pain is caused by serious diseases (e.g., cancer or infection) or by anatomical problems that require surgery.

Surgery is almost always elective, possibly providing faster relief of symptoms but may have little effect on long term outcomes.

Non-specific pain could originate with the muscles, ligaments, facet joints or discs and it is generally impossible to be certain of the exact cause.

Medical Intervention Snippets

In a small fraction of cases, the pain will move down the leg into the foot, usually as a result of a disc herniation; however, only about 2% of persons with back pain undergo surgery.

Most herniated disc symptoms abate without surgery and have been found to be surprisingly common even in non-symptomatic adults.

  

Stretching and Exercise

Stretching and exercise are often recommended for back pain, however, some of these activities may aggravate some conditions.

Some discomfort is considered acceptable during the activity, but should not persist when the activity is discontinued.

Speak to your physician or other health care practitioner for stretches and exercises suited to your specific condition.

Back Belts

The National Institute for Occupational Safety & Health has concluded that:

there is insufficient data to support back belt endorsement;

there is a potential for cardiovascular problems and;

back belts are not considered personal protective equipment.

To issue a back belt, ISU requires:

• job analysis
• medical recommendation
• fitting 
• employee training

Thoracic outlet syndrome problem and phase

    

TOS

                   

PHASE-1 (MANAGE ACUTE SYMPTOMS)

1.    TO CONTROL SWELLING

2.    POSITION YOUR ARM IN RESTING POSITION AND MAY USE A SHOULDER IMMOBILISER UNTIL PAIN IS REDUCED

3.    PROM/AAROM/AROM OF SPINE,SHOULDER AND RELATED JOINTS

4.    RHYTHMICAL PASSIVE SIDE FLEXION OF THE NECK AWAY FROM THE SIDE WITH THE SHOULDER GIRDLE ON THE AFFECTED SIDE FIXED TO STRETCH THE SCALENI

5.    HOLD RELAX AND REPEATED CONTRACTION TECHNIQUES TO LEGTHEN THE SCALENI

6.    STRETCH PECTORALIS MINOR, SHOULDER RETRACTORS,SHOULDER LATERAL ROTATORS

7.    IF NERVE PAIN ,THEN USE ICE ,POSITIONING AND DESENSITIZATION TECHNIQUES SUCH AS VIBRATION ,BRUSHING ETC

PHASE-2 (PAIN STABILIZED)

1.    NEURAL MOBILISATIONS FOR SPECIFIC NERVES

2.    INTRODUCE MORE EXERCISES FOR STABILIZATION AND NEUTRAL POSITIONING

3.    MANUAL TECHNIQUES- APPLIED  TO SUPERIOR SURFACE OF THE RIB IN CAUDAL DIRECTION

4.    BY THE END OF THE PHASE THE PATIENT SHOULD BE ABLE TO CONTROL CERVICAL,THORACIC,LUMBAR AND SCAPULAR NEUTRAL POSITIONS IN SITTING,STANDING,SUPINE/PRONE AND SIDE-LYING

PHASE-3 (PROGRESSING TO FUNCTION)

1.    PROGRESS TO FUNCTIONAL MOVEMENT SLOWLY, WITH A FOCUS ON ACTIVELY CONTROLLING NEUTRAL POSITIONS BEFORE ADDING WEIGHT

2.    RECOMMEND ABOUT ERGONOMICS AND WORKING

3.    ADD RESISTANCE TO EXERCISES

·       NO CERVICAL TRACTION

Best Exercise of pelvic floor for man

Bismillahirahmanirahim.....

PELVIC FLOOR EXERCISES IN MEN

OBJECTIVES

At the end of this lecture every one should be able to describe

·         Why pelvic floor muscles get weak in men.

·         How to check pelvic floor muscles in men.

·         How to perform pelvic floor exercises in men.

INTRODUCTION

The pelvic floor consists of layers of muscle that provide a‘hammock’ or ‘sling’ from the pubic bone at the front to the coccyx at the back. Its function is to support the pelvic organs—the bladder and rectum, helping to keep these structures in the correct position and to keep the bladder and back passage outlets closed. This prevents the leakage of urine or faeces and acts as a safety mechanism in men.

WHY THE PELVIC FLOOR MUSCLES GET WEAK
The pelvic floor muscles can be weakened by:

·         some operations for prostate disease

·         continual straining to empty your bowels, usually due to constipation

·         a chronic cough, such as smoker’s cough or chronic bronchitis or asthma

·         being overweight.

·         persistent heavy lifting

·         Neurological damage (e.g., after a stroke or spinal injury, or resulting from multiple sclerosis or other conditions) can also produce poor pelvic muscle function.

HOW TO CHECK PELVIC FLOOR MUSCLES IN MEN

The following techniques help you to identify your pelvic floor muscles:

1. Imagine trying to stop the flow of urine mid stream (the stop test)

2. Imagine trying to stop passing wind

·         The first thing to do is to identify correctly the muscles that need to be exercised.

·         Sit or lie comfortably with muscles of your thighs, buttocks and abdomen relaxed.

·         Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks or tighten your thighs or tummy muscles.

·         Imagine you are passing urine, trying to stop the flow mid-stream, then restarting it. (You can do this "for real" if you wish, but do so only to learn which muscles are the correct ones to use: do not make a practice of it or it may interfere with normal bladder emptying.) If your technique is correct, each time that you tighten your pelvic floor muscles you may feel the base of your penis move up slightly towards your abdomen.

·         If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles (or are unable to even slow the stream of urine as described in point 3), you should seek professional help to get your pelvic floor muscles working correctly

DOING YOUR PELVIC FLOOR EXERCISES

Now that you can feel the muscles working, you can start to exercise them:

·         Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Try and hold this contraction strongly as you count to five, then release slowly and relax for a few seconds. You should have a definite feeling of "letting go".

·         Repeat ("squeeze and lift") and relax. It is important to rest in between each contraction. If you find it easy to hold the contraction for a count of five, try to hold for longer - up to ten seconds

·         Repeat this as many times as you are able up to a maximum of 8-10 squeezes. Make each tightening a strong, slow and controlled contraction.

·         Now do five to ten short, fast, but strong contractions, pulling up and immediately letting go.

·         Do this whole exercise routine at least 3-4 times every day. You can do it in a variety of positions - lying, sitting, standing, walking.

·          It is important to do both sets of exercises as the slow contractions help build up stamina of the muscle and the rapid exercises help the pelvic floor muscles to respond quickly when needed.

WHILE DOING THE EXERCISES:

1.      DO NOT hold your breath.

2.      DO NOT push down instead of squeezing and lifting up.

3.      DO NOT tighten your tummy, buttocks or thighs.

POINTS TO REMEMBER:

·         Get into the habit of doing your exercises regularly.

·         Watch your weight. As your weight increases the amount of strain on your pelvic floor muscles also increases.

·         You may find the exercises more difficult to do in the evening when you muscles are tired. If you notice this is a problem for you, try to do your exercises in the first part of the day.

·         Avoid constipation and prevent any straining during a bowel movement.

·         Seek medical advice for hay-fever, asthma or bronchitis to reduce sneezing and coughing.

·         Share the lifting of heavy loads.

ADDITIONAL BENEFITS OF PELVIC FLOOR EXERCISES FOR MEN

·         Pelvic floor exercises for men have been found to be highly effective in restoring erectile function according to recently published research. Research at the Faculty of Health and Social Care at the University of the West of England, Bristol, shows that pelvic floor exercises result in the same overall improvement rate seen in a large trial of men taking Viagra.      

      

    Wallahuaklam..

                     

Physiotherapy and PROCEDURE: Postural Drainage

 Procedure : Postural Drainage

DEFINITION/DESCRIPTION

The use of gravity to facilitate the drainage of excess secretions from the lung

CONTRAINDICATIONS:

-           subject intolerance

-           swelling of the brain or recent head injury

-           cardiovascular instability

-           a recent history of coughing up blood

-           nose bleed

-           undrained air in the space around the lung

-           hiatus hernia

-           recent ear, nose or throat surgery

-           eye surgery

-           recent removal of one lung

-           recent heart surgery

-           recent stomach surgery

-           unstable spinal cord injury

-           connection between a major airway and the space surrounding the lung

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           hypertension

-           headache

-           recent history of seizures

-           abdominal distension

-           indigestion

INFECTION CONTROL:

-           hand hygiene

-           appropriate management and disposal of expectorated products