→ Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability.
→ Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson’s disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells (neurons).

→ Parkinsonism disease (PD) is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. For reasons not yet understood, the dopamine-producing nerve cells of the substantia nigra begin to die off in some individuals. When 80 percent of dopamine is lost, PD symptoms such as tremor, slowness of movement, stiffness, and balance problems occur.
→ Body movement is controlled by a complex chain of decisions involving inter-connected groups of nerve cells called ganglia. Information comes to a central area of the brain called the striatum, which works with the substantia nigra to send impulses back and forth from the spinal cord to the brain. The basal ganglia and cerebellum are responsible for ensuring that movement is carried out in a smooth, fluid manner.

→ STAGE ONE – A Person usually has mild symptoms, such as tremors or shaking in a limb.Change such as poor posture, loss of balance,and abnormal facial expressions.
→ STAGE TWO – Symptoms affect both limbs and both sides of the body. The person has usually has problem walking or balancing, and the inability to complete physical tasks becomes more apparent.
→ STAGE THREE – Symptoms can be severe and include the inability to walk straight or stand. there is a noticeable slowing of physical movements.
→ STAGE FOUR – The ability to walk is often limited
→ STAGE FIVE – THE PERSON is often unable to take care of herself and may not be able to stand or walk .she may need constant one on one nursing care.

→ Brain injury
→ Encephalitis
→ Meningitis
→ Multiple system atrophy
→ Progressive supranuclear palsy
→ Stroke
→ Wilson disease

Other causes of secondary Parkinsonism include:

→ Brain damage caused by anesthesia drugs (such as during surgery)
→ Carbon monoxide poisoning
→ Certain medicines used to treat mental disorders or nausea
→ Mercury poisoning and other chemical poisonings
→ Overdoses of narcotics
→ MPTP (a contaminant in some street drugs)

→ Symptoms of Parkinson’s disease differ from person to person. They also change as the disease progresses.
→ Symptoms typically begin appearing between the ages of 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them.
→ The most common one is tremor.
Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson’s disease is a tremor of your hand when it is relaxed (at rest).
Slowed movement (bradykinesia). Over time, Parkinson’s disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move.

Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain.
Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease.
Loss of automatic movements. In Parkinson’s disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
Speech changes. You may have speech problems as a result of Parkinson’s disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
Writing changes. It may become hard to write, and your writing may appear small.


→ Computed tomography (CT) scans of people with PD usually appear normal.
→ MRI has become more accurate in diagnosis of the disease over time, specifically through iron-sensitive T2* and SWI sequences at a magnetic field strength of at least 3T, both of which can demonstrate absence of the characteristic ‘swallow tail’ imaging pattern in the dorsolateral substantia nigra.

→ Carbidopa-levodopa.
→ Carbidopa-levodopa infusion.
→ Dopamine agonists.
→ MAO-B inhibitors.
→ Catechol-O-methyltransferase (COMT) inhibitors.
→ Anticholinergics.
→ Amantadine.

→ Maintain and improve levels of function and independence, which will help to improve a person’s quality of life
→ Use exercise and movement strategies to improve mobility
→ Correct and improve abnormal movement patterns and posture, where possible
→ Maximize muscle strength and joint flexibility
→ Correct and improve posture and balance, and minimise risks of falls
→ Maintain a good breathing pattern and effective cough
→ Educate the person with Parkinson’s and their carer or family members
→ Enhance the effects of drug therapy

Visual cueing – a focus point to step over and initiate gait; strips of tape on the floor to initiate or continue walking through areas that cause slowing or freezing.

Auditory cueing – counting 1-2-3 to initiate walking; stepping to the beat of a metronome or specific music at a specified cadence to continue the rhythm of a walk.

Gait Training Exercise

Attention – Thinking about taking a big step; making a wider arc turn

Proprioceptive cueing – rocking from side to side ready to initiate a step; taking one step backwards as a cue ready to then walk forwards.



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