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Definition

Parkinson’s disease ( PD ) is a neurodegenerative disorder; patients often suffer from bradykinesia, and limb rigidity and tremor. There are also medicines and brain disorders that could induce Parkinson like symptoms.

Anatomy and Physiology

Basal ganglia ( BG ), located in both cerebral hemispheres, is engaged in movement coordination. The components of the basal ganglia include corpus striatum, lentiform nucleus, subthalamic nucleus and substantia nigra. The function of corpus striatum is supposed to transform cortical commands into conscious actions. It is modulated by acetylcholine ( Ach ) secreted in the cerebral cortex and dopamine ( DA ) secreted in the substantia nigra. Abnormality of the Ach/DA ratio may cause hyper or hypokinetic movement disorders.

Etiology

PD is caused by insufficient Dopamine in the Striato-nigra pathway.

Clinical Manifestations

• Resting tremor or “Pill-rolling” tremor
• Rigidity
• Bradykinesia
• Masked face
• Drooling
• Flexed posture
• Impaired posture reflex
• Stiff and shuffling gait

Diagnosis

PD is usually diagnosed by clinical symptoms of limb rigidity, resting tremor, and bradykinesia.

Treatment

• Medical therapy:

Clinical manifestations of PD are mainly attributed to insufficient Dopamine in Corpus striatum. Therefore, the aim of medical therapy is to increase intra-cerebral Dopamine effect.

• Surgical therapy:

Surgical therapy could improve resting tremor and rigidity of PD. However, surgery does not change the nature course of the disease or guarantee permanent improvement of symptoms. It is mostly performed on patients with severe Parkinson’s symptoms and carefully selected patients. 

• Exercise is a complement to other treatments for patients with Parkinson’s disease. Exercise programs can help you stay active and support your daily living activities. It is important for patients to conduct their exercises during an ‘on’ period when possible.

There is no exercise that clearly is better than another. The most important thing is to do exercise that you enjoy and will continue. Researchers have studied and recommend several exercises for people with PD. Some examples include:

1. Strength Training: can improve gait speed.
2. Aerobic Activity: including Treadmill training, Nordic walking, cycling, etc. This training improves cardiopulmonary function and gait.
3. Sensory attention focused exercise: applying auditory and visual cues can improve the disturbed gait pattern.
4. Gait and step training: improve gait speed, stride length and stride width, etc.
5. Balance exercise: improve gait and prevent falls.
6. Tai Chi: requiring multitasking movement which may improve gait and prevent falls.
7. Dancing: most studies were conducted in tango and Irish set dancing, which may improve motor impairments, non-motor symptoms, and quality of life. 

Conclusion

Parkinson’s disease occurs more frequently to elder people; the prolonged life span and growth of elderly population increase the prevalence of the disease. This disease affects not only the patients’ life of quality but family loading as well as burden of the society; therefore, we should get to know this disease better.