Parkinson's Disease (PD): A Case Study

Original Editor - Akshay Misir Top Contributors - Akshay Misir, Gurshan Mann, Mohammed Ahmed, Kevin Jeyendran, Pawmir Aminullah, Maxine Edos, Sara Bayanati, Cindy John-Chu, Kim Jackson and Uchechukwu Chukwuemeka

Introduction

Parkinson’s Disease is a progressive neurodegenerative condition that is caused by the death of dopaminergic neurons in the pars compacta within the midbrain. The Pars compacta is a dopamine producing region located in the substantia nigra of the midbrain.(9) Dopamine is a neurotransmitter that is heavily involved in neural regulation of behavioral and physiological functions such as motivation, reward, coordination, balance, neuroendocrine control, and executive function.(10) Motor symptoms of PD include uncontrollable tremor, bradykinesia, balance deficit, postural dysfunction, and rigidity. (11) Non-motor symptoms include impaired memory, planning, mood (anxiety and depression), speech, smell, and sleep (insomnia) as well as fatigue and difficulty swallowing. (11)(12)

The purpose of this case study is to portray the positive effects of VR (Virtual Reality) on motor function and quality of life in patients living with PD. Previous research demonstrates the benefits of simulating external environments within the safety and comfort of a patient’s home on the efficacy of their rehabilitation program.(13) Triegaardt et al. completed a metanalysis of ten papers (N = 343) and systematic review of 27 papers (N = 688) to investigate the use of virtual reality (VR) intervention strategies for patients with PD. Although the underlying mechanism that is responsible for how VR is beneficial for patients remains unknown, their findings demonstrate that VR is associated with a variety of improvements to physical and mental health when used in a rehabilitation program. The different domains that Triegaardt et al. examined include stride length, gait speed, balance, coordination, cognitive function, mental health, quality of life and activities of daily living.(13) The current literature supports the active approach that incorporates various types of training including balance, endurance, strength, and flexibility. This case study will demonstrate how those training techniques play an important role in improving the motor function and quality of life in those living with PD.

Intervention

Short term goals  

• Increase gait speed by 0.3m/s by the end of 3 weeks of treatment  

• Patient will be able to perform a tandem stance for at least 30s with minimal assistance within 4 weeks  

• Patient will increase strength in all bilateral shoulder movements to at least a grade 4/5 on the manual muscle testing scale by the end of 4 weeks

• Patient will increase strength in all bilateral hip and knee movements to at least a grade 4/5 on the manual muscle testing scale by the end of 4 weeks

Long term goals  

• Patient will be able to stand up and teach for at least 50% of the time within 3 months  

• Patient will be able to actively participate in playful activities with her dog in the next 4 months  

Strengthening Interventions

• Strengthening exercises are very important for our patient as they will challenge her muscles and help gain back strength. Our patient has experienced weakness post PD onset, and it is therefore crucial for our team to integrate a strengthening program to ensure that we prevent muscle atrophy. We will begin with light functional exercises and eventually progress these exercises by increasing resistance. Attached is the week 1 exercise program, the team will progress these strengthening exercises once the patient starts to comfortably perform the exercises below.

Stretching Interventions

• Stretching exercises are also extremely important to integrate into our patient’s treatment program as it will help increase her flexibility. Our patient presents with rigidity, so it is particularly important that we manage this and limit the muscle tone that she is experiencing by stretching out different muscle groups. Attached is the week 1 exercise program, the team will progress these stretches once the patient is comfortably performing the stretches below.