Kendell M. Jno-Finn 9/15/2018 1
Parkinson's Disease
KE NDE LL M. JNO- FINN, PT, DPT, TPI , FMS, FCS
A Team Approach
CONGRATULATIONS!
Kendell M. Jno-Finn 9/15/2018 2
Now What?Advocacy
Engagement
Collaboration◦ This domain is where we will focus most of our time.
◦ Where do you see this today?
◦ What does it look like in 5 years?
◦ What does it look like in 10 years?
Let's Start With A Story...Oren is an established patient diagnosed with Parkinson's Disease (PD) who was discharged after a successful Physical Therapy episode of care.
He lived independently, drove and was independent with instrumental activities of daily living (IADLs)
He was given a home exercise program (HEP) which he understood and committed to being compliant with.
He return to the clinic after a year and must be driven to his appointment.
He is no longer living independently
His mobility, safety and confidence are all decreased
What is the outlook in this scenario?
Kendell M. Jno-Finn 9/15/2018 3
Putting the Puzzle TogetherMicroscopic versus macroscopic management◦Are the presentations typical?
Two dimensions of symptom presentation◦ Is this a movement problem or a psychological problem
Pharmacology conundrum◦Are prescribing criteria clear-cut?
Communication paradox◦Does our current facility models meet the needs of this patient
population?
Digging A Little DeeperFive Stages
Varied age presentations
60,000 new cases each year
PD versus Parkinsonism (Parkinson - plus syndrome)
Parkinsonism◦ More difficult to treat than PD
◦ There are six types
$25 Billion impact
Kendell M. Jno-Finn 9/15/2018 4
I Have a Movement Problem!
Shaking or tremor at rest
Bradykinesia or freezing—being
stuck in place when attempting to walk
Low voice volume or muffled speech
Lack of facial expression
Stiffness or rigidity of the arms, legs or
trunk
Trouble with balance and falls
Stooped posture
Decreased ability to swallow (dysphagia) and drooling Non-
Motor
This Doesn't Sound Like A Movement Problem
Depression Anxiety ConstipationCognitive
decline and dementia
Impulse control
disorders
Orthostatic hypotension
PainHallucinations and psychosis
Sleep disturbances
Sexual dysfunction
Urinary dysfunction
The Pillbox
L-DOPA Dopamine Agonist
MAO-B Inhibitors Anti-Cholinergics
COM-T Inhibitors
Other
• Amantadine
• antiviral (side effects can be helpfu)
Kendell M. Jno-Finn 9/15/2018 5
Surgical Options
Deep Brain Stimulation (DBS)◦ Implanted device
Duopa◦Gel delivery system through a stoma versus pill
◦Delivered directly to the gut
◦MAO excludes this as an option
Proceed With Extreme Caution
Antipsychotics
Pain Medication
Anesthesia
Nausea/ GI Drugs
Antidepressants
Facility Management
Carbidopa-levodopa confusion
1
Timing of carbidopa-levodopa regarding meals and surgery
2
Carbidopa-levodopa dosing intervals
3
Non-Motor Presentations revisited
•Insomnia
•Orthostatic hypotension
•Nausea
•Hallucinations and delusions
•Pain and levodopa
•Dyskinesias
•Anxiety and panic
4
Kendell M. Jno-Finn 9/15/2018 6
Acceptance doesn't mean resignation: it
means understanding that something is what it is and that there's got to be a way through it.
~ Michael J. Fox