1. tremor at rest 2. sluggish intention of movements (poverty of movement) 3. muscle rigidity 4. postural instability
Incidence: 1 in 250 people over age 40; 1 in 100 over 65
Etiology: While the cause is idiopathic, there is a loss of the neurons in the substantia nigra of the basal ganglia and midbrain, which release dopamine.
Secondary Parkinsonism may be caused by encephalitis, trauma, carbon monoxide poisoning, and infarction in the midbrain.
Pathophysiology: The loss of dopamine leads to loss of inhibition from the basal ganglia. This loss of inhibition leads to unchecked excitation from areas that control movements.
Signs and symptoms:
1. The condition begins insidiously with a resting pill-rolling tremor of one hand. The tremor is maximal at rest, lessens with movement, and disappears while sleeping. It is enhanced by emotional tension or fatigue. The hands, arms, and legs usually are most affected, in that order. Many patients display only rigidity and never manifest tremor.
2. Reflexes and strength are often normal.
3. Hypertonia and progressive rigidity
4. Slowness and poverty of movement (bradykinesia), and difficulty in initiating movement.
5. Rigidity and hypokinesia may contribute to muscular aches and sensations of fatigue.
6. The face has a blank expression and is mask-like (Parkinson's mask) and open- mouthed, with diminished blinking. Patient may drool, or choke.
7. Posture becomes stooped.
8. Patients find it difficult to start walking; the gait becomes shuffling with short steps, and the arms are held flexed to the waist and fail to swing with the stride. The steps may inadvertently quicken and the patient may break into a run to keep from falling. This is a festinating gait (festination).
9. A loss of balance and tendency to fall forward or backward when the center of gravity is displaced results from the loss of postural reflexes.
Note: most symptoms appear together in what is known as Parkinson's syndrome: tremor, hypertonus, rigidity, blank face, festination. [There is also loss of balance, frequent falling, and poverty of movement.]
Massage Treatment: Full body massage to try to lessen rigidity. Lots of PROM and gentle stretching Medical : Medications such as levadopa (carbidopa) which can produce side effects of
athetosis, involuntary movements of tongue and lips, head bobbing, grimacing Stem cell transplants, DBS, laser surgery