4.11|World Parkinson's Day-If you have Parkinson's, rehabilitation can help

Parkinson's disease (PD) is a slowly progressive neurodegenerative disease that is common in middle-aged and elderly people, characterized by progressive degeneration of dopamine neurons in the substantia nigra of the midbrain and involving multiple systems. The main clinical manifestations are motor symptoms of bradykinesia, resting tremor, muscle rigidity, and postural gait disorders, as well as non-motor symptoms such as cognitive-emotional disorders, sleep disorders, abnormal bowel movements, pain, and fatigue. At present, drug therapy is still the basic treatment for Parkinson's disease and for controlling the progressive development of the disease. At the same time, combined with rehabilitation therapy, improving the patient's functional disorders is a necessary means to improve their ability to take care of themselves. So if you encounter Parkinson's disease, what can rehabilitation do?

According to the "Parkinson's Rehabilitation Chinese Expert Consensus" published in 2018, the rehabilitation process of Parkinson's disease can be completed based on the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. As we all know, the ICF classification system divides functional status into three dimensions, namely body function and structure, the ability of individuals to complete tasks or movements, and the ability to participate in family and social activities. The evaluation of Parkinson's patients, the selection and formulation of treatment goals and treatment plans should also be carried out step by step from these three aspects.

First of all, the functional assessment of Parkinson's patients should be based on their different clinical symptoms. Doctors and therapists use appropriate scales or evaluation methods to conduct targeted and individualized assessments of motor symptoms and non-motor symptoms. Parkinson's patients usually have problems such as bradykinesia, muscle and joint stiffness, postural balance disorders, gait abnormalities, and difficulty in hand functional activities. At this time, physical therapists can use the MDS Unified-Parkinson Disease Rating Scale (MDS-UPDRS) to assess the corresponding problems. At the same time, based on the actual situation, the Berg balance scale and functional reach test are used to quantitatively evaluate the patient's balance and body stiffness. The six-minute walk test is used to understand the patient's exercise endurance and walking status, and a simple upper limb function test or a nine-hole column test of hand functional activities is selected. For secondary conditions such as decreased muscle strength caused by long-term reduction in exercise, manual muscle strength tests and joint range of motion measurements can be selected to understand the basic situation. In view of their speech disorders and decreased swallowing function, speech therapists can use the modified Frenchay dysarthria assessment method and the water drinking test to assess them respectively.

In addition, what cannot be ignored is the non-motor function disorders of Parkinson's patients, including cognitive disorders, mood disorders, sleep disorders, etc. Questionnaires such as the Mini-Mental State Examination (MMSE), the Parkinson's Disease Cognitive Rating Scale (PD-CRS), the Depression and Anxiety Scale, and the Sleep Quality Index can all be used. Combined with the assessment of daily living activities and understanding of the quality of life, we can fully understand the disease status of Parkinson's patients and carry out targeted therapeutic interventions.

The goal of Parkinson's disease treatment must be to strengthen self-management and participation on the basis of drug treatment, to delay disease progression to the greatest extent possible, to improve various functional disorders, to improve functional independence and overall adaptability, to minimize secondary disorders and various complications, to improve ADL, and ultimately to improve the quality of life of PD patients.

What can we do about Parkinson's?

1. Lie on your back and raise your legs straight

Action essentials: Place one leg on the bed with the knee bent, straighten the other leg and lift it until the heel is 30-50 cm from the bed (depending on your ability). Hold for 15 seconds and then slowly return to the original position.

Function: Strengthens hip and knee muscles.

2. Bridge exercise

Action essentials: The patient lies on his back, puts both feet on the bed, and bends his legs. Lift the buttocks as high as possible off the bed, hold for 15 seconds, and then slowly lower it.

Function: It strengthens the hip muscles, inhibits the spasm pattern of the lower limb extensor muscles, and helps improve the control and coordination ability of the pelvis over the lower limbs. It is the basis for successful standing and walking training.

3. Trunk rotation

Action essentials: Sit down, place your hands on your thighs, and rotate your neck, shoulders, and trunk muscles as much as possible. Feel the muscles in your trunk being stretched.

Function: Promotes the activity of neck, shoulder and trunk muscles.

4. High Leg Raise

Action essentials: While keeping the upper body straight, lift each knee as high as possible toward the chest and bend at the hip joint. The patient can hold on to something for support.

Function: Improve breathing and cardiopulmonary function, promote waist, hip and leg strength, improve the flexibility of shoulder and hip joints, and exercise the whole body.

5. Application of auxiliary braces

(1) Choose appropriate auxiliary braces to prevent joint deformities and falls.

(2) To prevent deformity, patients need to wear necessary orthopedic braces.

(3) If you have difficulty dressing, you can use a dressing aid.

(4) Patients with poor upper limb function can use some self-help tools to help complete daily living skills training, such as easy-to-grip spoons and forks, fixed plates, sock putons and long-handled brushes.

(5) For patients who are bedridden for a long time, they can wear an orthosis on the affected side regularly to prevent deformities such as foot drop and inversion.

(6) To prevent patients from falling, provide them with appropriate walking aids and stabilization devices. Pay attention to adjusting the height of the walker and do not let the patient hunch over.

Hard bed.