Community Resources and Disease

Parkinson's disease impacts the human brain's dopamine-secreting nerve cells. Its symptoms include tremors, gait and speech modifications and muscle rigidity. The disease has no permanent cure; a patient of Parkinson's disease can only take treatment to alleviate his/her symptoms (WebMD, 2017).

Subjective

A fifty-year-old male patient complains of trembling hands, a condition that has been aggravating over the course of the last two or three years. His hands tremble when eating, writing, tying his shoelaces, cutting things, and doing other activities by hand. He complains that his handwriting is now nearly illegible and slumping. He is a carpenter by profession, and is anxious that his problem may affect his ability to continue earning a living.

Parkinson's disease symptoms are different for different individuals. Further, with disease advancement, the symptoms transform. Initial symptoms of a particular patient may never surface in another, or may only surface at a very advanced stage of the disease. Normally, symptoms start surfacing between fifty and sixty years of age, developing gradually and frequently going undetected by the patients, their families and their friends. The following symptoms and signs may manifest themselves in Parkinson's patients:

• Tremors in limbs, usually fingers or hands.

• Muscular rigidity

• Bradykinesia or slowed movement

• Balance and posture impairments

• Reflex loss

• Modifications in writing and • Modifications in speech (MFMER, 2015).

Objective

Parkinson's patients exhibit the following four cardinal disease indications, namely, bradykinesia, resting tremors, rigidity and postural instability - 3 out ofn4 are already inhibited in our subject. Except for the last condition, two out of the remaining three are necessary for clinical diagnosis. The 4th indication, namely difficulties balancing or postural instability, only crops up in the advanced stages of the disease (often 8+ years after diagnosis).

Postural Instability

This denotes imbalance and righting reflex loss. Its appearance among Parkinson's patients is a key milestone, as it is weakly responsive to treatment as well as a frequent source of advanced stage disability. Postural instability is often gauged by making the patient stand with his/her eyes open followed by pulling his/her shoulders backwards. The patien in this case was informed of the imminent displacement and asked to regain his/her balance as fast as he/she can. It is normal to take a step or two back for regaining one's balance. Examiners were to be positioned behind the patient to ensure they can catch him if he could not regain his/her balance.

Assessment

There are various scales for quantifying Parkinson's-related motor manifestations. UPDRS (Unified Parkinson's Disease Rating Scale) comprises of 4 subscales which gauge: 1) mentation, mood and behavior; 2) everyday activities; 3) clinician judgment of Parkinson's' motor manifestations; and 4) treatment-linked complications. Subscale three-related information is based on testing while that for the remaining subscales is garnered from caregivers and patients (Perlmutter, 2010)

UPDRS Subscale 1: Mentation, Behavior, and Mood

Examiners questioned the subject on a number of mood or cognitive functioning aspects while raters score their answers on a 0-4 scale; 4 marks highest dysfunction level, depending on caregiver/patient reactions. Hence, the sum total of scores for subscale 1 lie between 0 (normal) and 16.

UPDRS Subscale 2: Activities of Daily Living

Patient was made to describe their functions separately at OFF and ON states. Hence, answers for this 14-item subscale are scored two times (for OFF and ON separately). Ratings depend on caregiver/patient reactions, with overall subscale score lying between 0 and 56.

UPDRS Subscale 3: Motor Examination

Parkinson's related motor manifestations are assessed by this subscale. This most widely utilized subscale involves 14 distinct kinds of ratings, ranging between 0 and 4. A number of ratings are separately carried out for different limbs. The earliest form of UPDRS used only integers; however, some of them employ 0.5 increments, which hasn't been "clinometrically" tested or validated. The sum total of scores for 27 observations for this subscale lies between 0 and 108.

Plan

There is no treatment available for stemming or reversing Parkinson's related nerve cell breakdown. However, numerous therapies facilitate symptom alleviation and improved patient quality of life (QOL). Patient age, family, employment status and living conditions impact treatment commencement decisions, kind of therapy to employ, and decisions pertaining to therapeutic changes. With transformations in the patient's health condition, routine therapy changes for balancing QOL problems, therapy expenses and side effects are necessary. The patient must routinely visit healthcare team members (once in three months or half a year, or as instructed) to adjust his/her therapy with health condition changes.

Parkinson's Treatments include:

• Medicines, like dopamine and levodopa agonists, which are the most widely employed Parkinson's therapy which were given to our subject.

• Home treatment. Numerous home remedies exist to assuage Parkinson's symptoms, including eating nutritious food and exercising regularly which were advised for our subject.

• Surgery. Deep brain stimulation and other brain surgeries can be taken into account if medication cannot control Parkinson's symptoms or yields disabling or acute side-effects.

• Speech Therapy. Speech and breathing exercises aid patients in overcoming their monotone and subtly imprecise speech which develop during advanced stages of the disease and these were strongly recommended for our subject.

• Occupational Therapy. Through this, patients learn novel ways of doing things independently and remaining independent longer which was an advised treatment for our subject.

• Physical Therapy. This can improve patients' walking and lower their susceptibility to falls.

• Mental health-issue therapy. Parkinson's patients may start experiencing issues with cognitive functions including memory, learning and problem solving. Dementia occurs when these issues prevent them from performing their everyday tasks, a problem that may be treated via medications.

Disease Prevention/Health Promotion

Undoubtedly, prevention of Parkinson's is the ideal course for our subject, which may be achieved through the following steps.

Consume Fresh Vegetables Raw

Researchers reveal that insufficient folic acid in the diet can increase Parkinson's development risks. Raw fresh vegetables form a great folic acid source. Thus, vegetable juices can be easily included in the subject's diet.

Avoid Petrochemical Solvents and Pesticides

Herbicide, pesticide, insecticide, glue, paint, and other petroleum-based hydrocarbon solvent exposures are all associated with Parkinson's disease. Fumes from mosquito fogging should be carefully avoided as they contain pesticides in huge doses. Also, home paints should be of low volatility and doors and windows should be left wide open to allow proper ventilation immediately after painting.