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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…
References
Harvard Health Letter. (2012). Exercise helps prevent, fight Parkinson's disease. Harvard Health Letter. Retrieved from http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/March/another-reason-to-get-out-there-and-get-moving?utm_source=health&utm_medium=pressrelease&utm_campaign=Health0312
MFMER. (2015, July 7). Parkinson's disease. Retrieved from Mayo Foundation for Medical Education and Research: http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/symptoms/con-20028488
Parkinson's Disease Foundation, Inc. (2017, February). Resources for People with Parkinson's. Retrieved from Parkinson's Disease Foundation, Inc.: http://www.pdf.org/en/summer08_resources
Perlmutter, J. S. (2010). Assessment of Parkinson Disease Manifestations. Curr Protoc Neurosci, 10(1).
WebMD. (2017, February). Parkinson's Disease Health Center. Retrieved from http://www.webmd.com/parkinsons-disease/tc/parkinsons-disease-symptoms
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