Parkinson's Disease and Physical Therapy - Research Paper Example

?Summarize and analyze the article “Is Physical Exercise Beneficial for Persons with Parkinson’s Disease?” is a study based on literature reviewing by Alexander Michael Crizzle and Ian J. Newhouse. 1 Indicators of physical therapy’s impacts on studied patients are improved strength, balance, mobility, activities of daily living and decreased mortality. Adopting a well stipulated indicator for measuring the performance before and after receiving physical therapy by the studied patients had been a significant criterion for selecting studies for this literature analysis. Other criteria for selecting theses particular studies include technical and convenience related considerations. Authors have adhered to the following literature compilations as data sources (1) Cochrane Database of Systematic Reviews (CDSR) (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL) (3) PubMed and (4) Medline/NARIC (National Rehabilitation Information Center) (pp 423). Nevertheless the statistical or technical rational behind selecting these particular sources, is not provided in the report. Following are the criteria for selecting seven research studies from the above data sources; subjects are patients with Parkinson’s Disease, researchers intervention consists physical therapy, the effects of the physical exercise were evaluated, published in one of the above journals and are written in English language2. Authors have omitted the studies involving drugs and physical therapy integrated treatment programs. Study first introduces Parkinson’s Disease, symptoms, causes and vulnerable persons. The medical condition termed as Parkinson’s Disease is resulted by lacking of neurotransmitter dopamine which is the biochemical coordinating the functions of substantia nigra and the striatum of human brain. Due to lacking of coordination between these two brain structures patients’ movement, balance, walking, swallowing and speech abilities deteriorate. Hence results in the medical conditions known as akinesia, bradykinesia, postural instability, pathologic muscle tremor at approximately 5 to 6Hz and increased susceptibility to falling and hip fractures.2 A person in any age can strike with Parkinson’s Disease. But the incident and prevalence is high among the elderly population example: 20 per 100,000 elderly in the United States are suffering from this disease. Diagnosing Parkinson’s Disease is difficult because most of its symptoms are also general signs of aging. Furthermore appearance of the first clinical symptoms is generally happening after 60% to 80% degeneration of the dopamine producing cells in the brain. Despite using prescribed drugs or therapeutic treatments the general health conditions of Parkinson’s Disease patients continue to worsen. Thus it is a medical condition that can be temporarily controlled but incurable in long term. According to the previous studies integrated treatments of physical therapy, rehabilitation, psychotherapy and prescribed drugs are used for Parkinson’s Disease. Physical therapy for these patients consists of activities such as gait training, training of daily activities, relaxation therapy, and breathing exercises which mainly focuses on the functional disabilities of these patients. The benefits of physical exercises can be described as follows. Firstly, physiotherapy is useful for treating akinesia and bradykinesia symptoms by substituting the external reference points for internal motor generation in patients with Parkinson’s Disease. Secondly, moderate level exercise increases the dopamine level in plasma. Thirdly, the intensity of physical exercises and the level of activity of dopamine consists a statistically significant correlation i.e. with increasing the intensity of exercising the activity of dopamine increases at exponential rates. Benefits of physiotherapy are observed in terms increased stride length, walking speed, walking ability, activities of daily living (ADL), health related quality of life and decreased side effects of prolonged drug usage. Physical exercises are capable of increasing the longevity of muscles and slowing the nurodegenerative process associated with Parkinson’s Disease (pp 423).When the physical deterioration is somehow slowed the prescribing dosage of drugs is also lowered. Thus authors suggest that physiotherapy can delay or reverse the secondary complications arising as the side effects of prolonged drugs intake by the patients with Parkinson’s Disease. When psychotherapy is integrated to the treatment program the effectiveness of physiotherapy increases i.e. educating patients and their families about the benefits of exercising program. 2 Since there is no cure for Parkinson’s Disease, its victims are eventually institutionalized. In addition to increasing the effectiveness of physical therapy, group treatment and psychotherapy sessions are also beneficial for the patients and their families while coping up with the fears and socio-economic challenges related to the Parkinson’s Disease. Thus rehabilitation is rationalized by many of the authors. Nevertheless authors of the current study indicate the dearth of studies relating to rehabilitating of patients with Parkinson’s Disease. Authors have used a specific combination of key words for locating the relevant literature in above mentioned data sources i.e. Parkinson’s disease, Parkinson disease, exercise and physical exercise. Accordingly Hirsch et al, 2003, Miyai et al, 2002 and Schenkman et al, 1998 are randomized controlled studies. These three studies involved 15, 24 and 46 patients respectively. In the first study one group received balance and training excersise while the other group received balance training only. Results showed decreased number of falls and long lasting effects on the group which received both types of exercises. In the second study one group received body weight supported treadmill training while the other group received normal physiotherapy for the same time duration per month. Results showed improved performance on short step gait by the group who received treadmill training. In the third study one group received individual physical exercises while the second group had no intervention. Findings revealed significant improvements in axial rotation and functional reach by the first group (pp 424). Baatile et al, 2000, Nieuwboer et al, 2001 and Kuroda et al, 1992 studies are based on patients’ questionnaire to evaluate the effect of physiotherapy. These three studies involved 6, 33 and 438 patients respectively. In the first study all the subjects revealed improved mobility and activities of daily life while in the second study home care and hospital care settings showed significantly high improvements. The third study revealed much lower mortality rates among the patients who exercised compared to the otherwise. Reuter et al, 1997, is an open trial study involving 16 participants who are able to walk and stand without help and had no cardio vesicular disease. Significant improvements in physical and mental conditions of the patients were observed after involving in standardized sport activities in water and gym. The specific source which the above studies were picked from is not mentioned in the report. It is mentioned that 2 studies from PubMed, 3 from NAIRC and 4 studies each from CDSR and CINAHL qualified authors’ selection criteria. Subjects of these selected studies include both male and female patients and the number of observations varied from 6 to 438. Authors also claim that reliability of some studies on Parkinson’s Disease and physiotherapy was low due to the drawbacks in the research methodologies,3 example: not involving before and after comparison and not reporting selection criteria of the patients. A number of new research avenues have been suggested for future researches. Firstly authors indicate that there is no scientific literature on rehabilitation of patients with Parkinson’s Disease. Whether treating at home environment is more effective compared to institutionalization is not known (425pp). Secondly physical therapy is widely accepted as an effective treatment for Parkinson’s Disease in scientific literature. There is a need for developing standardized exercise programs specific for problems associated with Parkinson’s Disease. These programs can be specified according to the gender, age and severity of the patients as well. Thirdly authors point out unreliability of the methodologies employed in many of the research studies. Thus developing standardized testing methods for measuring the improvements in Parkinson’s Disease patients is important. Fourthly assessing the long term effects (over one year) of physical therapy on patients with Parkinson’s Disease is also required. The current study is useful compilation for researchers, research policy makers, physiotherapists and also students learning about Parkinson’s Disease. It compiles useful information on the disease, symptoms, development and alternative treatment programs. It is a comprehensive report written in simple language style for the readers. Nevertheless authors have purified the search results by omitting the studies which have used integrated drugs and therapeutic treatments. In actual clinical practice prescribed drugs, physical therapy and psychotherapy are used as an integrated treatment program for Parkinson’s Disease. Thus the integrated effect of physical therapy can be rather significant on patients with Parkinson’s Disease than physical therapy only. This can be indicated as a major limitation of the study. References Read More