Parkinson Disease - Case Study Example

RUNNING HEAD: PARKINSON’S DISEASE Parkinson’s disease Name Institution Date Introduction Parkinson’s disease is considered as the second most prevalent neurodegenerative disorder after the Alzheimer’s disease, with its prevalence argued to be rising steadily as the global population ages (Dancun & Rositano, 2011 & Chan et.al, 2005). The disorder is often associated with the elderly of the age 60 years and above, with one in every 100 individuals over 60 years of age being affected. However, this disease is not only restricted to the elderly as it has also been noted to affect about 10% of persons aged below 40 years. According to World Parkinson’s Program (2013), Parkinson’s disease has been a day-to-day struggle for over 6 million individuals globally with the number still expected to double by the year 2030. In light of the above therefore, this particular education plan intends to offer an insightful, educative, informative and suitable evidence-based education plan for an elderly (63 years old). Parkinson’s disease, also paralysis agitans is basically a neurodegenerative disorder affecting an individual’s movement, how the person communicates (speaks) as well as how he/she writes. It is categorized under a group of disorders known as movement disorder, which describes various unusual body movements having neurological basis including conditions such as Tourette syndrome (unusual movements and vocalization), cerebral palsy and ataxia (lack of proper muscle coordination).Parkinson’s disease is currently becoming a serious problem globally especially for the elderly hence it is obvious that at some point in time every physician will be expected to diagnose and thereafter manage the Parkinson’s disease patients (Schapira, 2010).According to BHC (2011), an estimate of four per 1000 individuals in Australia have this condition, with its prevalence rising to one out of every 100 people aged over 60. This is a similar case with Mr. Wallace, aged 63 years. Mr. Wallace has presented problems of rigidity and shaking. His movement has also gradually slowed down besides having an unstable posture.Mr.Wallace is likely to be suffering from Parkinson’s disorder which is common at his age. Other symptoms associated with Parkinson’s disease include freezing, Micrographia/small handwriting, lethargy, shuffling gait, disturbing sensory signs as well as pain within the affected limbs. A number of Parkinson’s disease patients are also known to experience symptoms of autonomic breakdown (failure) including constipation, urinary hesitancy, orthostatic hypertension and impotence amongst men.However, not all the patients diagnosed initially present with each and every of these classic signs as there may only be one or two symptoms evident. Often, the initial complaint from Parkinson’s patient is muscle stiffness (rigidity) or motor weakness with its cause commonly being misdiagnosed. The frequency, severity as well as the progression of the disease’s symptoms however varies significantly (Saxon et.al (2010) & WebMD (2013). Clinical diagnosis is also often based on the medical history as well as the neurological examinations since there is absence of laboratory test capable of definitely establishing such a diagnosis. As such, a sizeable number of patients diagnosed with the condition fail to reveal the essential histopathologic hallmarks associated with the condition upon autopsy. A number of Parkinson’s disease patients are also known experience symptoms of autonomic breakdown (failure) including constipation, urinary hesitancy, orthostatic hypertension and impotence amongst men. Though the disorder’s causes are unknown, a number of factors including aging (the chief cause), genetic predisposition and environmental factors have been cited to play a significant role in its development. Some gene variations seem to heighten the risk of acquiring the disease, although with a slight risk for every genetic marker (Louise, 2013). Similarly, the exposure to certain environmental factors especially some specific toxins is argued to aggravate the risk, though relatively small risk. There is still more work needed to establish the root factors causing the disorder (Access Economics for Parkinson’s Australia, 2007) Handling an individual with Parkinson’s disease is often a challenging task. As such, neurologists and doctors are often consulted on proper medications to be administered. These symptoms however can be managed mainly through medication, neurosurgery and multidisciplinary therapy by counselors, physiotherapists and dietitians. In terms of care, the disease presents numerous challenges to both the patient and the family involved. The implications are that the family and the community must offer significant emotional support more than hands-on care. This is the moment for the patient and the family members to acquire relevant education as regards this particular condition. Preparing for such a care begins with education. The patients and their care givers need to be educated on the fundamentals of the disease. The education concerning the elderly patients aged 60 years and above should primarily focus on self-management strategies and medication regime since this knowledge is in deficit would help curb the high mortality incidences associated with the disease while further reducing its impacts especially to the majority who suffer due to the knowledge deficit (Galvan & Wichmann, 2008). Most of the Parkinson’s disease medications can be grouped under some major categories including levodopa (dopamine-replacement therapy), dopamine agonists (mimics dopamine action), COMT inhibitors (blocks the COMT enzyme), Anticholinergics (blocks acetylcholine), Amantadine (improves transmission of dopamine) and MAO type B inhibitors (prevent dopamine metabolism in the brain) (BHC, 2011). However, the most frequently prescribed medication is the levodopa which replenishes the depleted dopamine within the brain. Sinemet (levodopa-carbidopa combination), on the other hand, is cited as the drug used by most doctors in the treatment of Parkinson’s disorder (Pahwa & Lyons, 2010). Doctors are likely to prescribe multiple drugs as most work perfectly together in the control of symptoms and the reduction of the side effects, since with all the medications side effects are also a problem (Deloitte, 2011). For instance Sinemet causes nausea/dizziness, prolonged use of levodopa causes dyskinesias or uncontrollable movements, and dopamine agonists cause problems related to impulse control/behavioural problems such as excessive spending, pornography, sex and hoarding behaviours (Vajda & Solinas,2006). In general, drug therapies are often argued to provide a relief for approximately 10-15 years or even more. Apart from medications, surgery and deep-brain stimulation also provide treatment alternatives especially for patients with motor fluctuations or those experiencing off time periods with troublesome disease symptoms that alternate with on time periods having good symptom-control. Deep-brain stimulation involves using implantable device resembling pace-makers (neurostimulator) to send electrical impulses in brain parts responsible for movement (Hayes et.al (2010) & Toffler (2010). The treatment basically entails electrical stimulation for a long period. Generally; the best patients who respond quite positively to this treatment are often aged below 70 years and have few body-center symptoms including swallowing and stability problems (Silberstein et. al, 2009). As highlighted earlier, caring for the Parkinson’s patients poses serious challenges to care givers, and as such it is not an easy task. Some emergency admissions for Parkinson’s disease may be avoided if better management not only within the outpatient setting but also the community setting. Preparing for such a task begins with getting prepared, taking care of oneself, getting additional help, working to maintain good relationship with the patient to be taken care of and encouraging activeness among such patients (Temlett & Thompson, 2006). Such an elder person also needs to manage nutrition and the prescribed medication appropriately so as to maintain a higher life quality with the disease. Performing activities such as exercising and painting are also beneficial in terms of alleviating the symptoms. Additionally; such a patient needs to connect with Parkinson’s disease community to be more informed on this particular disease. An elderly patient of this age needs to involve himself in advocacy, further clinical trials, educational conferences as well as other support groups (Toffler, 2010). Such a patient is therefore needed to plan ahead in order to maximize their adaptation to the particular disease in their own terms and prioritize on better living both at home and at work throughout the disease process especially by utilizing the assistive technologies and maximizing on the expertise from allied professionals including occupational therapists, speech therapists, physical therapists and nutritionists wherever needed (Deloitte, 2010). Patients with Parkinson’s disease and the families affected need to be counseled on the best strategies of managing such a neurodegenerative disorder. The best evidence-based strategy to relay this crucial information to the elderly is basically face-to-face or one-to-one teaching. Learning this particular information from the public media can also be effective as long as it is readily available, easily understood and interpreted and shared by well-informed experts (Webicina, 2013). There are several helpful video channels on the disease, however, video channels with the most relevant and updated information, very informative interviews as well as animations should be selected. Social media especially community sites and blogs focusing on the management of the disease may also be utilized considering that most empowered patients as well as healthcare professional upload remarkable slideshows relating to the condition while also relaying practical advices (Webicina,2013). Recommendations Evidence related to physiotherapy intervention managing issues relating to the Parkinson’s seems limited hence should be enlarged. Additionally, there seems to be a need to assess how the physiotherapy guidelines may be effectively implemented into the day-to-day clinical practice especially for the elderly. Furthermore, future research ought to investigate appropriate methods that will enable patients to benefit more from the s scientific research (Keus et.al, 2007). In particular, a significant methodological issue that ought to be addressed is that involving the use of applying appropriate measures of outcomes particularly relevant to patients, physicians, physiotherapists, and care givers Conclusion From the analysis above, it is clearly evident that Parkinson’s disease has lately become a serious problem especially among the elderly. Even though its underlying cause has eluded many scientists, it is already clear that the main factors for its development include genetical predisposition, environmental factors and aging, which is also ranked as the main cause in most cases. While its cure is not totally conclusive, the paper has clearly highlighted a number of strategies including the administration of drugs, surgery and deep-brain stimulation and multidisciplinary therapy. References Access Economics for Parkinson’s Australia (2007).Living with Parkinson’s disease; Challenges and Positive Steps for the Future. Better Health Channel (BHC). (2011).Parkinson’s Disease, Retrieved on 12th August, 2013 from Chan, D et.al (2005). Prevalence of Parkinson’s disease in Sydney. Acta Neurologica Scandinavica, (111), Pp.7-11 Dancun, G & Rositano, P. (2011).Parkinson's disease in regional Australia. The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy, Pp.2-13 Deloitte. (2011).Living with Parkinson's disease: Parkinson’s Australia.Deloitte Access Economics Pty Ltd Galvan, A & Wichmann T. (2008).Pathophysiology of Parkinsonism. Journal of Clinical Neurophysiology.119 (7):Pp.1459-1514 Hayes, M, Fung, V, Kimber, T, O’Sullivan, J. (2010).Current concepts in the management of Parkinson disease. The Medical Journal of Australia, 192 (3): Pp.144-149 Keus, S,Bloem,B,Hendriks,E,Bredero,A & Munneke,M.(2007).Evidence-based Analysis of Physical Therapy in Parkinson's Disease with Recommendations for Practice and Research. Journal of Movement Disorders, Vol. 22, Iss.4, Pp.451–460 Louise, R. (2013).Parkinson's Disease: Recommendations for Wellness, Retrieved on 12th August, 2013 from Pahwa, R & Lyons, K. (2010).Early Diagnosis of Parkinson's disease: Recommendations from Diagnostic Clinical Guidelines. The American Journal of Managed Care Schapira, A. (2010).Parkinson's Disease, Oxford neurology library. Oxford University Press Saxon, S, Jean, M & Perkins, E. (2010).Physical Change and Aging: A Guide for the Helping Professions. Springer Publishing Company Sellbach, A & Silburn, P. (2012).Management of Parkinson’s disease, Journal of Australian PrescriberVol.35, No.6, Pp.183-188 Silberstein, P.et. al. (2009). Deep Brain Stimulation for Parkinson’s disease: Australian Referral guidelines. Journal of Clinical Neuroscience, (16), Pp.1001-1008 Temlett, J & Thompson, P. (2006).Reasons for admission to hospital for Parkinson’s disease. Internal Medicine Journal, Vol.36, Iss.8, Pp.524–526 Tofler, D. (2010).Current Concepts in the Management of Parkinson disease. The Medical Journal of Australia 193 (3): 185-186. Vajda, F & Solinas, C. (2006).Current Approaches to Management of Depression in Parkinson’s disease. Journal of Clinical Neuroscience, Vol.12, Iss.7, Pp.739–743 WebMD. (2013).Parkinson's Disease Overview, Retrieved on 12th August, 2013 from World Parkinson’s Program. (2013). “Those who fight Parkinson’s with knowledge always find solutions”, Retrieved on 12th August, 2013 from Webicina. (2013).Parkinson's Disease in Social Media, Retrieved on 12th August, 2013 from Read More