Assessment needs to be comprehensive, focusing on function. A thorough history should be obtained to determine all the factors that may have an impact on the patient's functioning. These include general medical history, functional history, vocational and avocational history, living situation, and support system.
The neurodegenerative disease process of PD produces a host of physical impairments that affect the PD patient's functional mobility and ability to participate in activities of daily living. Rigidity, tremor, bradykinesia, loss of postural control, and postural instability can all be present to some degree in PD patients, and these impairments in turn affect the ability to perform gross and fine motor tasks (1,2).
Rigidity, especially trunk rigidity, negatively affects the ability to transfer when a sequence of segmental movements of several regions of the body is required. Tremor
is often present and can be one of the first outward signs of PD; however, it seldom causes functional deficits since it usually stops when performing transfers or fine motor activities. Bradykinesia creates difficulty in the ability to perform repetitive movements. The progressively smaller movement arcs seen with bradykinesia are particularly evident in gait. It is also demonstrated by micrographia. Akinesia or freezing is another motor manifestation of PD and is characterized by difficulty in initiating a movement or a tendency to stop movement part way through a motor sequence. Attention to environmental distractions, such as a change in floor surface or doorways, is thought to be one cause of freezing during the gait cycle. Many individuals with PD also demonstrate difficulty in terminating action sequences. When walking, this can increase the risk of falling. Tremor, dyskinesia, and other unwanted and nonfunctional movements may be present to some degree and affect the individual's functional mobility. Dystonia may occur when the patient has had prolonged overactivity of a certain muscle or muscle group or can be a side effect of levodopa. Dystonia can negatively affect posture and movement patterns (1).
Numerous studies indicate that rehabilitative interventions can increase the ability to maintain independence with transfers, to ambulate safely in the home and community, to perform fine motor tasks, and to maintain a basic level of fitness for as long as possible (1-6).
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