Parkinsons Disease, Dystonia, Ataxia, Tremors, Tic’s/Tourette, Gait Disorders, and Restless Leg are just a few of the vast array of Movement Disorders. Movement Disorders are neurologic conditions in which there is either an excess of movements &/or a paucity of voluntary and autonomic movements, unrelated to weakness or spasticity. They can be casued by genetic abnormalities, mTBI/concussions, infections, medicines, metabolic disorders, stroke, vascular disease, toxins or damage to the brain, spinal cord or peripheral nerves.
Nearly 1 million people will be living with Parkinson’s disease (PD) in 2020, with approximately 60,000 diagnosed each year. Michigan has a higher prevalence of PD (>20.9 k) compared to the majority of other states. The incidence of PD increases with age, with the majority over 50 years old. Men are 1.5 times more likely to have PD than women. On average direct and indirect healthcare cost each year is nearly $52 billion.
PD is a neurodegenerative disease mainly affecting the dopaminergic neurons in the brain. Symptoms include: Tremor (mainly at rest & pill rolling), bradykinesia, limb rigidity, gait and balance problems. Some early signs are: small handwriting, loss of smell, constipation, shoulder pain, trouble sleeping, trouble walking/moving, soft/low voice, masked face and stooped/hunching over.
Each patient with Parkinson’s Disease, must have an individualized approach. Some patient may have difficulty with walking while others focus may be reduction in tremors. Thus, exam will be focused on the areas involved. Patients exam will have focus on gait analysis, especially if a primary complaint. Posturography (balance assessment) is obtained to quantify postural changes resulting in hunched or campticormia. RightEye exam is performed to assess a patients eye function. RightEye was recently approved by the FDA in the diagnosis PD due to known abnormalities in eye function. Additional focus will be on the cranial nerves due to involvement with eyes, masked face and vagus nerve integrity. These techniques in addition to more will create a baseline in assessing a patients progress.
After the inital evaluation, an individualized plan of care is designed to address the patients’ complaints. If gait issues are the primary complaint, we have specific gait protocol to improve initiation of gait and walking. Gait protocol may include physical exercise, leg nerve stim and vestibular exercises. We have similar approach when dealing with ridgity and tremors. Based on research, dietary changes may be address.
Dystonia is the third most common movement disorder, with about 250,000 people in the U.S. It is a condition that knows no age, ethnicity or racial boundaries, affecting children and adults. Dystonia results in uncontrolled movements such as twisting, repetitive movements, abnormal posturing and positions. It can affect any part of the body including the arms, legs, trunk, face and vocal cords. Dystonia can be classified by body part, focal involves one area and segmental is multiple. It can also be classified by cause, such as Primary (ideopathic), Secondary (symptomatic), Dystonia-plus and Heredodegenerative.
It is estimated 150,000 Americans are affected by hereditary or sporadic ataxia. It can strike anyone at any time regardless of age, gender or race. Ataxia is a group of progressive neurological diseases affecting coordination and speech. Symptoms may mimic a person being drunk with slurred speech, stumbling, falling and incoordination. The symptoms are as a result of damage to the cerebellum, which is responsible for coordinating movements. Symptoms include lack of coordination (fingers, hands, arms, legs, walking), slurred speech, trouble eating/swallowing, loss of fine motor skills, gait abnormalities, eye movement abnormalities, tremors and heart problems. Causes can be hereditary (spinocerebellar, episodic, Friedrech’s, Mitochondrial and telangiectasia) or squired (sporadic, multiple systems atrophy). Treatment includes a combination of speech/language therapy, occupational therapy, physical therapy and more.