1/16. Postural instability in Parkinson's disease.persons with Parkinson's disease are at great risk of suffering traumatic injuries from falls. Intervention with physical therapy and the use of assistive devices are helpful in preventing falls. Unfortunately, many patients are not referred for these interventions until they have already suffered traumatic injury. A simple measure of balance, which can easily be performed in an office setting, is the functional reach. This measure has been shown to be predictive of falls in the elderly. In this study, the functional reach was measured in patients with idiopathic Parkinson's disease during each visit over at least one year. patients deemed at risk of falling were referred for physical therapy and possibly assistive devices. Those patients subsequently suffering falls were noncompliant with the recommendations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Niemann-Pick disease type B: an unusual clinical presentation with multiple vertebral fractures.We report here a unique case of a 55-year-old woman presenting with a clinical picture of parkinson disease, severe back pain, splenomegaly, and pronounced dyspnea. Radiographic examination of the spine showed multiple vertebral fractures. Niemann-Pick disease type B was diagnosed by findings of lipid-loaded histiocytes and a strongly reduced sphingomyelinase enzyme activity. She was homozygous for the deletion of codon 608 (delR608), which encodes an arginine residue in the Acid Sphingomyelinase gene. To investigate the cause of the unusual vertebral fractures, we screened for polymorphisms previously described as possibly associated with increased risk for osteoporosis and fractures. Our patient was heterozygous for the polymorphisms of the vitamin d receptor gene, the estrogen receptor gene, and the collagen 1A1gene. Increased physical activity after Parkinson treatment, a genetic predisposition, together with worsening disease due to interfering medications could explain the dramatic presentation of this patient. She was treated with cholesterol lowering drugs such as statins to decrease sphingomyelin synthesis, avoidance of drugs that inhibit sphingomyelinase, and bisphosphonates. No new fractures have occurred, but the interstitial lung disease has progressed.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/16. Unique use of botulinum toxin to decrease adductor tone and allow surgical excision of vulvar carcinoma.Here, we present the case of an 86-year-old woman with vulvar carcinoma requiring surgical resection and with Parkinson's disease with severe spasticity and contractures of the lower extremities. Because of the patient's severe contractures and spasticity (her knees could only be separated by 2 cm with sustained abducting force), surgical positioning and access to the vulva were impossible. The patient was admitted, intending to undergo surgery after injection with botulinum toxin (BTX) to hip adductors and intensive physical therapy. After confirmed healed hip arthroplasty, the patient underwent BTX injection (400 U) to her bilateral adductor brevis, adductor longus, adductor magnus, and semimembranosus and semitendinosus muscles on day 2 of her hospital stay. On day 3, a physical therapist began a twice-a-day stretching program. An adjustable abduction brace was custom-made to provide sustained stretching. On day 9, the patient underwent wide local excision of vulvar carcinoma with the abductor brace in place. The patient tolerated the surgery well and was discharged home on day 11 with continuous physical therapy. Upon discharge, the distance between the patient's knees was 14 cm. This unique case demonstrated a new indication for BTX treatment in the preoperative setting to allow surgical positioning and access.- - - - - - - - - - ranking = 1.5keywords = physical (Clic here for more details about this article) |
4/16. The postanesthesia patient with Parkinson's disease.Parkinson's disease, or paralysis agitans, is a central nervous system disease. Concentrations of dopamine and acetylcholine, neurotransmitters in the substantia nigra of the basal ganglia, become imbalanced. Bradykinesia, rigidity, rhythmic head nodding, and pill-rolling motion of the thumb and forefinger are characteristic. Difficulty verbalizing, dementia, and depression are also common. levodopa, the medication of choice, restores dopamine to brain cells, reducing parkinsonian symptoms. awareness by the PACU nurse of the potential for systemic effects of dopamine is one important element of postanesthesia care for the patient with Parkinson's disease. In addition, recognition of the unique physical limitations and medication combinations for each patient promotes optimal postanesthesia nursing assessment and intervention.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/16. Cognitive performance in multiple system atrophy.The cognitive performance of a group of patients with multiple system atrophy (MSA) of striato-nigral predominance was compared with that of age and IQ matched control subjects, using three tests sensitive to frontal lobe dysfunction and a battery sensitive to memory and learning deficits in Parkinson's disease and dementia of the Alzheimer type. The MSA group showed significant deficits in all three of the tests previously shown to be sensitive to frontal lobe dysfunction. Thus, a significant proportion of patients from the MSA group failed an attentional set-shifting test, specifically at the stage when an extra-dimensional shift was required. They were also impaired in a subject-ordered test of spatial working memory. The MSA group showed deficits mostly confined to measures of speed of thinking, rather than accuracy, on the Tower of london task. These deficits were seen in the absence of consistent impairments in language or visual perception. Moreover, the MSA group showed no significant deficits in tests of spatial and pattern recognition previously shown to be sensitive to patients early in the course of probable Alzheimer's disease and only a few patients exhibited impairment on the Warrington Recognition memory Test. There were impairments on other tests of visual memory and learning relative to matched controls, but these could not easily be related to fundamental deficits of memory or learning. Thus, on a matching-to-sample task the patients were impaired at simultaneous but not delayed matching to sample, whereas difficulties in a pattern-location learning task were more evident at its initial, easier stages. The MSA group showed no consistent evidence of intellectual deterioration as assessed from their performance on subtests of the Wechsler adult intelligence Scale (WAIS) and the National adult reading Test (NART). Consideration of individual cases showed that there was some heterogeneity in the pattern of deficits in the MSA group, with one patient showing no impairment, even in the face of considerable physical disability. The results show a distinctive pattern of cognitive deficits, unlike those previously seen using the same tests in patients with Parkinson's and Alzheimer's diseases, and suggesting a prominent frontal-lobe-like component. The implications for concepts of 'subcortical' dementia and 'fronto-striatal' cognitive dysfunction are considered.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/16. Flexion contracture after total knee arthroplasty in a patient with Parkinson's disease: successful treatment with botulinum toxin type A.The few reports in the orthopedic literature that discuss outcomes after total knee arthroplasty in patients with Parkinson's disease cite mixed results. These patients are at increased risk for the development of flexion contracture, which has been shown to significantly worsen functional scores. The present report describes the development of a flexion contracture in a patient with Parkinson's disease after total knee arthroplasty. This contracture was successfully treated with manipulation under anesthesia and injections of botulinum toxin type A into the hamstring and gastrocnemius muscles, in conjunction with a static progressive extension orthosis and rigorous physical therapy.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/16. association of PINK1 and DJ-1 confers digenic inheritance of early-onset Parkinson's disease.Mutations in genes encoding both DJ-1 and pten-induced kinase 1 (PINK1) are independently linked to autosomal recessive early-onset familial forms of Parkinson's disease (PD). We here report identification of a family with PD patients harboring novel heterozygous missense mutations in both PINK1 and DJ-1 genes encoding DJ-1A39S and PINK1P399L, respectively. In transfected cells, DJ-1 interacts with PINK1. PINK1P399L is less stable than the wild-type protein and is degraded via the ubiquitin-mediated proteasomal pathway. Expression of wild-type DJ-1 increased steady-state levels of PINK1, whereas expression of DJ-1A39S reduced steady-state levels of PINK1. Furthermore, co-expression of wild-type DJ-1 and PINK1 suppresses neurotoxin 1-methyl-4-phenylpyridinium (MPP( ))-induced death of dopaminergic SH-SY5Y cells. In contrast, co-expression of PD-associated DJ-1A39S and PINK1P399L significantly potentiated susceptibility of SH-SY5Y cells to MPP( )-induced cell death. This study reports the first case of autosomal recessive PD with digenic inheritance and demonstrates that DJ-1 and PINK1 physically associate and collaborate to protect cells against stress via complex formation.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/16. Multidimensional exercise for people with Parkinson's disease: a case report.The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. Changes in gait and symptoms after bilateral pallidotomy: a client with Parkinson's disease.A single-subject, time-series design was used to describe a female with young-onset Parkinson's disease who, after a period of 15 years, was demonstrating long term side effects of medication in addition to the progression of Parkinson's disease. She underwent a bilateral pallidotomy to address these problems. Prior to her surgery, her spatiotemporal gait kinematics were measured at intervals before and after medication ingestion. The identical procedures were undertaken one month and at four months post-pallidotomy. In all three sessions, the Webster Scale scored her symptoms while her medication was not working (Off) and again when effective (On). After surgery, she was interviewed to obtain a qualitative impression of the outcome. Before the surgery, the gait parameters demonstrated a fluctuating profile. Forty-five minutes post-medication, her gait parameters approached normal levels but significant dyskinetic movements were evident. Her Webster Scale scores indicated advanced Parkinson's disease particularly when Off One-month post-pallidotomy, her gait parameters were more consistent with dyskinesias mildly present. Her Webster Scale scores were reduced while both Off and On. Four months post-pallidotomy her gait parameters were entirely consistent and within normal limits. Her Webster Scale scores were the same Off and On and no dyskinesias were detectable. The excellent result was probably enhanced by the patient's dedication to regular exercise designed to minimize secondary physical complications.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/16. Reversible pathologic jealousy (Othello syndrome) associated with amantadine.We describe a case of pathologic jealousy (Othello syndrome) in a patient with parkinson disease, which abated after discontinuing amantadine. We indicate that early recognition and treatment of the syndrome in this disease may avert physical violence. We also believe that our report further suggests a link between this specific behavioral disorder and dopaminergic activity.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
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