I. Overview
Parkinson’s disease (PD), also known as tremor palsy (shaking palsy, paralysis agitans), is a neurodegenerative disease that often occurs in middle and old age. It was first described systematically in 1817 by James Parkinson, an English physician. The prevalence of Parkinson’s disease in China is about 1000 per 100,000 people over 65 years of age, increasing with age, and is slightly higher in men than in women. Most patients with Parkinson’s disease are epidemic cases, and less than 10% have a family history of the disease. The average age of onset is about 60 years old, and Parkinson’s disease is less common in young people under the age of 40. The most important pathological change in Parkinson’s disease is the degenerative death of dopamine (DA)-ergic neurons in the midbrain substantia nigra, resulting in a significant decrease in striatal DA content and causing the disease. The exact etiology of this pathological change is still unclear. Genetic factors, environmental factors, ageing and oxidative stress may all be involved in the degenerative death of dopaminergic neurons in PD.
II. Rehabilitation treatment
1.General rehabilitation measures
Guide patients to maintain a positive and optimistic attitude and build up confidence to overcome the disease. Diet should be regular and reasonable. Eat more brain-healthy foods, such as fish and shrimp, egg yolk, walnuts and milk, etc. Eating fava beans in moderation can also help treat Parkinson’s disease. Pay attention to the regularity of work and rest, to ensure the time and quality of sleep. Actively participate in physical exercise, adhere to the daily 30-minute walk after dinner, 10 minutes jogging in the morning, 30 minutes of tai chi in the morning, 30 minutes of aerobics and push-ups each time 5 groups, 10 times each group and other exercises.
2.Exercise therapy
The principles of exercise therapy are to inhibit abnormal movement patterns and learn normal movement patterns; make full use of visual and auditory feedback; allow patients to actively participate in treatment; avoid fatigue; and avoid resistance.
Training methods.
(1) Relaxation and whistling exercises.
Find a quiet location, dim the lights, and lay the body on its back as comfortably as possible. Close your eyes and begin a deep, slow whistle. Abdominal bulge in the inhalation, and imagine that the air reaches up to the top of the head, in the whistle abdominal relaxation, and imagine that the air flows down from the top of the head, through the back to the soles of the feet, and imagine relaxing the muscles of the body. Repeat this exercise for 5-15 minutes.
You can also take a sitting position, back against the back of the chair, the whole body relaxed, put both hands on the chest to do deep whistling.
(2) facial movements exercise.
Frowning action: frown as much as possible, and then forcefully spread the eyebrows, repeated several times.
Open and close the eyes with force.
Cheek exercise: first force the cheeks bulge, and then try to inhale both cheeks.
Teeth and whistling action, try to show the teeth, followed by whistling action.
In the mirror, let the face show a smile, smile, smile with teeth, pout, whistle, cheeks, etc.
(3) Head and neck exercises.
People with Parkinson’s disease tend to have a forward leaning, very stiff neck, which many people think is caused by cervical spondylosis. If no attention is paid to neck exercises and rehabilitation, it is easy to aggravate the abnormal posture and manifest as an increasingly severe hunchback. The following is a set of methods for neck rehabilitation. However, it should be noted that since most patients with Parkinson’s disease are elderly people, most of them are accompanied by cervical spondylosis of varying degrees. Therefore, the following exercises must be performed in a gradual manner, gradually increasing the amplitude of movements and moving slowly and gently.
Head backward, eyes on the ceiling for about 5 seconds, up and down movement: then head down, jaw touching the chest as much as possible.
Turning from side to side: turn the head and face to the right and look back to the right for about 5 seconds, then turn to the left in the same motion. Repeatedly and slowly turn the face sideways to the left and right shoulders and try to touch the shoulders with the lower jaw.
Swing from side to side: Slowly lean your head sideways toward the left and right shoulders and try to reach the shoulders with your ears.
Forward and backward movement: Hold the jaw forward for 5 seconds, then inward for 5 seconds.
(4) Exercises for the trunk.
Lateral bending exercise: feet apart and shoulder-width apart, knees slightly bent, right upper limb straightened upward, palms inward, torso bent to the left, back and forth several times; then repeat on the left side.
Turning movement: feet apart, slightly wider than the shoulders, both upper limbs flexed elbows flat end in front of the chest, turn the body twice to the right back, the movement should be elastic. Then repeat in the opposite direction.
(5) Exercises for the abdominal muscles.
Lying flat on the floor or bed, both knees are bent toward the chest for a few seconds. Then do this movement bilaterally at the same time.
Lie flat on the floor or on the bed, hold both knees with both hands and slowly extend your head towards both knee joints.
Exercise for low back muscles: lie prone with abdomen extended, legs and pelvis pressed against the floor or bed, and hold up with arms for 10 seconds. Prone, arms and legs simultaneously raised off the floor for 10 seconds, then relax. Repeat several times.
(6) Exercises for upper limbs and shoulders.
Shrug both shoulders up as far as possible toward the ears, then try to bring both shoulders down. Straighten your arms, raise them high above your head and hold them backwards for 10 seconds. Clasp your hands down behind your back and pull them back for 5 seconds. Repeat several times.
With your arms above your head and your elbows bent, grab the opposite elbow with each hand and bend your body to each side in turn.
(7) Hand exercises.
Straighten the metacarpophalangeal joints, spread the palms of the hands, you can use one hand to grasp the fingers of the other hand to move pressure in the direction of the back of the hand to prevent deformity of the metacarpophalangeal joints.
Place the palm of the hand on the table, try to make the fingers touch the table, and repeatedly practice the action of separating and combining the fingers.
To prevent deformity of the finger joints, repeatedly practice the action of making a fist and extending the fingers.
(8) Exercise of the lower limbs.
Stand with your legs slightly apart, knees slightly bent, bend downward and touch the ground with both hands as far as possible.
Left hand on the wall, the right hand grab the right foot to pull backward to maintain a few seconds, and then change the opposite side of the lower limbs to repeat.
”Indian plank sit”: with the palms of the feet facing each other, bring the knees to the floor, maintain and repeat.
Sit with your feet in a “V” shape, and lean your head towards your right leg, between your feet and left leg respectively, maintaining each position for 5-10 seconds.
(9) Gait training.
Most patients with Parkinson’s disease have gait disorders, the lighter ones show dragging steps, walking without lifting the feet, while the upper limbs do not swing the arms, there is no synergistic movement. In severe cases, it is difficult to move forward with small steps, turn and cross doorways. Gait exercise requires the patient to look straight ahead with both eyes, the body upright, the toes should be raised as high as possible when starting, first the feet follow the ground and then the toes land, the stride should be as slow and large as possible, the two upper limbs try to swing back and forth when walking. The key is to raise the feet and stride to large. It is best to have someone else present during the exercise to remind and correct abnormal posture at any time.
Patients in the start and march, often appear “frozen phenomenon” appears, the foot can not step, as if glued to the ground. In this case, do not be anxious, you can use the following method: First, follow the foot to the ground and stand upright. After gaining balance, then start walking, you must remember to walk first with the foot followed by the ground, toes dorsiflexion, and then the toes on the ground. In front of each step of the foot in the position of a 10-15 cm high obstacle, to do the foot across the obstacle walking exercise. But this method is more trouble, it is impossible to place a bunch of obstacles at home, so with the help of “L” crutches is a good method.
You can also use the robot to correct gait.
(10) Balance exercise training.
Patients with Parkinson’s disease show postural reflex disorders, walking fast forward, easy to fall when encountering obstacles or when the patient suddenly stops, through balance exercises can improve the focus on symptoms.
The feet are separated by 25-30 centimeters, shifting the center of gravity to the left, right, front and back, and maintaining balance. Rotate the trunk and pelvis from side to side and make the upper limbs swing with it, which is good for balancing posture and relieving muscle tension.
(11) Training for speech disorders.
Patients often become increasingly reluctant to speak because of the language disorder, and the more they do not speak, the more their language function deteriorates. The long-term absence of verbal communication with family members, combined with the lack of expression in patients with Parkinson’s disease, often results in emotional communication barriers and disconnection between patients and relatives. Therefore, it is important for patients to have regular functional training in speech.
Exercise of tongue movement
Keeping the tongue flexible is an important condition for speech, so insist on practicing the following movements – the tongue repeatedly sticks out and retracts; the tongue moves from side to side between the two mouths as quickly as possible; the tongue tip moves around the mouth and lips in a circular motion as quickly as possible; and the tongue can accurately say “la-la-la”, “ka-ka-ka “, “ka-la-ca”, repeat several times.
Lip and upper and lower jaw exercises
Slowly and repeatedly open and close the mouth; force the upper and lower lips tightly for a few seconds, then relax; repeatedly pucker the upper and lower lips as if kissing, then relax; repeatedly open and close the mouth as soon as possible, repeat several times; say “? Repeat.
Read aloud exercise
Read aloud a newspaper or beautiful prose slowly and loudly. It is best to read aloud poetry, Tang poetry, Song lyrics or modern poetry, depending on your preference. Poetry has an iambic rhythm and is read aloud. It can cure language disorders and develop sentimentality, and good poetry can also inspire your fighting spirit.
Singing exercises
Singing is a great way to do this. You can choose your favorite songs to practice. Some patients have told me that after the change of illness, their speech has become incoherent, but their singing is not affected. After practicing singing consistently, the speech also improved significantly. What’s more, singing can exercise the lung volume and help improve the feeling of lack of breath in speech, and also prevent the occurrence of pneumonia.
3.Physical therapy
(1) Scalp electro-acupuncture treatment: insert acupuncture needles under the skin in the motor area of the head, and then connect the electro-acupuncture instrument for 15 minutes, 1 time/day, 15 times as a course of treatment, which can control tremor.
(2) Heat therapy: Heat therapy using infrared light and short wave can reduce the tonicity. 1 time/day, infrared light for 30 minutes each time, short wave for 15 minutes each time.
(3) Massage: massage of limbs, trunk and face can reduce tonicity and tremor. 2 times/day, 20 minutes each time, 15 days as a course of treatment.
4.Operational therapy
The main purpose is to stimulate the patient’s interest, increase the range of motion of joints, improve hand function and correct forward posture. Increase the range of motion of joints by kneading play dough, knitting, sanding boards, etc. In the standing position, various head raising operations are performed to correct the anteversion posture. Training of activities of daily living such as standing, walking, dressing, washing, eating, urinating and defecating, and writing should also be carried out twice a day for 30 minutes each time.
5.Language training
Let the patient speak aloud consciously, emphasizing that each word should be pronounced as accurately as possible, usually facing a mirror and trained under the teaching of the therapist, paying attention to mouth shape, tongue position and facial muscle expression. Practice singing by licking the lips with the tongue after applying honey. 1 time/day, 30 minutes/time.
Among the above treatment modalities, exercise therapy and occupational therapy should be carried out daily; physical therapy should be stopped for 7 days after two courses of treatment for observation, and patients can adapt to it and then carry out it once a day; speech therapy should be selected according to the patient’s condition, and training should be carried out according to the above program when speech impairment occurs; the use of levodopa can have postural hypotension, central side effects such as insomnia, hallucinations, delusions, hyperactivity and restlessness, etc. Therefore Parkinson’s disease rehabilitation is to try to improve the patient’s function using occupational therapy such as exercise therapy and ADL training.