Kinetoterapia in tratarea bolii Parkinson

Facultatea de Educaie Fizic i Sport

Studii de masterat: Kinetoterapie, recuperare i reeducare motric

Student: Apolozan tefania Cerasela

Scopul i motivaia lucrrii
La scar mondial, boala este diagnosticat la 300 000 persoane n fiecare an. Incidena i prevalena
bolii cresc odat cu vrsta. Boala Parkinson afecteaz 1% din persoanele cu vrsta peste 65 ani. Rareori,
boala survine n copilrie sau adolescen. Incidena bolii este de 1,5 ori mai mare la brbai dect la
femei.1

Terapia fizic este adesea prescris n tratamentul bolii Parkinson. ase zone specifice au fost
identificate pentru terapia fizic: transferuri, postur, exerciii de extensie i de apucri ale obiectelor,
echilibru, mers i capacitatea fizic.2 Am extras patru recomandri specifice de tratament, care s-au
bazat pe probe de la mai mult de dou studii clinice controlate: strategii de asisten pentru
mbuntirea mersului; strategii de micri cognitive pentru mbuntirea transferurilor; exerciii
pentru a mbunti echilibrul i antrenarea mobilitii articulare i a puterii musculare pentru a
mbunti capacitatea fizic. 3Aceste recomandri de exerciii ofer o baz pentru tratamentul fizic
curent n boala Parkinson n practica clinic de zi cu zi, precum i pentru cercetrile viitoare n acest
domeniu.4

n cursul bolii lor, majoritatea pacienilor cu boala Parkinson (PD) se confrunt cu deficite de mobilitate
care se dezvolt, inclusiv dificulti cu transferurile, postura, echilibrul i mersul pe jos.5 Acest lucru duce
frecvent la pierderea independentei, (teama de) czturi, leziuni i inactivitate, care duc la izolare
social i un risc crescut de osteoporoz sau boli cardiovasculare6. 7n consecin, costurile cresc 8i
calitatea vieii descrete9. Aceste deficite de mobilitate sunt dificil de tratat cu medicamente sau
neurochirurgie.1011

1
https://ro.wikipedia.org/wiki/Boala_Parkinson
2
Goede CJ, de, Keus SH, Kwakkel G, Wagenaar RC. The effects of physical therapy in Parkinson's disease: a research
synthesis. Arch Phys Med Rehabil 2001; 82: 509515.
3
Bergen JL, Toole T, Elliott IIIRG, Wallace B, Robinson K, Maitland CG. Aerobic exercise intervention improves
aerobic capacity and movement initiation in Parkinson's disease patients. NeuroRehabilitation 2002;
4
Cerri C, Arosio A, Biella AM, Premoselli S, Piccini L. Physical exercise therapy of Parkinson's. Mov Disord 1994;
5
Chandler C, Plant R. A targeted physiotherapy service for people with Parkinson's disease from diagnosis to end
stage: a pilot study. In: PercivalR, HobsonP, editors. Parkinson's Disease: Studies in Psychological and Social Care.
Leicester: BPS Books; 1999
6
Bloem BR, van Vugt JP, Beckley DJ. Postural instability and falls in Parkinson's disease. Adv Neurol 2001; 87: 209
223.
7
Garrett NA, Brasure M, Schmitz KH, Schultz MM, Huber MR. Physical inactivity: direct cost to a health plan. Am J
Prev Med 2004; 27: 304309.
8
Pressley JC, Louis ED, Tang MX, et al. The impact of comorbid disease and injuries on resource use and
expenditures in parkinsonism. Neurology 2003; 60: 8793.
9
Schrag A, Jahanshahi M, Quinn N. How does Parkinson's disease affect quality of life? A comparison with quality
of life in the general population. Mov Disord 2000; 15: 11121118.
10
Management of Parkinson's disease: an evidence-based review. Mov Disord 2002; 17(Suppl. 4): S1S166.
11
Bloem BR, Beckley DJ, van Dijk JG, Zwinderman AH, Remler MP, Roos RA. Influence of dopaminergic medication
on automatic postural responses and balance impairment in Parkinson's disease. Mov Disord 1996; 11: 509521.
Strategii de asisten

Este plauzibil ca, la pacientii cu PD, mersul s fie mbuntit prin oferirea de asisten prin
repere vizuale sau auditive, care au fost oferite n timpul antrenamentului.12 13Aceste repere sunt
stimuli din mediul nconjurtor sau generai de ctre pacient, pe care pacientul i utilizeaz, n
mod contient sau nu, pentru a facilita micrile (automate i repetitive). Nu este nc foarte clar
modul n care reperele mbuntesc deplasarea.14 Poate c ele ofer un ritm extern, care poate
compensa ritmul intern furnizat n mod necorespunztor al ganglionilor bazali, corectarea
deficienei motorii, sau (n cazul reperelor vizuale) genereaz un flux vizual, care activeaz o
cale vizual-motorie cerebeloas. 15Nu toi pacienii beneficiaz n mod egal de pe urma utilizrii
reperelor.

Metode de tratament

Fazele n cursul bolii Parkinson (PD): Interventii si obiective pentru terapie fizica posibile in
boala Parkinson.
Scopurile tratamentului in sunt:
- Prevenirea inactivitatii
- Prevenirea fricii de a se misca sau de a cadea
- Mentinerea sau imbunatatirea capacitatii fizice16

Cum intervenim:
- promovarea unei vieti active
- suplimentarea informatiilor pentru a preveni inactivitatea17
- exercitii active in grup pentru imbunatatirea balansului, a fortei musculare si a mobilitatii
articulare: 30 sesiuni, 10 saptamani, 22.5 h
- implicarea partenerului de viata;
18

Scopuri aditionale ale tratamentului:

- prevenirea caderilor
- reducerea limitarilor in: transferuri, posturi, balans, echilibru.
- Exercitii active (acasa) prin strategii de miscare cognitiva19 : 18 sesiuni, 6 saptamani, 18h

12
Nieuwboer A, De Weerdt W, Dom R, Truyen M, Janssens L, Kamsma Y. The effect of a home physiotherapy
program for persons with Parkinson's disease. J Rehabil Med 2001; 33: 266272.
13
Thaut MH, McIntosh GC, Rice RR, Miller RA, Rathbun J, Brault JM. Rhythmic auditory stimulation in gait training
for Parkinson's disease patients. Mov Disord 1996; 11: 193200.
14
Rubinstein TC. Giladi N, Hausdorff JM. The power of cueing to circumvent dopamine deficits: a review of physical
therapy treatment of gait disturbances in Parkinson's disease. Mov Disord 2002; 17: 11481160.
15
Stack E, Ashburn A. Fall events described by people with Parkinson's disease: implications for clinical interviewing
and the research agenda. Physiother Res Int 1999; 4: 190200.
16
Wade DT. Outcome measures for clinical rehabilitation trials: impairment, function, quality of life, or value? Am J
Phys Med Rehabil 2003 Oct; 82(Suppl.): S26S31.
17
Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different
instruments. Pain 1996
18
Bergen JL, Toole T, Elliott IIIRG, Wallace B, Robinson K, Maitland CG. Aerobic exercise intervention improves
aerobic capacity and movement initiation in Parkinson's disease patients. NeuroRehabilitation 2002
Scopuri aditionale ale tratamentului pentru boala Parkinson in stadiu avansat:
- Mentinerea functiilor vitale
- Prevenirea escarelor
- Prevenirea contracturilor
- Ajustari posturale in pat sau scaun cu rotile
- Exercitii active asistate20

19
Patti F, Reggio A, Nicoletti F, Sellaroli T, Deinite G, Nicoletti F. Effects of rehabilitation therapy on Parkinsons'
disability and functional independence. J Neurol Rehabil 1996
20
Nieuwboer A, De Weerdt W, Dom R, Truyen M, Janssens L, Kamsma Y. The effect of a home physiotherapy
program for persons with Parkinson's disease. J Rehabil Med 2001