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PT on the Run

Parkinson's Problems

Published June 13, 2014 10:00 AM by Michael Kelley

According to the National Parkinson's Foundation, nearly 1 million people in the US are currently living with Parkinson's Disease, with an estimated 50,000-60,00 new diagnoses each year. Here in the US, the CDC has identified it as the 14th-leading cause of death and worldwide, nearly 6 million people are believed to be affected by this debilitating disease. As with all-too-many neurodegenerative disorders, there is no cure, but research is ongoing.

Over the last month, I've treated two patients with Parkinson's Disease. I didn't treat them for their Parkinson's, however, but rather for fractures they had suffered following falls. While presenting an interesting case, both patients were difficult to manage from an orthopedic standpoint as a direct result of manifestations from their Parkinson's.

In the first case, the patient took Parkinson's medications every hour, on the hour, for 17 hours a day (not at night). Obviously for his surgery he needed to be off his medications for the 5 or 6 hours before, during and after surgery. Needless to say, when he woke up, he had some significant dyskinesia. He didn't have tremor and any bradykinsia wasn't too apparent, but the extraneous movements of his entire trunk, head, neck, arms, even eyes were very pronounced. All this movement did not lend well to ambulation, as you might guess. Over his 3 or 4 days in the hospital, the dyskinesia improved, but he never did make it back to his baseline (which was not having any dyskinesia at all). 

The second case was a patient who also did not have any dyskinesia or tremor or any extraneous movement prior to her fall. In fact, she fell getting up from playing the piano at home. The same situation occurred where she was off her medications for surgery and woke up with significant dyskinesia. Her movement wasn't as bad as the previous case, but still ambulation was difficult to perform for her.

In both cases, the medical team seemed to focus more on her acute orthopedic needs rather than her more chronic neurological needs. The only problem with this approach is while on the surface they may seem separate issues, each directly impacted the other.

Because Parkinson's is more of a chronic issue, it's not something that we see a whole lot of in the acute setting. Certainly our outpatient department sees a lot of patients with Parkinson's; we even have a therapist who has written a couple books about the treatment and management of patients with Parkinson's. They have been challenging patients to treat, but I think good overall exposure to a diagnosis and world of movement disorders we don't typically get to see.

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Perfect example of how an ounce of prevention is worth a pound of cure. We see many, many people with Parkinson's in our fall prevention clinic. We know we will never stop them all from falling, but we can decrease the rate of falling and teach them how to optimise their strength, flexibility, and mobility. Once a fracture happens, it is rare they regain previous levels of function.

Dean Metz June 13, 2014 1:14 PM

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