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Assessment and Treatment of Parkinson’s Disease

Making your own diagnosis – the good and the bad

When someone arrives at their Doctor’s appointment, it’s quite common for them, or family members, to have consulted ‘Dr Google’ and come already prepared for the diagnosis of Parkinson’s Disease (PD). It’s understandable that people would try and figure out what’s wrong.

However, some doctors get a little annoyed about that, because the problem with consulting the internet for medical information is that it’s very general. Also, internet information is not always peer-reviewed, and may be unreliable.

So while a person may have the correct diagnosis, they may not have an accurate understanding of how that diagnosis affects them, or what the outlook for them might be. That is the information the doctor must try and provide.

The doctor must individualise the information, so it is specific for the person affected, and try and help that person to understand the context and the likely outlook for them as a person.


Accurate diagnosis is not so simple

Sometimes it can take quite a long time for the person to get an official diagnosis because there are other conditions with very similar symptoms. (See also: What Causes Parkinson’s Disease)

Diagnosis may be particularly difficult for people who don’t have a tremor. The tremor is usually obvious to the person with PD, and the people around them, and makes it much simpler to diagnose. If there is no tremor it is more complex.

However, just knowing that a tremor isn’t required for PD to be diagnosed is useful. Perhaps 20-30% of people with Parkinson’s disease don’t have a tremor, or have very little tremor.


Is it better to delay treatment?

To start with it’s important to get an accurate diagnosis of PD, because it may in fact be something else. If it IS PD, there are good benefits to be had from early treatment, which are important not to miss out on. Also, the doctor has to consider what the other causes could be.

So the sooner the person sees the Doctor to determine what is going on and to seek treatment, the better.


Will Physiotherapy and Occupational Therapy be needed?

Physiotherapy helps manage issues to do with mobility, balance and posture. The person with PD has a problem due to a reduction in what is called “automatic motor function” or “motor memory”.

Motor memory occurs because you have done something over and over and over again like walking, or using your hands to write, or undo buttons; to show facial expression, speak, swallow, turn over in bed or get out of a chair. You have done it so many times there is a program of motor memory contained within your muscles.

However, people with PD have difficulty in initiating the motor memory. Once it is initiated, typically it flows better. People can be taught ways of overcoming those motor memory deficits. It involves using the frontal lobes of the brain: using attention, concentration and tricks to overcome the deficit.

Physiotherapists understand those techniques. There’s an Australian program called the Parkinson’s Disease Warriors. The program involves people learning to make big movements, instead of the tiny little slow movements that fade off, which is often a feature in Parkinson’s disease.

In addition to a physiotherapy program, an Occupational Therapist will look at the everyday functions of life. So this includes activities of daily living such as showering, dressing, meal preparation, using a computer and driving a car. The OT will analyse the way that PD may be having an impact in those areas and to try to overcome that impact.

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