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Atypical Parkinsonism, a collection of neurodegenerative diseases that share symptoms with Parkinson's disease but have unique features, poses challenges for patients and healthcare providers. They include conditions like multiple system atrophy (MSA), corticobasal syndrome (CBS), progressive supranuclear palsy (PSP), and others that consist of a broad range of neuronal degeneration, unlike Parkinson’s disease, which mainly affects neurons that make dopamine. To relieve the complex nature of this disease, the review emphasizes that integrated approach of neurorehabilitation with medication is needed to optimize quality of life and functional autonomy.
Understanding atypical Parkinsonism
The term "atypical parkinsonism" describes a class of neurodegenerative diseases that resemble Parkinson's disease (PD) but proceed more quickly, react poorly to levodopa, and have unique clinical characteristics and they are connected to aberrant protein accumulation in brain cells. Key conditions include progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration (CBD). These conditions, in contrast to Parkinson's disease, frequently exhibit symmetrical symptoms, early balance problems, and less noticeable tremors. The incidence rates of MSA, PSP, and CBD are approximately one per 100,000 person-years, and they haven't changed in the last ten years and the age of onset varies, with MSA typically beginning in the late 50s, CBD in the early 60s, and PSP in the late 60s and there are no significant gender differences in atypical Parkinson but slight female predominance has been noted. Tau protein accumulation (also known as "tauopathy") that affects the frontal lobes, brainstem, cerebellum, and substantia nigra in progressive supranuclear palsy and the symptoms may include trouble moving their eyes, issue with balancing when going down stairs and backward falls are also common. In multiple system atrophy the substantia nigra, the autonomic nervous system and occasionally the cerebellum is all impacted with the symptoms include urinary retention and incontinence, constipation and additionally, patients may notice changes in the colour and temperature of their hands and feet, such as coldness and redness. Patients with corticobasal syndrome, a rare tauopathy that usually affects one side of the body more than the other, may experience myoclonus and dystonia, which makes it challenging for them to see and move around. A comprehensive history and neurologic examination are the first steps in diagnosing an atypical Parkinsonian disorder in a patient displaying symptoms. If medication therapy for Parkinson's disease is ineffective, the doctor will decide on the next course of action and PET, MRI and DAT-SPECT are the imaging techniques which used to confirm the diagnosis. At this time, it is not believed that atypical Parkinsonian illnesses are inherited.
The reasons of the majority of instances are unknown, but some may be linked to trauma or prolonged drug use. Recent research emphasizes how crucial an early and precise diagnosis is since patients with atypical parkinsonism could not respond well to conventional PD treatments.
Interdisciplinary neurorehabilitation
Neurorehabilitation a very specialized subspecialty of physical therapy in that patients with a variety of neurological conditions were treated by neurological physiotherapy, The evaluation, management, and rehabilitation of patients are the main objectives of neurological physiotherapy. Neurological physiotherapists are able to offer patients who are facing significant obstacles associated with their conditions comprehensive care and support because this type of therapy focuses on conditions that impact both the central nervous system and the peripheral nervous system. For patients with a variety of neurological conditions, neurological physiotherapists are qualified to diagnose and carry out specialized therapy regimens. Enhancing mental, emotional, and physical health is the main goal of neurorehabilitation. An interdisciplinary approach is essential due to the complex nature of atypical Parkinsonism. This entails cooperation between psychologists, occupational therapists, neurologists, physiotherapists, and speech-language pathologists. Interdisciplinary neurorehabilitation for atypical parkinsonian syndromes is an emerging field that seeks to address the complex motor and non-motor symptoms associated with these conditions. There has been support for the interdisciplinary management of atypical Parkinson's disease and evidence that rehabilitative therapies can be used in addition to pharmaceutical and neurosurgical treatments. The primary goal of neurological rehabilitation is to initiate the signal channel that the brain is struggling to use through repeated activities and exercises. This helps to promote neuroplasticity by creating new pathways. Enhancing their physical, mental, and emotional capacities is the goal in order to help the patient realize their full potential and live a better life.
A physical therapist is essential to the management of motor symptoms and enhancement of functional independence in neurorehabilitation for atypical parkinsonism. A comprehensive assessment of the patient's motor skills, including posture, walking, balance, muscle strength, range of motion, and coordination, comes first and they evaluate the intensity of symptoms that are common in atypical parkinsonism, such as bradykinesia, stiffness, and postural instability. Physical therapist management according to the symptoms, likely muscle stiffness is addressed with stretching exercises, especially in the neck and limbs. Enhancing stability and general mobility can be achieved by strengthening workouts for the lower leg and core muscles. Depending on the patient's capacity, the therapist employs body weight exercises, weights, or resistance bands. Patients often develop stooped postures, therapists guide exercises to strengthen postural muscles and promote spinal alignment, incorporating therapeutic exercises like yoga or Pilates-based movements. Balance training is essential because disorders like PSP and MSA have a greater risk of falls.
Using equipment like stability balls and balance boards, the therapist creates workouts to enhance proprioception and postural control. They practice functional skills including turning and negotiating obstacles. Structured programmes to prevent falls in atypical Parkinsonism include exercises to promote balance, strength and coordination. PD patient have shuffling or freezing type of gait for that therapist use techniques like rhythmic cueing (metronomes or music) to enhance stride length and walking speed. Assistive devices, such as walkers or canes, may be recommended and respiratory problems are common in disorders such as MSA. In order to boost general endurance, enhance oxygenation, and develop respiratory muscles, physical therapists may use breathing exercises.
Occupational therapy focuses on maintaining independence in daily activities. Activity modification: Simplifying tasks to match the patient’s abilities. Environmental adaptations on home modifications, such as grab bars and non-slip flooring, to enhance safety. Energy conservation techniques educating patients on pacing activities to avoid fatigue. Speech and swallow difficulties also present in atypical Parkinson so exercise to improve articulation volume and swallowing by speech and swallow therapist, psychological support for the patient to avoid depression and anxiety.
Medicine meets movement
Despite the fact that atypical Parkinsonism does not react well to conventional dopaminergic therapies, medication is essential for managing symptoms. Plans for treatment are very specific and cover both motor and non-motor problems. Dopamine agonists and levodopa are frequently used to treat motor symptoms however; they are less successful in atypical parkinsonian syndromes than in idiopathic Parkinson's disease. For diseases including progressive supranuclear palsy and corticobasal degeneration, additional drugs such as amantadine, co-enzyme Q10, and selective serotonin reuptake inhibitors may offer some symptomatic relief. Clozaril and nuplazid have shown efficacy in treating psychosis associated with Parkinson's disease without exacerbating motor symptoms, research works have concluded that integration of drugs with physiotherapy shows high effectiveness in the management of atypical Parkinson rather than giving the drugs alone.
Role of emerging therapies
Neuromodulation techniques like transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) is a promising emerging therapy in managing atypical Parkinson. Biological therapies such as gene therapy and neuroprotective agents help in modify or halt the disease progression. Digital health solutions refers to the use of wearable devices and AI helps in tracking disease symptoms.
Real-life impact: Transforming lives
The complicated symptomatology and quick course of atypical Parkinsonism present difficulties for both patients and medical professionals. However, there is promise for better results when interdisciplinary neurorehabilitation and customized medication are combined. This comprehensive approach changes lives by addressing both motor and non-motor symptoms, improving functional independence, and promoting emotional well-being. Patients with atypical Parkinsonism can live happy, respectable lives thanks to ongoing research and innovation that could lead to even more effective interventions.
(Authors Dr. Vignesh Srinivasan, Dr. Poovarasan are with Saveetha College of Physiotherapy & Saveetha Institute of Medical and Technical Sciences, Chennai)
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