Do your nursing assistants know that Parkinson's Disease affects nearly 5 million individuals worldwide and that 1 of every 100 senior citizens has PD? At some point, your CNAs are bound to care for clients with this common disease. By sharing the following information at your next CNA inservice meeting, you'll give your aides an increased understanding of what it's like to live with Parkinson's Disease.
Driving with Your Foot on the Brake
Imagine trying to drive a car with your foot jammed on the brake pedal. Will the car move? Maybe a little depending on how new the brakes are! But movement will be sluggish, and jerky. The car will be hard to handle in turns and on hills. Starts and stops will seem odd, not smooth like the other cars on the road. This is kind of what it's like to have Parkinson's Disease.
People who have Parkinson's Disease (also called PD) do not have enough of a chemical called dopamine in the brain. Dopamine is the chemical that tells the brain how to control and coordinate body movements.
When dopamine is low, the brain pulls the brakes on the body's ability to move and control movement. This leaves the person less able to control the body. Like driving with your foot on the brake … movement is sluggish and jerky, difficult to control, and starting and stopping a movement is not smooth.
PD is a chronic condition which means that it continues over a long period of time. It's also a progressive condition which means that it gets worse as time goes on. Parkinson's Disease affects about one in every 100 people over age 60. The average age at onset is 60, but about 10 percent of sufferers have symptoms as early as 30 years old.
No one really knows the exact cause of PD. There is no test to actually diagnose it, and right now, there is still no cure.
What's Happening in the PD Brain?
There is a small area in the brain stem, just above the spinal cord called the substantia nigra (SN). Cells in the SN produce dopamine. Dopamine is a neurotransmitter that is responsible for regulating movement and balance.
Over time, in people with PD, the cells of the substantia nigra degenerate or die, and therefore no longer produce the dopamine needed for movement and balance. This is why we see loss of control, slowed movements, and tremors.
Symptoms of PD are not present until nearly 80 percent of the SN cells have died. The symptoms may appear minor at first. Then, as more and more SN cells die … less and less dopamine is available to control movement.
Doctors do not know why SN cells die in the first place, and they do not know how to stop it. But, they can replace dopamine with medications and temporarily improve movement and coordination.
The Five Stages of Parkinson's Disease
One of the most common evaluation scales for Parkinson's Disease clients is the Hoehn-Yahr scale. According to this scale there are five stages of Parkinson's Disease. They are:
Stage 1-Symptoms are very mild and annoying. They are usually on one side of the body. The client's family and friends have started to notice some changes in posture, walking and facial expression.
Stage 2-Symptoms begin to affect both sides of the body and they are more obvious. The client's posture and walking are affected. Minor signs of disability are starting to show.
Stage 3-Symptoms are very obvious. The client's balance and walking are affected a lot. Standing is a problem, too. The general coordination of the client begins to fail.
Stage 4-Symptoms are more severe. The client can still walk, but not very well. Stiffness and slowness are a big problem. Many clients become unable to live alone.
Stage 5-Symptoms are disabling. The client is unable to walk or stand. They become completely dependent on others and require constant care.
Each stage of Parkinson's can last for many, many, many years!
The Main Symptoms of Parkinson's Disease
There are four main symptoms of Parkinson's Disease. They are:
1. TREMOR (SHAKING) Tremor is also called Resting Tremor because it's most noticeable when the client is at rest. It usually begins with the hands and feet, but can affect the head, neck, face, tongue, lips, and jaw.
The shaking or trembling is at a regular beat of around four to six beats every second. It may happen only on one side of the body or it could be worse on just one side depending on the time of day. Stress can make it worse.
2. RIGIDITY (STIFFNESS)
Rigidity is a stiffness or an ache in the muscles. The muscles are always tense and it gets worse with movement. This happens to all the voluntary muscles. So, it's hard for a PD client to move their arms, and legs. Their arms do not swing when they walk.
Parkinson's clients can have trouble with breathing, eating, swallowing, and speech, too. The face loses expression and becomes "mask-like". The eyes do not blink as often, and it's hard to smile.
3. BRADYKINESIA (SLOWNESS)
This symptom is about slow movement. It's very frustrating for people with PD because it takes them a very long time to do routine things like walking, bathing, eating, and dressing.
They move in slow motion. And to make it worse, they never know when it will happen. One minute they seem to be moving fine and the next minute they are not.
4. POSTURAL INSTABILITY (UNSTEADINESS)
This term means loss of balance or unsteadiness. People with Parkinson's Disease lose their coordination and fall down easily.
They tend to lean forward or backward especially when they walk. They tend to have poor posture and can have droopy shoulders and a lowered head.
5 Key Points to Remember
- Parkinson's eventually effects every part of the body and mind.
- There is no cure for PD but medication or surgery can ease the symptoms.
- When caring for a client with PD, your goal should be to encourage independence for as long as possible … even when it seems to take forever for your client to perform simple tasks!
- It can be very frustrating for clients with PD to suddenly lose the ability to care for themselves. Never take an anxious or angry outburst personally.
- Clients with a chronic disease like Parkinson's, for which there is no cure, may become depressed, withdrawn, and even suicidal. Be sure to report any signs that your client is becoming depressed or suicidal immediately so intervention can be initiated.