An evidence-based osteopathic approach to Parkinson disease
Section snippets
Biomechanical perspective
Approaching the patient with PD from a structural and mechanical perspective provides a model by which the cardinal features of PD can be addressed directly. PD is a progressive neurologic depletion of dopaminergic neurons from the basal ganglia which manifests as common motor or extrapyramidal signs: tremor, bradykinesia, rigidity, and, as the disease progresses, postural instability.2 In a review of the clinical features of PD, the characteristic distal resting 3-6 Hz tremor or an active
Respiratory-circulatory perspective
Morbidity and mortality in the patients with PD is greatly linked to both the respiratory and cardiovascular systems. In a study investigating mortality in 340 patients with parkinsonism, the primary causes of death were arteriosclerotic heart disease and bronchopneumonia.16 A cohort study with 1948 patients with PD documented that the most commonly reported comorbidity after arthritis is heart or circulation problems (36.3%). There is evidence that cardiovascular comorbidity correlates more
Neurologic perspective
Autonomic dysfunction has been well documented as a nonmotor feature of PD.26 It affects almost every system in the body and has added to the disease burden and disability of patients with PD.27 The pathology behind the autonomic dysfunction is not completely understood but is believed to be due to cell loss and Lewy bodies in the sympathetic and parasympathetic nervous systems as well as within the neural plexi of the gastrointestinal tract system, heart, and pelvic structures.28
Metabolic-energy perspective
The family physician can expect fatigue to be a common complaint reported by patients with PD. Its etiology has been hypothesized to be connected to both depression and sleep problems, but the pathophysiology is still not well understood. Fatigue is a symptom that is difficult to measure objectively and has a wide range of severity, but it has been found to directly impact the quality of life of patients with PD.37 Several studies have documented fatigue to be a symptom in 40%-78% of patients
Behavioral perspective
The psychobehavioral effects of PD on the patient have been assessed through measurements of disability, quality of life, activities of daily living, anxiety, and depression. Disability is common in many disease processes, but, in a study comparing disabled populations with and without PD, there were significant absolute risk differences between the 2 groups with regard to limitations in the following categories: communication, mobility, pain, memory, and vision. This is evident by an increased
Conclusion
PD is a chronic and progressively debilitating disease that affects patients in many different ways. A rational approach that utilizes OMT as an adjunctive management may play a major role in caring for patients with PD. OMT can be particularly helpful in treating patients with PD when supporting functional gains or minimizing decline over time. Considering the promising results in initial studies, the authors recommend more research investigating the application of OMT on PD.
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