Functional Assessment and Movement Therapy in Individuals with Parkinson's Disease

Abstract

Parkinsonova bolest je progresivni neurodegenerativni poremećaj središnjeg živčanog sustava, karakteriziran primarno motoričkim simptomima koji uključuju tremor u mirovanju, rigidnost, bradikineziju i posturalnu nestabilnost. Etiološki, nastaje zbog degeneracije dopaminergičkih neurona u području substantia nigra pars compacta, što uzrokuje disfunkciju bazalnih ganglija i narušenu kontrolu pokreta. Dijagnostički postupak obuhvaća kliničku evaluaciju uz neuroimaging tehnike poput magnetske rezonancije (MRI) radi isključenja drugih neuroloških entiteta te SPECT snimanja za prikaz dopaminergičkog deficita. Klinička dijagnoza često zahtijeva longitudinalno praćenje, budući da rani simptomi mogu biti nespecifični. Funkcionalna procjena predstavlja temelj u planiranju rehabilitacijskih intervencija. Korištenje standardiziranih ljestvica kao što su Hoehn-Yahr stadijacija (za motoričko pogoršanje), Bergova ljestvica ravnoteže (procjena statičke i dinamičke ravnoteže), Timed Up and Go (TUG) test (procjena mobilnosti) i Modificirana Ashworthova ljestvica (za mjerenje mišićnog tonusa) omogućuje kvantifikaciju stupnja funkcionalnog oštećenja i praćenje učinkovitosti terapijskih postupaka. Fizioterapijski pristup temelji se na principima neuroplastičnosti i funkcionalne reedukacije, s ciljem očuvanja i unapređenja mobilnosti, ravnoteže, posturalne kontrole i svakodnevne funkcionalnosti. Individualizirani program vježbanja uključuje: trening inicijacije i izvođenja pokreta radi suzbijanja bradikinezije, specifične vježbe za povećanje amplitude i ritma hoda, vježbe balansa i propriocepcije u svrhu prevencije padova, jačanje mišićne snage i povećanje opsega pokreta, te edukaciju o strategijama za svakodnevno funkcioniranje i energetski učinkovit pokret. S obzirom na progresivnu prirodu bolesti, rehabilitacija mora biti kontinuirana i prilagođena kliničkom statusu bolesnika, uz jasno definirane kratkoročne i dugoročne ciljeve. Kvaliteta života i stupanj samostalnosti bolesnika značajno ovise o pravovremenom uključivanju fizioterapije u multidisciplinarni terapijski plan.Parkinson’s disease (PD) is a progressive neurodegenerative disorder of the central nervous system, primarily characterized by motor symptoms including resting tremor, rigidity, bradykinesia, and postural instability. The disease is etiologically linked to the degeneration of dopaminergic neurons in the substantia nigra pars compacta, resulting in basal ganglia dysfunction and impaired motor control. Diagnosis relies on clinical evaluation supported by neuroimaging techniques. Magnetic resonance imaging (MRI) aids in excluding alternative neurological conditions and visualizing basal ganglia structures. Single-photon emission computed tomography (SPECT) can detect presynaptic dopaminergic deficits characteristic of PD. Due to the nonspecific nature of early symptoms, longitudinal clinical observation is often necessary to establish diagnostic accuracy. Functional assessment is critical for individualized rehabilitation planning. Standardized tools such as the Hoehn and Yahr scale (motor progression), the Berg Balance Scale (static and dynamic balance assessment), the Timed Up and Go (TUG) test (mobility evaluation), and the Modified Ashworth Scale (muscle tone assessment) provide objective measures of disease severity and functional capacity. These tools also facilitate the monitoring of therapeutic outcomes over time. Physiotherapy interventions are grounded in principles of neuroplasticity and functional retraining, aiming to maintain and enhance mobility, balance, posture, and activities of daily living. Individualized therapeutic exercise programs typically include: training to initiate and execute movements to counteract bradykinesia, gait retraining with emphasis on amplitude and cadence, balance and proprioceptive exercises for fall prevention, muscle strengthening and range of motion enhancement, and patient education on movement strategies and energy conservation. Given the progressive nature of PD, physiotherapeutic management should be continuous and adaptable to clinical changes. The establishment of short- and long-term rehabilitation goals is essential for maintaining patient autonomy and improving quality of life. Early and sustained integration of physiotherapy within a multidisciplinary care model significantly contributes to functional preservation and overall well-being in individuals with Parkinson’s disease