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Morbo di Parkinson, patologia e consigli utili

Il Parkinson è una malattia cronico-degenerativa del sistema nervoso centrale che colpisce l'1-2% della popolazione in genere dai 60 anni (la percentuale aumenta con l’aumentare dell’età).
Ciò che viene colpito in questi pazienti sono le cellule nervose contenute nella sostanza nera del mesencefalo, area deputata alla creazione della dopamina, proteina responsabile della coordinazione e dell'elaborazione di movimenti involontari annessi ai volontari.
Il Parkinson può essere primario le cui cause sono ancora a noi sconosciute, o secondario (acquisito), meno frequente, dato per esempio da micro traumi, farmaci, sostanze tossiche,...(sono state individuate anche delle possibili predisposizioni genetiche).
I sintomi di questa "paralisi agitante" sono vari: lentezza di movimenti (bradicinesia); tremore; rigidità, la quale conferisce la classica postura in flessione di tronco e arti (atteggiamento camptocormico);
Fig.1
instabilità posturale e perdita di equilibrio; difficoltà nell'iniziare la marcia  (freezeng) e nel proseguirla, ecc... Con l'avanzare della malattia possono comparire altri disturbi, fino ad arrivare alle discinesie (movimenti involontari) e alla demenza.
La terapia che cerca di limitare la malattia viene effettuata grazie ad un farmaco chiamato levodopa (a volte si deve ricorrere a tecniche di stimolazione o di chirurgia).
Ora, tutti si chiedono: la fisioterapia può essere utile per questa patologia? 

SI! la fisioterapia, accompagnata fin da subito alla terapia farmacologica, è un ottimo metodo per cercare di combattere alcuni dei sintomi e prevenire gli effetti secondari. Qui sotto riporteremo alcuni consigli pratici per voi: 

- Per la rigidità: effettuare esercizi di allungamento in estensione accompagnati da stretching, nel tentativo di evitare l'insorgere di retrazioni muscolotendinee e patologie dolorose ossee. Molto utile può essere l’esercizio contro il muro.
Fig.2

- Per la coordinazione e l'equilibrio: effettuare esercizi che coinvolgono movimento sinergico di arti,  tronco e capo, per esempio lanciarsi la palla, esercizi o percorsi su appoggi instabili, esercizi ad occhi chiusi,ecc… (ricordandoci sempre che spesso si tratta di pazienti anziani).
-per il tremore: in questo caso la fisioterapia non può fare molto, ma è utile seguire alcuni consigli pratici per conviverci: poiché coinvolge maggiormente le mani, può essere utile stringere i gomiti contro la vita ed effettuare il movimento desiderato velocemente. 

- Per la deambulazione: per aiutare il paziente ad iniziare la marcia può essere utile porlo di fronte ad una linea o il vostro piede e dirgli di superarli (Fig.3) oppure simulare una marcia con le ginocchia alte; anche il ritmo verbale può essere d'aiuto; inoltre, poiché il freezing non si manifesta facendo le scale e in acqua, si possono usare questi metodi per riallenare il paziente alla marcia.
Fig.3
- Bastone? Spesso è sconsigliato, poiché il paziente può trovarsi impacciato nell'usarlo (anche a causa del tremore) e inciampare su di esso.

- Per le disabilità della vita quotidiana: effettuare esercizi funzionali. Per questo è molto di aiuto la terapia occupazionale, la quale si occupa di insegnare al paziente alcune manovre e dare alcuni consigli e strumenti adatti per renderlo il più autonomo possibile nei gesti della vita quotidiana.

Nel vestirsi: indossare o togliere i vestiti prima dalla parte del corpo più rigida; indossare indumenti larghi e facili da infilare, privi di stringhe e bottoni e che si allaccino sul davanti; usare un calzascarpe lungo. In bagno: usare tappetini antiscivolo, montare delle maniglie a muro nella doccia e vicino al water, usare un sedile del water rialzato per facilitare l'alzarsi in piedi. 
Alimentazione: i pazienti hanno spesso problemi di deglutizione; si consiglia perciò di mangiare e masticare lentamente piccoli pezzi e di portare la testa leggermente in avanti quando si deglutisce; ricordiamo inoltre che una dieta bilanciata e sana è importante per la forma fisica del paziente ma soprattutto per l’assorbimento della levodopa. Per scendere dal letto: portarsi verso il bordo del letto, girarsi sul fianco e quindi portare giù le gambe e contemporaneamente spingersi con le braccia.

Questi sono solo dei consigli utili da seguire a casa, che a volte purtroppo non sono sufficienti. Per combattere al meglio la malattia sarebbe utile effettuare anche a livello ambulatoriale o in regime di ricovero dei cicli di fisioterapia e terapia occupazionale.

Essendo cronica la malattia non si potrà mai debellare del tutto, ma se si compie un buon lavoro di prevenzione e riabilitazione l’aspettativa di vita di questi pazienti in genere può essere comparata a quella di un anziano non affetto.


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1028 commenti a Morbo di Parkinson, patologia e consigli utili:

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