Interventions for Parkinson disease

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Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health education/ Awareness creation among the elderly and communities on Parkinson disease and related conditions Advocacy programs on parkinsonism	Encourage elderly persons to Exercise regularly to reduce the risk of Parkinson's disease Advice on other preventive measures such as; Avoidance of exposure to pesticides and herbicides Use of vitamins such as Vitamin C and E* *Advice on diet/use of balance diet		Recognition of cardinal signs of parkinsonism including slowness of movement; tremor, stiffness or rigidity and postural instability or difficulty in walking Advice on diet/use of balance diet Monitoring any indication of progression or severity of the disease Pain relief and exercise Encourage adherence to medication Referral to a health facility for management	Encourage Regular Physical Exercise programs for adults persons with early onset Parkinsonism disease to improve mobility and flexibility Generalized relaxation techniques such as gentle rocking to improve flexibility	Psychosocial support and counselling for the adult patient with early onset parkinsonism and to the family to address factors such as loss of function and jobs, depression, fear Stress management for both patient and families
Primary Care
Education to the elderly and communities on Parkinson and related conditions	Encourage elderly persons to Exercise regularly to reduce the risk of Parkinson's disease Advice on other preventive measures such as Avoidance of exposure to pesticides and herbicides Use of vitamins such as Vitamin C and E Identification of at-risk patients Encourage /Advice on adherence to medication Monitoring for any complications arising including difficulties in swallowing; urine incontinence; breathing complications Stabilize patient in case on any complications e.g.patient with difficulties in breathing before referral to a hospital Referral for a patient with parkinsonism to a hospital for further management		Regular Physical Exercise programs for elderly persons with Parkinsonism disease to improve mobility and flexibility Physiotherapy Generalized relaxation techniques such as gentle rocking to improve flexibility Speech and language therapy Occupational therapy	Regular Physical Exercise programs for adults with early onset Parkinsonism disease to improve mobility and flexibility Generalized relaxation techniques such as gentle rocking to improve flexibility	Palliative care to improve quality of life for both the person with Parkinson's and the family by Providing relief from the symptoms such as pain for the patient Stress relief for the patient and families Provide emotional support/counselling to address factors such as loss of function and jobs, depression, fear Palliative care serves an important role in addressing goals of care.
Referral Facility: General
Awareness creation among adults and communities on parkinsonism disease including early onset parkinsonism disease Advocacy programs on parkinsonism Health workers training on parkinsonism and its management	Encourage elderly persons to Exercise regularly to reduce the risk of Parkinson's disease Advice on other preventive measures such as Avoidance of exposure to pesticides and herbicides Use of vitamins such as Vitamin C and E		Medical history and neurological examination Diagnosis through neuro-imaging -MRI Symptomatic treatment Diet therapy/guidance on balanced diet Use of medication such as levodopa Surgery for deep brain stimulation has been used to reduce motor symptoms in severe cases where drugs are ineffective. Monitoring the disease progression and management of any complications arising Management of difficulties in swallowing/feeding e.g., through use of feeding tube Managing breathing complications e.g., through use of non-invasive ventilator, and tracheostomy. Management of Urine incontinence Management of constipation, pain, blood pressure Management of secondary causes of parkinsonism’s such as stroke	Regular Physical Exercise programs for elderly persons with Parkinsonism disease to improve mobility and flexibility Physiotherapy services for elderly with parkinsonians improve mobility, gait, speed, flexibility Generalized relaxation techniques such as gentle rocking to improve flexibility Speech therapy-Lee Silverman Voice treatment Occupational therapy to promote health and quality of life by helping elderly persons with the disease to participate in as many of their daily living activities as possible.	Palliative care to improve quality of life for both the person with Parkinson's and the family by providing relief from the symptoms such as pain for the patient Stress relief for the patient and families , Psychosocial and emotional support/counselling to address factors such as loss of function and jobs, depression, fear
Referral Facility: Specialist
Awareness creation among adults and communities on parkinsonism disease including early onset parkinsonism disease Advocacy programs on parkinsonism Health workers training on parkinsonism and its management	Encourage elderly persons to Exercise regularly to reduce the risk of Parkinson's disease Advice on other preventive measures such as Avoidance of exposure to pesticides and herbicides Use of vitamins such as Vitamin C and E		Medical history and neurological examination Diagnosis through neuro-imaging -MRI Symptomatic treatment Diet therapy/guidance on balanced diet Use of medication such as levodopa Surgery for deep brain stimulation has been used to reduce motor symptoms in severe cases where drugs are ineffective. Monitoring the disease progression and management of any complications arising Management of difficulties in swallowing/feeding e.g., through use of feeding tube Managing breathing complications e.g., through use of non-invasive ventilator, and tracheostomy. Management of Urine incontinence Management of constipation, pain, blood pressure Management of secondary causes of parkinsonism’s such as stroke	Regular Physical Exercise programs for elderly persons with Parkinsonism disease to improve mobility and flexibility Physiotherapy services for elderly with parkinsonians improve mobility, gait, speed, flexibility Generalized relaxation techniques such as gentle rocking to improve flexibility Speech therapy-Lee Silverman Voice treatment Occupational therapy to promote health and quality of life by helping elderly persons with the disease to participate in as many of their daily living activities as possible.	Palliative care to improve quality of life for both the person with Parkinson's and the family by providing relief from the symptoms such as pain for the patient Stress relief for the patient and families , Psychosocial and emotional support/counselling to address factors such as loss of function and jobs, depression, fear

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Integrated media and public education campaigns to avoid stigmatizing perceptions of PD and to create awareness on symptoms and initiation of treatment	Health life style: regular Exercise, healthy diet etc. Avoidance of exposure to pesticides and herbicides	Recognition of classic Parkinson disease symptoms	Referral to a health facility for management Monitor progression of disease severity	Support for self-management and family carers	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members
Primary Care
Provide educational materials for better diagnosis, communicating the diagnosis and follow-up care, including support	Guidance and counselling on promotion of healthy behaviour (exercise and diet)	Recognition of classic Parkinson disease symptoms	Referral to a health facility for further management	Occupational therapy Physical therapy Speech therapy Strength training, gait and balance training and hydrotherapy	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members
Referral Facility: General
Provide educational materials for better diagnosis, communicating the diagnosis and follow-up care, including support	Guidance and counselling on promotion of healthy behaviour (exercise and diet)	History Physical examination Psychological assessment Cognitive assessment Complete blood count (CBC) Metabolic panel (CMP) Thyroid function tests	Dopaminergic medications Non-dopaminergic medications	Occupational therapy Physical therapy Speech therapy Strength training, gait and balance training and hydrotherapy	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members
Referral Facility: Specialist
Provide educational materials for better diagnosis, communicating the diagnosis and follow-up care, including support	Guidance and counselling on promotion of healthy behaviour (exercise and diet)	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members	Dopaminergic medications Non-dopaminergic medications Levodopa-carbidopa enteral suspension Deep brain stimulation	Occupational therapy Physical therapy Speech therapy Strength training, gait and balance training and hydrotherapy	Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members