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Neuro II - Final Content > 10/2- Physical Exam and Intervention for PD part 2 > Flashcards

10/2- Physical Exam and Intervention for PD part 2 Flashcards

1
Q

What is the difference between using outcome measures for examination and using clinical decisions?

A

Outcome measure- has psychometric properties and allows for a reliable/valid assessment of progress

Clinical decision - relies on task analysis to evaluate impairments, does not have psychometric properties but is functional for the patient

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2
Q

What are the 5 most important big picture items to focus on in the history for someone with PD?

A
  1. Patients goals- focus on the person not the disorder
  2. Chief complaints of activity and participation- roles and responsibilities
  3. Typical level of activity and exercise
  4. Fall history- how often, when, where why
  5. Social History
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3
Q

What Parkinson’s disease specific information should you obtain in the history?

A 
Characteristics of PD
1. initial side of onset
2. profile of symptoms at onset and now
3. Type of PD
Relationship of symptoms to medications
Co-morbidities and treatments
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4
Q

What does the UPDRS stand for? What are the 5 subscales on the test?

A

Unified PD Rating Scale

  1. Mentation, behavior, mood
  2. ADL
  3. Motor
  4. Complications of drug therapy
  5. other issues
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5
Q

What is the purpose of the Schwab and England test?

A

It rates overall physical function on a 10 point scale
100= completely independent
0 = totally dependent - vegetative

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6
Q

What items are examined on the Profile PD test? What is special about the Profile PD?

A

24 item scale- 96 point total

  • Body systems- rigidity, tremor, postural instability
  • Activities- turn in bed, adjust bed sheets, transfer, gait
  • Memory, depression, involvement
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7
Q

What key (7) functional activities should you observe during the examination of someone with PD?

A
  1. Bed mobility and transfers
  2. Stability- balance control
  3. Gait- on level, uneven surfaces, in cluttered spaces, over obstacles, turning
  4. Reaching
  5. Dual task performance
  6. Fine motor performance
  7. Specific ADL’s
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8
Q

What is the CS-PFP? What does it evaluate?

A

Continuous Scale Physical Functional Performance

  • performance based test with 15 real life functional tasks
  • reliable and valid for people with PD

Healthy adults in their 60’s typical score 64

Transition from independence scores -57

PD scores H & Y stage 3 - 30 - really low in comparison

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9
Q

What is the cut off score for individuals with PD in the functional reach test? Timed up and Go?

A

FRT- >12.5 inches is at an increased risk of falls

TUG- 7.95 sec

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10
Q

How does an individuals functional axial rotation change with an increase in the H & Y stages of PD? What are the expected values for men and women ages 40-59?

A

It quickly declines with an increase in stage

40-59 males - 117 degrees
40-59 females- 127.8

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11
Q

What other (8)measures can evaluate balance and gait for individuals with PD

A
  1. Activity balance confidence
  2. Berg Balance Scale
  3. Dynamic Gait Index
  4. Functional Gait Assessment
  5. Best test
  6. Four Square step test vs 360 turn
  7. TUG
  8. Freezing of gait
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12
Q

What are the most typical impairments seen in individuals with PD?

A 
Posture
ROM and flexibility-  hamstrings, gastroc, soleus, 
Strength
Pain
Cardiovascular condition
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13
Q

What two measures used for PD detect deficits early on in the diagnosis ?

A

CS-PFP

Functional Reach test

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14
Q

In the early stage of PD, what tests should be used to evaluate Balance, Gait and Impairments?

A

Balance

  1. postural pull test
  2. functional reach

Gait

  1. 6 minute walk test
  2. 10 meter walk test

Impairments

  1. Functional axial rotation
  2. muscle length
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15
Q

What tests should be used to evaluate balance for people with Middle Stage PD?

A

postural pull test
ABC scale
Fall risk assessment- BBS, DGI, TUG, FRT
Falls diary

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16
Q

What tests should be used to evaluate gait for people with Middle Stage PD?

A 
TUG
6MWT
10 meter walk
walking in various conditions
Turning
Freezing of gait
17
Q

What 3 tests combine balance and gait in the evaluation for the middle stage PD?

A
  1. TUG
  2. 360 degree turn
  3. Four square step test
18
Q

What H & Y stage is classified as a late stage?

A

Level 4 and Up

19
Q

What tests are used to evaluate gait/balance for the late stages of PD?

A

2 minute walk
TUG
Falls Diary
Freezing of gait

20
Q

How does the pharmacology impact physical therapy interventions?

A

The medications allow for a decrease in the rigidity, bradykinesia, tremor and postural instability to allow for exercise and a decrease in functional limitations

21
Q

What should the emphasis of physical intervention be for individuals with PD?

A

Strategy training - to compensate for problems in neuromotor processing and pathophysiology

Secondary impairments- correct/ improve the underlying impairments to enhance function

Address falls

22
Q

What are 3 types of strategy training that can have direct effects on the pathophysiology?

A
  1. movement organization - avoid dual task performance
  2. visualization
  3. rhythmic auditory stimulation/ mental rehearsal
23
Q

T/F individuals with PD have trouble learning new things

A

True -
Early stages- can still learn motor skills however it is slower and requires more repetition
Late stages - have more difficulty and may need to bypass the defective basal ganglia

24
Q

What are the concepts for treatment goals for individuals with PD?

A
  1. Optimize independence and participation in work, home and leisure
  2. Optimize safety and independence with functional tasks- bed mobility, transfers, balance, gait, ADLS
  3. Preserve/improve physical capacity- CV endurance, strength, flexibility
  4. Prevent falls
  5. Optimize long term independence with HEP and activity
25
Q

What are the 4 key elements of an appropriate plan of care and intervention for PD?

A
  1. Promote physical activity- BIGGETS EMPHASIS
  2. Strategy training
  3. Management of secondary impairments
  4. Fall prevention/ reduction
26
Q

What are important aspects to consider when encouraging someone with PD to engage in physical activity?

A

Think about their barriers and abilities for exercise

implement strategies for the barriers

Establish realistic goals

Think about what they like to do- walking, dancing

27
Q

What are two types of strategies that can be used for strategy training?

A

Motor learning strategies to improve performance through practice

compensatory strategies

28
Q

What are different types of cues? Cueing strategies?

A

1/ Verbal cues

  1. Auditory cues
  2. Visual cues
consciously think
visualize
mentally rehearse
break down complex movements
avoid dual task performance 
use feedback/ cues
29
Q

Cardiovascular fitness is beneficial for individuals with PD, what should the dosing of endurance training be?

A

3/wk for at least 30 min for 4 months at 65-80% of HR max to establish change

need to keep doing it in order to keep the effects of exercise

30
Q

Strength training is also beneficial for PD- what muscle groups should strength training target and what should be the dose?

A

LE balancing muscles- specifically LE extensors and postural extensors

Dose - 2-3 x/wk 1-3 sets of exercise, use resistance loads equivalent to 8-12 reps for atleast 6 weeks

use body weight for load

31
Q

How can flexibility training impact someone with PD? What area is the most important to target for flexibility

A

it leads to improved balance and gait
Spinal flexibility
3x wk for 6-12 weeks

32
Q

What is the over all intervention strategy for early stage PD?

A

Promote active lifestyle with continued involvement at home, work and leisure
Strategy training while they can still learn new things
Begin a general exercise program - aerobic, flexibility, and strength
Think PREVENTION!

33
Q

What is the over all intervention strategy for MID stage PD?

A

Promote an active lifestyle
encourage participation in activities and exercise when meds are ON
strategy training with compensation techniques
prevent. reduce falls
reduce multi tasking
exercise

34
Q

What is the over all intervention strategy for LATE stage PD?

A

Teach the care giver how to assist
active assisted exercise to prevent the worsening of sequelae- ex contractures
change position regularly to prevent skin break down

Neuro II - Final Content (16 decks)

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