Disorders of motor function

Question 1

What is Parkinson’s Disease

Answer 1

Progressive gradual neurological degenerative disorder of the brain.

• Affects motor function through loss of extrapyramidal activity
• Occurs bc of progressive degenerative changes in basal nuclei in substantia nigra
• Decreased number of neurons in substantia nigra secrete dopamine (inhibitory neurotransmitter) leading to an imbalance between excitation and inhibition in the basal nuclei. The excess stimulation affects movement and posture by increasing muscle tone and activity leading to resting tremors, muscular rigidity, difficulty in initiating movement, and postural instability
• Many PTs w/ Parkinson’s have a reduced # of cortical neurons, which is characteristic of Dementia

Question 2

What are the forms of Parkinson’s

Answer 2

PRIMARY and SECONDARY
Primary: idiopathic
• Develops after age 60
• Occurs in men & women
• Several genes identified in familial Parkinson’s
• Damaging effects of viruses + toxins on cells
• Recent research focuses on mitochondrial cell changes in cells of parkinson’s PTs – these changes suggest periods of oxidative stress  accumulation of free radicals within the cell
• Secondary Parkinson’s:
• D/t CNS infection (encephalitis), tumor growths in the brain, cerebral ischemia, antipsychotic medications, trauma, vascular disease, drug induced (clorapromazine/phenothiazine)-effects may be reversible or diminished when the drug taking is discontinued

Question 3

What are the EARLY manifestations of Parkinson’s?

Answer 3

Early signs: Fatigue, muscle weakness/ache, decreased flexibility, less spontaneous change in facial expression

Question 4

What are the clinical manifestations of Parkinson’s?

Answer 4

• Hand tremor occurs at rest; repetitive pinrolling of hand
• Usually unilateral to start
• Becomes bilateral later on
• Tremors cease with voluntary movement + during sleep
• Tremors will also affect feet, face, tongue, lips
• Rigidity – increased muscle rigidity
• Bradykinesia – slow movements
• Akinesia – lack of associated involuntary movement
• Loss of arm swinging when walking
• Spontaneous postural adjustments when sitting
• Standing posture: stooped, leaning forward, head + neck flexed
• Festination: propulsive gait
• Short, shuffling steps with increasing acceleration
• Postural reflexes impaired
• High risk for falls
• Complex activities such as setting out of chair: slow + difficult task
• Quiet monotone voice
• Dysarthria: impaired movement of muscles used for speech production
• Mask-like face, blinking reduced  blank staring face
• Cogwheeling: “pullback”, jerky or ratcheting effect in an arm of leg that the examiner perceives when moving a patient’s rigid limb

Question 5

What are the ADVANCED manifestations of Parkinson’s?

Answer 5

• Dysphagia
• Prolonged eating time
• Drooling
• Dementia
• Slurred Speech
• Autonomic dysfunction: urinary retention, constipation, orthostatic hypotension (threat of falls increases)
• Risk for UTI, Respiratory infections

Question 6

How to diagnose Parkinson’s?

Answer 6

• No specific diagnostic test
• Diagnosis based on clinical manifestations
• CT/MRI to rule out brain tumors/neoplasms

Question 7

Management of Parkinson’s

Answer 7

• Medications: Dopaminergics
o Dopamine replacement therapy to reduce motor impairment
o Levadopa: precursor of dopamine is administered bc dopamine does not cross BBB
• Anticholinergic drugs
• Antidepressants
• Deep Brain Stimulation
• Transplant of fetal dopamine creating cells; adult stem cells
• Nursing Priority: tertiary level prevention strategies (safety)

Question 8

What is multiple sclerosis?

Answer 8

Chronic autoimmune disease characterized by progressive demyelination of the brain, spinal cord, and cranial nerves w/ exacerbations and remissions
o Loss of myelin interferes with conduction of impulses in the affected fibers
o Affects all nerve fibers (motor, sensory, autonomic)
o Occurs in diffuse patches throughout nervous system

One causative factor can be genetic activation of SYNCYTIN (genes encoding proteins)

Later on, glial scarring occurs causing axon degeneration

Question 9

When is the typical onset of MS and what population is most affected?

Answer 9

Onset is typically 20-50 years old, and the disease is twice as likely to occur in FEMALES.

Multiple Sclerosis is the 2nd most common cause of disability in the US

Question 10

What are the classifications for multiple sclerosis?

Answer 10

1. Benign
2. Relapsing/Remitting (MOST COMMON)
3. Secondary chronic progressive: Begins with relapsing-remitting, later becomes steadily progressive
4. Primary Progressive: steady and gradual neurologic deterioration w/o remission of symptoms; progressive disability, no acute attacks; 40-60yo at onset of disease
5. Progressive Relapsing: frequent relapses with partial recovery w/ no return to baseline (VERY RARE. Progressive, cumulative symptoms and deterioration occur over several years.)

Question 11

Clinical manifestations of multiple sclerosis

Answer 11

• Manifestations are determined by areas of demyelination
• Common early sign: Blurred vision; weakness in legs (d/t plaques on corticospinal tract)

If cranial nerves are affected:
• Diplopia (double vision); scotoma (spot in visual field)
• Dysarthria (words can’t be articulated clearly)
• Paresthesia, areas of numbness, burning, tingling (develop if sensory nerve fibers damaged)
• Progressive weakness and paralysis extending to the upper limbs
• Loss of coordination; bladder, bowel and sexual dysfunction;
• Chronic fatigue is common
• Sensory deficits include paresthesia and loss of position sense in upper body, face, legs

• Later stages: depression or euphoria
• Complications r/t immobility: respiratory infections, pressure ulcers, contractures are common w/ progression