Evaluation and Interventions for Movement Disorders Flashcards
what are the tests and measures for bradykinesia?
RAMs (rapid alternating movt)
observation
what are the tests and measures for motor planning?
RAMs
observation
what are the tests and measures for resting tremor?
observation
what are the tests and measures for fine motor?
9 hole peg test
OT referral?
what are the tests and measures for tone?
MAS
what are the tests and measures for sensory fxn and pain?
proprioception
t/f: we should compare symptoms BL
true
t/f: we should note if anything makes symptoms worse (ie changes in position, anxiety, etc)
true
what are the tests and measures for fxns of the CV, hemo, immuno, and resp systems in PD?
assess BP, HR, RR
2MWT or 6MWT
what is an indication to check BP in PD?
the pt becomes dizzy/lightheaded w/sitting or standing
what are the tests and measures for mental fxns in PD?
MoCA
TUGc
what are the tests and measures for voice/speech fxns?
observation
SLP referral?
what body structure and fxn outcome measures are recommended for all H and Y stages of PD?
UPDRS part 3 (revised)
UPDRS part 1
what body structure and fxn outcome measures are recommended for H and Y stage 1?
STS
MiniBEST
MoCA
PD fatigue scale
what body structure and fxn outcome measures are recommended for H and Y stage 2?
STS
MiniBEST
MoCA
PD fatigue scale
what body structure and fxn outcome measures are recommended for H and Y stage 3?
STS
MiniBEST
MoCA
PD fatigue scale
what body structure and fxn outcome measures are recommended for H and Y stage 4?
STS
MiniBEST
MoCA
PD fatigue scale
what body structure and fxn outcome measure is recommended especially for H and Y stage 5?
PD fatigue scale
what is the PD fatigue scale?
a pt rated scale that reflects the physical aspects of fatigue in pts with PD
measures both the presence of fatigue and its impact on daily fxn
t/f: the PD fatigue scale excludes cognitive and emotional features of fatigue
true
ratings in the PD fatigue are based on feelings and experiences over the past ___ weeks
2
the PD fatigue scale is recommended for all H and Y stages, esp stage ___
5
when is the PD fatigue scale given?
when the pt is reporting high fatigue
what info can we gain for our treatment based on the PD fatigue scale?
how many breaks we can expect the pt to need during the session
what is a great measure to use to objectify fatigue in PD?
PD fatigue scale
what are the highly recommended activity limitations outcome measures for all stages of PD?
6MWT
UPDRS pt 2
gait speed
MiniBEST
FGA
5xSTS
9 hole peg test
what are the activity limitations outcome measures for H and Y stage 1?
6MWT
FGA
gait speed
5xSTS
what are the activity limitations outcome measures for H and Y stage 2?
6MWT
FGA
gait speed
5xSTS
9 hole peg test
Berg
what are the activity limitations outcome measures for H and Y stage 3?
6MWT
FGA
gait speed
5xSTS
9 hole peg test
Berg
miniBEST
what are the activity limitations outcome measures for H and Y stage 4?
6MWT
FGA
gait speed
5xSTS
9 hole peg test
Berg
miniBEST
what are the activity limitations outcome measures for H and Y stage 5?
360 deg turn test
self reported disability scale in pts with PD
when do we start introducing more balance measures for pts with PD?
during H and Y stage 3 bc balance becomes an issue at this point
what is the cutoff of the 360 deg turn test
> 5 sec
what does the 360 deg turn test help us determine?
the subtype of PD
what is the MiniBEST test?
a shortened version for the BEST test
14 items 0-2 per item for a total of 28 points
balance test for reactive/ anticipatory balance, sensory organization, and dynamic gait
what measure is one of the best validated measures of balance in PD?
MiniBEST test
if a pt scores less than or equal to 19 on the MiniBEST test, what does this mean?
they are at risk for recurrent falls
if a pts scores less than or equal to 21 on the MiniBEST test, what does this mean?
they have postural deficits
what are the 4 domains of balance in the MiniBEST test?
anticipatory balance
reactive postural control
sensory organization
dynamic gait
why are the 4 domains of balance in the MiniBEST test important to assess in PD?
bc it is able to cast a wide net for PD impairments
t/f: your interventions should focus on the results of the each subsection of the MiniBEST test
true
what is anticipatory balance?
ability to generate postural adjustments prior to onset of and during voluntary movt for the purpose of either countering an upcoming postural disturbance due to voluntary movt
what is reactive postural control?
ability to respond to sensory input that signals a need for a response to ensure successful maintenance of postural control
need for a response is unanticipated but many be generated externally or secondarily to an internally generated movt
what is sensory organization?
ability of the CNS to select, weight, and integrate info to develop accurate and meaningful perceptions of the body and environment that allow for maintenance of postural control
what is dynamic gait?
ability to modify balance while walking in the presence of external demands
what are the 3 components of balance?
vestibular
visual
somatosensory
what is the freezing of gait (FoG) questionnaire?
an examination of the presence of freezing during gait
0-4 each item for a total of 0-24 with higher scores corresponding to more severe FoG
what are the components of the FoG questionnaire?
360 deg turns
small step walking
stops on command
narrow/cluttered passages
dual motor-tasking (ie carrying a tray)
cognitive dual tasking
what is a highly recommended participation outcome measure for PD?
PDQ-8 or PDQ-39
what is a participation measure used for H and Y stage 1?
ABC scale
what is a participation measure used for H and Y stage 2?
ABC scale
what is a participation measure used for H and Y stage 3?
ABC scale
what is a participation measure used for H and Y stage 4?
PDQ-8 or PDQ-39
what is a participation measure used for H and Y stage 5?
PDQ-8 or PDQ-39
what are the PD EDGE recommendations for body structure and fxn?
MDS-UPDRS revision part 3
MDS-UPDRS part 1
MoCA
what are the PD EDGE recommendations for activity?
6MWT
10mWT
MiniBEST test
MDS-UPDRS part 2
FGA
5xSTS
9 hole peg test
what are the PD EDGE recommendations for participation?
PDQ-8 or PDQ-39
what is the PD EDGE recommendation for FoG?
FoG questionnaire
what is the PD EDGE recommendation for fatigue?
PD fatigue scale
what is the PD EDGE recommendation for fear of falling?
ABC scale
what is the PD EDGE recommendation for dual tasking?
TUGc
what are common gait pattern deviations seen in PD?
decrease stride length, width, and height (shuffling gait)
insufficient heel strike w/increased forefoot loading
increased double limb support
increased cadence
problems w/initiation of gait
decreased turns
decreased arm swing
festination, freezing, retropulsion
decreased dual tasking
what do we need to document with festination, freezing, and retropulsion?
how many times they occur and when they happen (what is going on in the environment?)
what is a good test and measure for dual tasking?
TUGc
what are the benefits of the U step AD?
it is higher for promoting good posture
won’t roll unless the brakes are slightly compressed
t/f: it is easy to get Medicare coverage for a U step AD
false, it is difficult
t/f: ADs have a large effect on the gait patterns we observe in PD
true
do dystonias or dynkinesia appear like rigidity?
dystonias
what are involuntary, sustained muscle co-contractions of agonist and antagonist muscle groups resulting in abnormal postures/twisting?
dystonias
dystonias typically increase with what?
activity and during off times (not enough meds)
what are the mental fxn impairments seen in hyperkinetic disorders?
decreased cognition
dementia
aggression
irritability
moodiness
depression
what are the tests and measures for mental fxns in hyperkinetic disorders?
MoCA
A&Ox4
TUGc
what are the fxn of the CV, immuno, hemo, and resp systems that are impaired in hyperkinetic disorders?
resp dysfxn
bradycardia
sweating
what are the tests and measures for CV, hemo, immuno, and resp dysfxn in hyperkinetics disorders?
VS, temp, RPE, auscultation of chest sounds, cough assessment
6MWT, 2MWT
what are the neuromusculoskeletal and movt related dysfxns seen in hyperkinetic disorders?
chorea
weak trunk/neck extensors/instrinsic- of feet and hands
postural instability
coordination issues
what are the tests and measures for neuromusculoskeletal and movt related dysfxns seen in hyperkinetic disorders?
how much chorea is interfering with their fxns
MMT, ROM
6MWT, TUG, 10mWT, Berg
what is chorea?
inability to stabilize the trunk
spasmodic involuntary movts of the limbs and face
what is the unified HD rating scale (UHDRS)?
a way to monitor disease progression and effects of therapy
what are the 4 domains of the UHDRS?
cognitive
motor
behavioral
fxnal assessment
what are the movt impairments in HD?
exercise capacity/physical activity limitations
mobility and fxn limitations
balance issues and fall risk
respiratory dysfxn
secondary MSK and postural changes
limited active movt (end stage HD)
how can we assess exercise capacity in HD?
6MWT
VO2
how can we measure mobility and fxn in HD?
TUG
Tinetti mobility test
how can we measure balance and falls risk in HD?
Berg balance scale
how can we measure respiratory fxns in HD?
6MWT
how can we measure secondary MSK and postural changes in HD?
Berg balance scale
TMT
medical outcomes study short form 36
how can we measure limited active movt in HD?
medical outcomes study short form 36
world health organization disability assessment schedule (WHODAS)
why is exercise important in PD?
it enhances neuroplasticity in PD
maximizes synaptic plasticity to improve bradykinesia and gait
it promotes greater structural adaptations
rewarding activities increase dopamine levels and promote learning
dopaminergic neurons are highly responseive to exercise (use it or lose it)
it can slow PD progression
t/f: high intensity eccentric resistance training can decrease bradykinesia in PD
true
mod to high intensity CV training has been shown to improve what two things in PD?
bradykinesia and gait
what are the exercise recommendations that PTs SHOULD implement in PD treatment?
aerobic training
resistance training
balance training
gait training
task-specific training
motor learning (declarative learning)
external cueing
community-based exercise
what exercises MAY a PT implement in PD treatment?
flexibility exercise
rock climbing
what are the benefits of aerobic training in PD?
improvement in VO2
motor and non-motor impairment improvement
improvements in fxnal activity’s
improvements in QoL
reduced motor disease severity
what is mod intensity aerobic training target HR?
60-75% HRmax
what is high intensity aerobic training HRmax?
75-85% HRmax
what is the RPE range we should be aiming for with aerobic training in PD?
13-14
how is aerobic training different from HIGT?
HIGT is specific to walking, but aerobic training can be gait, bike, sitting, standing, etc
what are the benefits of resistance training in PD?
improvements in strength/power
improvements in non-motor symptoms
reductions in motor disease severity
improvements in activities
improvement in QoL
reduction in fall rate
how can we combine H.I.T and resistance training to maximize our time in the clinic?
increased bike resistance
circuit training with low rest breaks
what are the benefits of balance training in PD?
improvements in postural control impairments
improvements in balance outcomes
improvements in mobility outcomes
improvements in gait outcomes
improvments in outcomes related to balance confidence
improvements in QoL
improvements in non-motor symptoms
what are anticipatory postural control interventions?
practice tasks that require predictable dynamic control of COM (stairs, STS, reaching)
what are reactive postural control interventions?
practice tasks that require recovery of balance after unexpected perturbations (self initiated or external)
what are sensory organization interventions?
practice maintaining body position under predictable and unpredictable sensory and BOS conditions while varying availability and accuracy of 1 or more senses for orientation (foam, EC, etc)
what are dynamic gait interventions?
practice maintaining body position/modify balance while walking w/ external demands (stepping over a box, head turns with gait, etc)
what are the benefits of gait training in PD?
reduce motor disease severity
improved step length
improved walking speed
improved walking capacity
improved fxnal mobility
improved balance
t/f: pt preference should be highly considered when creating task specific interventions
true
what are the benefits of task-specific training in PD?
improvements in task-specific impairments
improvements fxnal outcomes
what is procedural learning?
acquisition of skills and habits through repetition, often unconsciously
what is declarative learning?
conscious acquisition and recall of factual info and events
is procedural or declarative memory more effected in PD?
procedural learning
why is procedural learning impaired in PD?
depletion of dopamine in PD impairs procedural learning and they have difficulty acquiring new skills
why is declarative learning usually relatively in tact in PD?
bc it is primarily dependent on the hippocampus which is less effected in the early stages of PD
what structures are involved in motor learning?
the motor and parietal (sensory) cortex
striatum of the BG
what is the efferent copy of movt?
representation (memory) of learned movt sequences retained
what structures are involved in the efferent copy of movt?
supplemental motor area
putamen/globus pallidus
what are the benefits of external cueing in PD?
improvements in motor disease severity
improvements in spatiotemporal parameters of gait
improvements in fxnal gait outcomes
improvements in FoG
what are some cueing strategies for someone presenting with a shuffled gait patterns?
markers on the floor to step over
hit pads to cue arm swing
speed ladder
metronome
music
internal counting
t/f: too many verbal cues and mental imagery doesn’t tend to be helpful in pts with PD
true
what are the 4 different types of external cues?
auditory cues
visual cues
tactile cues
cognitive cues (mental practice, breaking things down)
what are the benefits of community-based exercise in PD?
reduction in motor disease severity
improvements in non-motor symptoms
improvements in fxnal outcomes
improvements in QoL
what are the benefits of flexibility exercise in PD?
improvement in axial rotation
t/f: flexibility exercises are good to add to other exercises, like adding in trunk rotations
true
new research has shown what benefits of rock climbing in PD?
aerobic, resistance, and balance training components
cognitive demands
varies by difficulty
improvements in grip strength
improvements in QoL
what interventions can we use to improve motor disease severity in PD?
aerobic training
gait training
resistance training
integrated care
community based exercise
what interventions can we use to improve walking in PD?
gait training
balance training
external cueing
what interventions can we use to improve QoL in PD?
balance training
resistance training
community based exercise
behavior change approach
integrated care
what interventions can we use to improve fxnal mobility in PD?
aerobic exercise
resistance training
community based exercise
task-specific training
what interventions can we use to improve balance in PD?
balance training
gait training
tele-rehabilitation
what interventions can we use to improve non-motor symptoms of PD (ie. cognition, depression, anxiety, sleep)?
resistance training
community based exercise
integrated care
during the early stages of PD, are we using more restorative or compensatory strategies?
restorative
during the later stages of PD, are we using more restorative or compensatory strategies?
compensatory
what interventions should we use in H and Y stage 1?
aerobic and resistance training
what interventions should we use in H and Y stage 2?
aerobic and resistance training
what interventions should we use in H and Y stage 3?
aerobic, resistance, and balance training
what interventions should we use in H and Y stage 4?
aerobic, caregiver education, and balance training
what interventions should we use in H and Y stage 5?
caregiver education, task specific, flexibility, and resistance training
PTs _____ prescribe aerobic exercise at ____ intensity w/UE/LE strengthening exercises 3x/week for at least 12 weeks to improve fitness and stabilize/improve motor fxn in HD
should; moderate
how many times a week should HD pts be prescribed aerobic training?
3x/week
what are the benefits of aerobic training for HD?
improved fitness
stabilized/improved motor fxn
PTs ____ prescribe 1:1 supervised gait training to improve spatiotemporal measures of gait in HD
should
what are the benefits of 1:1 supervised gait training in HD?
improved spatiotemporal measures of gait
PTs _____ prescribe individualized exercises, including balance exercises, at ____ intensity to improve balance, and balance confidence in HD
may; moderate
what are the benefits of individualized balance exercises in HD?
improved balance and balance confidence
PTs ____ provide regular breathing exercises to improve respiratory muscle strength and cough effectiveness in HD
may
what are the benefits of breathing exercises in HD?
improved respiratory muscle strength and cough effectiveness
PTs ____ prescribe individualized tailored programs to improve postural control and may use positioning devices to optimize posture
may
PTs ____ include positioning, seating, active movt, respiratory exercises, and family education in end-stage HD interventions
may
when in HD would we consider including positioning, seating, active movt, respiratory exercises, and family education in our interventions?
in the end-stages
what interventions can be used in early stage HD?
aerobic exercise
stretching and ROM of trunk flexors, shoulder extensors, internal rotators, HS, and gastroc
strengthening exercise
balance/coordination exercise
what interventions can be used in middle stage HD?
fall prevention strategies
AD (RW)
balance exercises
environmental modifications
use of auditory cues, motor imagery, and dual tasks
what interventions can be used in late stage HD?
ADLs
improve posture and seating
prevent falls
environmental adaptations
family education
what are the exercise recommendations for PD+?
high intensity exercise
self efficacy
social engagement
nutrition and GI fxns
sleep hygiene
medial stability
mental health
fitness/fatigue resistance
t/f: interventions for PD+ are not going to stop disease progression, but can aid in secondary complications of the diseases
true
