Evaluation and Interventions for Movement Disorders Flashcards

1
Q

what are the tests and measures for bradykinesia?

A

RAMs (rapid alternating movt)

observation

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2
Q

what are the tests and measures for motor planning?

A

RAMs

observation

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3
Q

what are the tests and measures for resting tremor?

A

observation

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4
Q

what are the tests and measures for fine motor?

A

9 hole peg test

OT referral?

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5
Q

what are the tests and measures for tone?

A

MAS

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6
Q

what are the tests and measures for sensory fxn and pain?

A

proprioception

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7
Q

t/f: we should compare symptoms BL

A

true

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8
Q

t/f: we should note if anything makes symptoms worse (ie changes in position, anxiety, etc)

A

true

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9
Q

what are the tests and measures for fxns of the CV, hemo, immuno, and resp systems in PD?

A

assess BP, HR, RR

2MWT or 6MWT

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10
Q

what is an indication to check BP in PD?

A

the pt becomes dizzy/lightheaded w/sitting or standing

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11
Q

what are the tests and measures for mental fxns in PD?

A

MoCA

TUGc

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12
Q

what are the tests and measures for voice/speech fxns?

A

observation

SLP referral?

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13
Q

what body structure and fxn outcome measures are recommended for all H and Y stages of PD?

A

UPDRS part 3 (revised)

UPDRS part 1

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14
Q

what body structure and fxn outcome measures are recommended for H and Y stage 1?

A

STS

MiniBEST

MoCA

PD fatigue scale

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15
Q

what body structure and fxn outcome measures are recommended for H and Y stage 2?

A

STS

MiniBEST

MoCA

PD fatigue scale

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16
Q

what body structure and fxn outcome measures are recommended for H and Y stage 3?

A

STS

MiniBEST

MoCA

PD fatigue scale

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17
Q

what body structure and fxn outcome measures are recommended for H and Y stage 4?

A

STS

MiniBEST

MoCA

PD fatigue scale

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18
Q

what body structure and fxn outcome measure is recommended especially for H and Y stage 5?

A

PD fatigue scale

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19
Q

what is the PD fatigue scale?

A

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

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20
Q

t/f: the PD fatigue scale excludes cognitive and emotional features of fatigue

A

true

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21
Q

ratings in the PD fatigue are based on feelings and experiences over the past ___ weeks

A

2

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22
Q

the PD fatigue scale is recommended for all H and Y stages, esp stage ___

A

5

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23
Q

when is the PD fatigue scale given?

A

when the pt is reporting high fatigue

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24
Q

what info can we gain for our treatment based on the PD fatigue scale?

A

how many breaks we can expect the pt to need during the session

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25
what is a great measure to use to objectify fatigue in PD?
PD fatigue scale
26
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
27
what are the activity limitations outcome measures for H and Y stage 1?
6MWT FGA gait speed 5xSTS
28
what are the activity limitations outcome measures for H and Y stage 2?
6MWT FGA gait speed 5xSTS 9 hole peg test Berg
29
what are the activity limitations outcome measures for H and Y stage 3?
6MWT FGA gait speed 5xSTS 9 hole peg test Berg miniBEST
30
what are the activity limitations outcome measures for H and Y stage 4?
6MWT FGA gait speed 5xSTS 9 hole peg test Berg miniBEST
31
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
32
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
33
what is the cutoff of the 360 deg turn test
>5 sec
34
what does the 360 deg turn test help us determine?
the subtype of PD
35
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
36
what measure is one of the best validated measures of balance in PD?
MiniBEST test
37
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
38
if a pts scores less than or equal to 21 on the MiniBEST test, what does this mean?
they have postural deficits
39
what are the 4 domains of balance in the MiniBEST test?
anticipatory balance reactive postural control sensory organization dynamic gait
40
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
41
t/f: your interventions should focus on the results of the each subsection of the MiniBEST test
true
42
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
43
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
44
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
45
what is dynamic gait?
ability to modify balance while walking in the presence of external demands
46
what are the 3 components of balance?
vestibular visual somatosensory
47
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
48
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
49
what is a highly recommended participation outcome measure for PD?
PDQ-8 or PDQ-39
50
what is a participation measure used for H and Y stage 1?
ABC scale
51
what is a participation measure used for H and Y stage 2?
ABC scale
52
what is a participation measure used for H and Y stage 3?
ABC scale
53
what is a participation measure used for H and Y stage 4?
PDQ-8 or PDQ-39
54
what is a participation measure used for H and Y stage 5?
PDQ-8 or PDQ-39
55
what are the PD EDGE recommendations for body structure and fxn?
MDS-UPDRS revision part 3 MDS-UPDRS part 1 MoCA
56
what are the PD EDGE recommendations for activity?
6MWT 10mWT MiniBEST test MDS-UPDRS part 2 FGA 5xSTS 9 hole peg test
57
what are the PD EDGE recommendations for participation?
PDQ-8 or PDQ-39
58
what is the PD EDGE recommendation for FoG?
FoG questionnaire
59
what is the PD EDGE recommendation for fatigue?
PD fatigue scale
60
what is the PD EDGE recommendation for fear of falling?
ABC scale
61
what is the PD EDGE recommendation for dual tasking?
TUGc
62
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
63
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?)
64
what is a good test and measure for dual tasking?
TUGc
65
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
66
t/f: it is easy to get Medicare coverage for a U step AD
false, it is difficult
67
t/f: ADs have a large effect on the gait patterns we observe in PD
true
68
do dystonias or dynkinesia appear like rigidity?
dystonias
69
what are involuntary, sustained muscle co-contractions of agonist and antagonist muscle groups resulting in abnormal postures/twisting?
dystonias
70
dystonias typically increase with what?
activity and during off times (not enough meds)
71
what are the mental fxn impairments seen in hyperkinetic disorders?
decreased cognition dementia aggression irritability moodiness depression
72
what are the tests and measures for mental fxns in hyperkinetic disorders?
MoCA A&Ox4 TUGc
73
what are the fxn of the CV, immuno, hemo, and resp systems that are impaired in hyperkinetic disorders?
resp dysfxn bradycardia sweating
74
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
75
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
76
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
77
what is chorea?
inability to stabilize the trunk spasmodic involuntary movts of the limbs and face
78
what is the unified HD rating scale (UHDRS)?
a way to monitor disease progression and effects of therapy
79
what are the 4 domains of the UHDRS?
cognitive motor behavioral fxnal assessment
80
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)
81
how can we assess exercise capacity in HD?
6MWT VO2
82
how can we measure mobility and fxn in HD?
TUG Tinetti mobility test
83
how can we measure balance and falls risk in HD?
Berg balance scale
84
how can we measure respiratory fxns in HD?
6MWT
85
how can we measure secondary MSK and postural changes in HD?
Berg balance scale TMT medical outcomes study short form 36
86
how can we measure limited active movt in HD?
medical outcomes study short form 36 world health organization disability assessment schedule (WHODAS)
87
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
88
t/f: high intensity eccentric resistance training can decrease bradykinesia in PD
true
89
mod to high intensity CV training has been shown to improve what two things in PD?
bradykinesia and gait
90
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
91
what exercises MAY a PT implement in PD treatment?
flexibility exercise rock climbing
92
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
93
what is mod intensity aerobic training target HR?
60-75% HRmax
94
what is high intensity aerobic training HRmax?
75-85% HRmax
95
what is the RPE range we should be aiming for with aerobic training in PD?
13-14
96
how is aerobic training different from HIGT?
HIGT is specific to walking, but aerobic training can be gait, bike, sitting, standing, etc
97
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
98
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
99
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
100
what are anticipatory postural control interventions?
practice tasks that require predictable dynamic control of COM (stairs, STS, reaching)
101
what are reactive postural control interventions?
practice tasks that require recovery of balance after unexpected perturbations (self initiated or external)
102
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)
103
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)
104
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
105
t/f: pt preference should be highly considered when creating task specific interventions
true
106
what are the benefits of task-specific training in PD?
improvements in task-specific impairments improvements fxnal outcomes
107
what is procedural learning?
acquisition of skills and habits through repetition, often unconsciously
108
what is declarative learning?
conscious acquisition and recall of factual info and events
109
is procedural or declarative memory more effected in PD?
procedural learning
110
why is procedural learning impaired in PD?
depletion of dopamine in PD impairs procedural learning and they have difficulty acquiring new skills
111
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
112
what structures are involved in motor learning?
the motor and parietal (sensory) cortex striatum of the BG
113
what is the efferent copy of movt?
representation (memory) of learned movt sequences retained
114
what structures are involved in the efferent copy of movt?
supplemental motor area putamen/globus pallidus
115
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
116
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
117
t/f: too many verbal cues and mental imagery doesn't tend to be helpful in pts with PD
true
118
what are the 4 different types of external cues?
auditory cues visual cues tactile cues cognitive cues (mental practice, breaking things down)
119
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
120
what are the benefits of flexibility exercise in PD?
improvement in axial rotation
121
t/f: flexibility exercises are good to add to other exercises, like adding in trunk rotations
true
122
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
123
what interventions can we use to improve motor disease severity in PD?
aerobic training gait training resistance training integrated care community based exercise
124
what interventions can we use to improve walking in PD?
gait training balance training external cueing
125
what interventions can we use to improve QoL in PD?
balance training resistance training community based exercise behavior change approach integrated care
126
what interventions can we use to improve fxnal mobility in PD?
aerobic exercise resistance training community based exercise task-specific training
127
what interventions can we use to improve balance in PD?
balance training gait training tele-rehabilitation
128
what interventions can we use to improve non-motor symptoms of PD (ie. cognition, depression, anxiety, sleep)?
resistance training community based exercise integrated care
129
during the early stages of PD, are we using more restorative or compensatory strategies?
restorative
130
during the later stages of PD, are we using more restorative or compensatory strategies?
compensatory
131
what interventions should we use in H and Y stage 1?
aerobic and resistance training
132
what interventions should we use in H and Y stage 2?
aerobic and resistance training
133
what interventions should we use in H and Y stage 3?
aerobic, resistance, and balance training
134
what interventions should we use in H and Y stage 4?
aerobic, caregiver education, and balance training
135
what interventions should we use in H and Y stage 5?
caregiver education, task specific, flexibility, and resistance training
136
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
137
how many times a week should HD pts be prescribed aerobic training?
3x/week
138
what are the benefits of aerobic training for HD?
improved fitness stabilized/improved motor fxn
139
PTs ____ prescribe 1:1 supervised gait training to improve spatiotemporal measures of gait in HD
should
140
what are the benefits of 1:1 supervised gait training in HD?
improved spatiotemporal measures of gait
141
PTs _____ prescribe individualized exercises, including balance exercises, at ____ intensity to improve balance, and balance confidence in HD
may; moderate
142
what are the benefits of individualized balance exercises in HD?
improved balance and balance confidence
143
PTs ____ provide regular breathing exercises to improve respiratory muscle strength and cough effectiveness in HD
may
144
what are the benefits of breathing exercises in HD?
improved respiratory muscle strength and cough effectiveness
145
PTs ____ prescribe individualized tailored programs to improve postural control and may use positioning devices to optimize posture
may
146
PTs ____ include positioning, seating, active movt, respiratory exercises, and family education in end-stage HD interventions
may
147
when in HD would we consider including positioning, seating, active movt, respiratory exercises, and family education in our interventions?
in the end-stages
148
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
149
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
150
what interventions can be used in late stage HD?
ADLs improve posture and seating prevent falls environmental adaptations family education
151
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
152
t/f: interventions for PD+ are not going to stop disease progression, but can aid in secondary complications of the diseases
true