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DPT 620: Neuro > Evaluation and Interventions for Movement Disorders > Flashcards

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
Q

what is a great measure to use to objectify fatigue in PD?

A

PD fatigue scale

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26
Q

what are the highly recommended activity limitations outcome measures for all stages of PD?

A

6MWT

UPDRS pt 2

gait speed

MiniBEST

FGA

5xSTS

9 hole peg test

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27
Q

what are the activity limitations outcome measures for H and Y stage 1?

A

6MWT

FGA

gait speed

5xSTS

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28
Q

what are the activity limitations outcome measures for H and Y stage 2?

A

6MWT

FGA

gait speed

5xSTS

9 hole peg test

Berg

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29
Q

what are the activity limitations outcome measures for H and Y stage 3?

A

6MWT

FGA

gait speed

5xSTS

9 hole peg test

Berg

miniBEST

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30
Q

what are the activity limitations outcome measures for H and Y stage 4?

A

6MWT

FGA

gait speed

5xSTS

9 hole peg test

Berg

miniBEST

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31
Q

what are the activity limitations outcome measures for H and Y stage 5?

A

360 deg turn test

self reported disability scale in pts with PD

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32
Q

when do we start introducing more balance measures for pts with PD?

A

during H and Y stage 3 bc balance becomes an issue at this point

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33
Q

what is the cutoff of the 360 deg turn test

A

> 5 sec

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34
Q

what does the 360 deg turn test help us determine?

A

the subtype of PD

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35
Q

what is the MiniBEST test?

A

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

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36
Q

what measure is one of the best validated measures of balance in PD?

A

MiniBEST test

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37
Q

if a pt scores less than or equal to 19 on the MiniBEST test, what does this mean?

A

they are at risk for recurrent falls

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38
Q

if a pts scores less than or equal to 21 on the MiniBEST test, what does this mean?

A

they have postural deficits

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39
Q

what are the 4 domains of balance in the MiniBEST test?

A

anticipatory balance

reactive postural control

sensory organization

dynamic gait

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40
Q

why are the 4 domains of balance in the MiniBEST test important to assess in PD?

A

bc it is able to cast a wide net for PD impairments

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41
Q

t/f: your interventions should focus on the results of the each subsection of the MiniBEST test

A

true

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42
Q

what is anticipatory balance?

A

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

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43
Q

what is reactive postural control?

A

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

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44
Q

what is sensory organization?

A

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

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45
Q

what is dynamic gait?

A

ability to modify balance while walking in the presence of external demands

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46
Q

what are the 3 components of balance?

A

vestibular

visual

somatosensory

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47
Q

what is the freezing of gait (FoG) questionnaire?

A

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

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48
Q

what are the components of the FoG questionnaire?

A

360 deg turns

small step walking

stops on command

narrow/cluttered passages

dual motor-tasking (ie carrying a tray)

cognitive dual tasking

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49
Q

what is a highly recommended participation outcome measure for PD?

A

PDQ-8 or PDQ-39

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50
Q

what is a participation measure used for H and Y stage 1?

A

ABC scale

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51
Q

what is a participation measure used for H and Y stage 2?

A

ABC scale

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52
Q

what is a participation measure used for H and Y stage 3?

A

ABC scale

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53
Q

what is a participation measure used for H and Y stage 4?

A

PDQ-8 or PDQ-39

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54
Q

what is a participation measure used for H and Y stage 5?

A

PDQ-8 or PDQ-39

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55
Q

what are the PD EDGE recommendations for body structure and fxn?

A

MDS-UPDRS revision part 3

MDS-UPDRS part 1

MoCA

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56
Q

what are the PD EDGE recommendations for activity?

A

6MWT

10mWT

MiniBEST test

MDS-UPDRS part 2

FGA

5xSTS

9 hole peg test

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57
Q

what are the PD EDGE recommendations for participation?

A

PDQ-8 or PDQ-39

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58
Q

what is the PD EDGE recommendation for FoG?

A

FoG questionnaire

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59
Q

what is the PD EDGE recommendation for fatigue?

A

PD fatigue scale

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60
Q

what is the PD EDGE recommendation for fear of falling?

A

ABC scale

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61
Q

what is the PD EDGE recommendation for dual tasking?

A

TUGc

62
Q

what are common gait pattern deviations seen in PD?

A

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
Q

what do we need to document with festination, freezing, and retropulsion?

A

how many times they occur and when they happen (what is going on in the environment?)

64
Q

what is a good test and measure for dual tasking?

A

TUGc

65
Q

what are the benefits of the U step AD?

A

it is higher for promoting good posture

won’t roll unless the brakes are slightly compressed

66
Q

t/f: it is easy to get Medicare coverage for a U step AD

A

false, it is difficult

67
Q

t/f: ADs have a large effect on the gait patterns we observe in PD

A

true

68
Q

do dystonias or dynkinesia appear like rigidity?

A

dystonias

69
Q

what are involuntary, sustained muscle co-contractions of agonist and antagonist muscle groups resulting in abnormal postures/twisting?

A

dystonias

70
Q

dystonias typically increase with what?

A

activity and during off times (not enough meds)

71
Q

what are the mental fxn impairments seen in hyperkinetic disorders?

A

decreased cognition

dementia

aggression

irritability

moodiness

depression

72
Q

what are the tests and measures for mental fxns in hyperkinetic disorders?

A

MoCA

A&Ox4

TUGc

73
Q

what are the fxn of the CV, immuno, hemo, and resp systems that are impaired in hyperkinetic disorders?

A

resp dysfxn

bradycardia

sweating

74
Q

what are the tests and measures for CV, hemo, immuno, and resp dysfxn in hyperkinetics disorders?

A

VS, temp, RPE, auscultation of chest sounds, cough assessment

6MWT, 2MWT

75
Q

what are the neuromusculoskeletal and movt related dysfxns seen in hyperkinetic disorders?

A

chorea

weak trunk/neck extensors/instrinsic- of feet and hands

postural instability

coordination issues

76
Q

what are the tests and measures for neuromusculoskeletal and movt related dysfxns seen in hyperkinetic disorders?

A

how much chorea is interfering with their fxns

MMT, ROM

6MWT, TUG, 10mWT, Berg

77
Q

what is chorea?

A

inability to stabilize the trunk

spasmodic involuntary movts of the limbs and face

78
Q

what is the unified HD rating scale (UHDRS)?

A

a way to monitor disease progression and effects of therapy

79
Q

what are the 4 domains of the UHDRS?

A

cognitive

motor

behavioral

fxnal assessment

80
Q

what are the movt impairments in HD?

A

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
Q

how can we assess exercise capacity in HD?

A

6MWT

VO2

82
Q

how can we measure mobility and fxn in HD?

A

TUG

Tinetti mobility test

83
Q

how can we measure balance and falls risk in HD?

A

Berg balance scale

84
Q

how can we measure respiratory fxns in HD?

A

6MWT

85
Q

how can we measure secondary MSK and postural changes in HD?

A

Berg balance scale

TMT

medical outcomes study short form 36

86
Q

how can we measure limited active movt in HD?

A

medical outcomes study short form 36

world health organization disability assessment schedule (WHODAS)

87
Q

why is exercise important in PD?

A

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
Q

t/f: high intensity eccentric resistance training can decrease bradykinesia in PD

A

true

89
Q

mod to high intensity CV training has been shown to improve what two things in PD?

A

bradykinesia and gait

90
Q

what are the exercise recommendations that PTs SHOULD implement in PD treatment?

A

aerobic training

resistance training

balance training

gait training

task-specific training

motor learning (declarative learning)

external cueing

community-based exercise

91
Q

what exercises MAY a PT implement in PD treatment?

A

flexibility exercise

rock climbing

92
Q

what are the benefits of aerobic training in PD?

A

improvement in VO2

motor and non-motor impairment improvement

improvements in fxnal activity’s

improvements in QoL

reduced motor disease severity

93
Q

what is mod intensity aerobic training target HR?

A

60-75% HRmax

94
Q

what is high intensity aerobic training HRmax?

A

75-85% HRmax

95
Q

what is the RPE range we should be aiming for with aerobic training in PD?

A

13-14

96
Q

how is aerobic training different from HIGT?

A

HIGT is specific to walking, but aerobic training can be gait, bike, sitting, standing, etc

97
Q

what are the benefits of resistance training in PD?

A

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
Q

how can we combine H.I.T and resistance training to maximize our time in the clinic?

A

increased bike resistance

circuit training with low rest breaks

99
Q

what are the benefits of balance training in PD?

A

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
Q

what are anticipatory postural control interventions?

A

practice tasks that require predictable dynamic control of COM (stairs, STS, reaching)

101
Q

what are reactive postural control interventions?

A

practice tasks that require recovery of balance after unexpected perturbations (self initiated or external)

102
Q

what are sensory organization interventions?

A

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
Q

what are dynamic gait interventions?

A

practice maintaining body position/modify balance while walking w/ external demands (stepping over a box, head turns with gait, etc)

104
Q

what are the benefits of gait training in PD?

A

reduce motor disease severity

improved step length

improved walking speed

improved walking capacity

improved fxnal mobility

improved balance

105
Q

t/f: pt preference should be highly considered when creating task specific interventions

A

true

106
Q

what are the benefits of task-specific training in PD?

A

improvements in task-specific impairments

improvements fxnal outcomes

107
Q

what is procedural learning?

A

acquisition of skills and habits through repetition, often unconsciously

108
Q

what is declarative learning?

A

conscious acquisition and recall of factual info and events

109
Q

is procedural or declarative memory more effected in PD?

A

procedural learning

110
Q

why is procedural learning impaired in PD?

A

depletion of dopamine in PD impairs procedural learning and they have difficulty acquiring new skills

111
Q

why is declarative learning usually relatively in tact in PD?

A

bc it is primarily dependent on the hippocampus which is less effected in the early stages of PD

112
Q

what structures are involved in motor learning?

A

the motor and parietal (sensory) cortex

striatum of the BG

113
Q

what is the efferent copy of movt?

A

representation (memory) of learned movt sequences retained

114
Q

what structures are involved in the efferent copy of movt?

A

supplemental motor area

putamen/globus pallidus

115
Q

what are the benefits of external cueing in PD?

A

improvements in motor disease severity

improvements in spatiotemporal parameters of gait

improvements in fxnal gait outcomes

improvements in FoG

116
Q

what are some cueing strategies for someone presenting with a shuffled gait patterns?

A

markers on the floor to step over

hit pads to cue arm swing

speed ladder

metronome

music

internal counting

117
Q

t/f: too many verbal cues and mental imagery doesn’t tend to be helpful in pts with PD

A

true

118
Q

what are the 4 different types of external cues?

A

auditory cues

visual cues

tactile cues

cognitive cues (mental practice, breaking things down)

119
Q

what are the benefits of community-based exercise in PD?

A

reduction in motor disease severity

improvements in non-motor symptoms

improvements in fxnal outcomes

improvements in QoL

120
Q

what are the benefits of flexibility exercise in PD?

A

improvement in axial rotation

121
Q

t/f: flexibility exercises are good to add to other exercises, like adding in trunk rotations

A

true

122
Q

new research has shown what benefits of rock climbing in PD?

A

aerobic, resistance, and balance training components

cognitive demands

varies by difficulty

improvements in grip strength

improvements in QoL

123
Q

what interventions can we use to improve motor disease severity in PD?

A

aerobic training

gait training

resistance training

integrated care

community based exercise

124
Q

what interventions can we use to improve walking in PD?

A

gait training

balance training

external cueing

125
Q

what interventions can we use to improve QoL in PD?

A

balance training

resistance training

community based exercise

behavior change approach

integrated care

126
Q

what interventions can we use to improve fxnal mobility in PD?

A

aerobic exercise

resistance training

community based exercise

task-specific training

127
Q

what interventions can we use to improve balance in PD?

A

balance training

gait training

tele-rehabilitation

128
Q

what interventions can we use to improve non-motor symptoms of PD (ie. cognition, depression, anxiety, sleep)?

A

resistance training

community based exercise

integrated care

129
Q

during the early stages of PD, are we using more restorative or compensatory strategies?

A

restorative

130
Q

during the later stages of PD, are we using more restorative or compensatory strategies?

A

compensatory

131
Q

what interventions should we use in H and Y stage 1?

A

aerobic and resistance training

132
Q

what interventions should we use in H and Y stage 2?

A

aerobic and resistance training

133
Q

what interventions should we use in H and Y stage 3?

A

aerobic, resistance, and balance training

134
Q

what interventions should we use in H and Y stage 4?

A

aerobic, caregiver education, and balance training

135
Q

what interventions should we use in H and Y stage 5?

A

caregiver education, task specific, flexibility, and resistance training

136
Q

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

A

should; moderate

137
Q

how many times a week should HD pts be prescribed aerobic training?

A

3x/week

138
Q

what are the benefits of aerobic training for HD?

A

improved fitness

stabilized/improved motor fxn

139
Q

PTs ____ prescribe 1:1 supervised gait training to improve spatiotemporal measures of gait in HD

A

should

140
Q

what are the benefits of 1:1 supervised gait training in HD?

A

improved spatiotemporal measures of gait

141
Q

PTs _____ prescribe individualized exercises, including balance exercises, at ____ intensity to improve balance, and balance confidence in HD

A

may; moderate

142
Q

what are the benefits of individualized balance exercises in HD?

A

improved balance and balance confidence

143
Q

PTs ____ provide regular breathing exercises to improve respiratory muscle strength and cough effectiveness in HD

A

may

144
Q

what are the benefits of breathing exercises in HD?

A

improved respiratory muscle strength and cough effectiveness

145
Q

PTs ____ prescribe individualized tailored programs to improve postural control and may use positioning devices to optimize posture

A

may

146
Q

PTs ____ include positioning, seating, active movt, respiratory exercises, and family education in end-stage HD interventions

A

may

147
Q

when in HD would we consider including positioning, seating, active movt, respiratory exercises, and family education in our interventions?

A

in the end-stages

148
Q

what interventions can be used in early stage HD?

A

aerobic exercise

stretching and ROM of trunk flexors, shoulder extensors, internal rotators, HS, and gastroc

strengthening exercise

balance/coordination exercise

149
Q

what interventions can be used in middle stage HD?

A

fall prevention strategies

AD (RW)

balance exercises

environmental modifications

use of auditory cues, motor imagery, and dual tasks

150
Q

what interventions can be used in late stage HD?

A

ADLs

improve posture and seating

prevent falls

environmental adaptations

family education

151
Q

what are the exercise recommendations for PD+?

A

high intensity exercise

self efficacy

social engagement

nutrition and GI fxns

sleep hygiene

medial stability

mental health

fitness/fatigue resistance

152
Q

t/f: interventions for PD+ are not going to stop disease progression, but can aid in secondary complications of the diseases

A

true

DPT 620: Neuro (12 decks)

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