Exam 2 - PD Flashcards
what is the average age of onset for parkinsons
50-60 years
describe young onset PD vs juvenile onset PD
young onset: 21-50 years
juvenile onset: < 21 years
are men or women more likely to have PD
men
describe the etiology of PD
disturbance in the dopamine in the basal ganglia
typically, less DA in the substantia nigra
what types of PD are there
idiopathic - most common
genetic
secondary parkinsonisms
atypical parkinsonsims (parkinson’s plus syndrome)
describe postural instability gait disturbances related to PD
worse prognosis
more bradykinesia
higher prevalence of non-motor symptoms
higher likelihood of dementia
describe tremor dominant PD
better prognosis
lower incidence of non-motor symptoms
less difficulty with bradykenesia and postural instability
lower risk of developing dementia
list the secondary parkinsonisms
postencephalitic
toxic
drug-induced
what is toxic parkinsonism
exposed to pesticides or industrial chemicals (often miners)
synthetic heroine with chemical MPTP
what is drug-induced parkinsonisms
drugs that interfere with dopaminergic systems
neuroepileptic drugs, antidepressants, some antihypertensives
medications for PD increase DA, so any medication that influences DA systems will result in PD symptoms
list examples of PD plus syndromes
progressive supranuclear palsy
multiple systems atrophy
cortical-basla ganglionic degeneration
lewy body dementia
normal pressure hyrdocephalus
cretzfedlt-jakob disease
wilson’s disease
describe the pathophysiology of PD
degeneration of dopaminergic neurons resulting in less DA produced
direct loop of signal from basal ganglia to thalamus to cortex is inhibited
describe the direct loop
excitation putamen to globus pallidus
globus pallidus to ventral lateral nucleus of thalamus
VL nucleus of thalamus to supplemental motor area of the cortex
Result: voluntary motor movement and positive feedback loop
what is the function of DA in the direct loop
DA from substantia nigra helps with activation
how much/little DA determines the amplitude of the excitation/activation
what are the cardinal motor symptoms of PD
bradykinesia
resting tremor
postural instability
rigiditiy
how should muscle strength be tested in pts with PD, why
functional movements should be examined rather than MMT
MMT is not alway s consistent
how is motor function affected in pts with PD
difficulty with speed and accuracy
difficulty with dual tasking
difficulty with starting and stopping motion
how is gait altered in pts with PD
up to 25% have this as inital symptom
bradykinesia, flexed posture, decreased arm swing
possible freezing
what are the 4 cluster non-motor symptoms related to PD
rapid eye movement sleep behavior disorders
cognition related
mood related
sensory and disautonomia
describe symptoms related to rapid eye movement sleep behavior disorders in pts with PD
frequent nightmares
dream enacting behaviors (talking, walking during sleep)
insomnia
what are the cognition related symptoms of PD
memory complaints
cognitive fatigue
inattention
excessive day-time sleeping
mild cognitive impairment
list mood related symptoms of PD
anehodonia (lack of joy with joyful activities)
apathy (because of decreased apathy or bradykinetic facial muscles)
depression, subclinical depression, suicidal ideation, anxiety
describe sensory and dysautonomia symptoms related to PD
loss of taste, smell
visual perception disturbances (hallucinations)
chest pain
unexplained pain
parestesias (60-80% of pts)
hyperhydrosis (excessive sweating)
GI disorders
orthostatic hypotension
what is the MOvement Disorder Society (MDS) Clinical Diagnostic Criteria for PD
bradykinesia in combination with at least resting tremor and/or rigidity
absence of absolute exclusion criteria, at least 2 supportive criteria, and no red flags
what nutritional advise is appropriate for a pt with PD
high protein diets and block effectiveness of levodopa
high calorie, low protein diet
PEG tube could be neccessary
how is deep brain stimulation utilized in pts with PD
typically for tremor
can impact gait, on/off symptoms
electrodes typically in globus pallidus internus or subthalamic nucleus
what is the main function of pharmacology treatment of PD
increase or keep DA
what outcome measures are utilized for pt with PD
hoehn and yar
united parkinson’s disease rating scale
PD EDGE
describe the H&Y grading
1: unilateral involvement only
1.5: unilateral and axial involvement
2: bilateral involvement without impairment of balance
2.5: mild bilateral disease with recovery on pull test
3: mild to moderate bilateral disease; some postural instability; physically independent
4: severe disability; still abilty to walk or stand unassisted
5: WC bound or bed ridden unless aided
what does the united parkinson’s disease rating scale (UPDRS) measure and how is it scored
mentation, behavior, mood
ADLs
motor scale
other symptoms such as on/off periods, hypotension, etc
scored 0-4 with higher numbers being worse
what are the pros and cons for the UPDRS
gold standard for determining the severity of a disease
often done by neurologist
time consuming
what is evaluated during the mentation, behavior, and mood portion of the UPDRS section 1
intellectual impairment
thought disorder
depression
motivation/initiative
what is evaluated during UPDRS section 2 (ADLs)
speech
dressing
salvation
hygiene
walking
tremor
turning in bed
swallowing
handwriting
falling
sensory complaints
cutting food, handling utensils
freezing
what is assessed during UPDRS section 3, motor exam
speech
facial expression
tremor at rest
action or postural tremor of hands
rigidity
finger taps
hand movement
rapid alternating movements of hands
leg agility
arising from chair
posture
gait
postural instability
body bradykinesia and hypokinesia
what PD outcome measures belong in the body structure and function portion of the ICF model
parkinson’s fatigue scale
UPDRS
what PD outcome measures belong in the participation portion of the ICF model
parkinson’s disease questionnaire 8 & 39
what PD outcome measures belong in the activity portion of the ICF model
new freezing of gait questionnaire
parkinson’s fatigue scale
what exercises are highly recommended for pt with PD
aerobic fitness
resistance training
balance
external cueing
community based exercise
gait training
task specific training
behavior change approach
integrated care
what is the general POC for PD pts
remediations of function is possible
treatment of MSK is possible
may consider skilled maintenance between remediation episodes
medication timing may matter
desscribe dyskinesia
abnormal voluntary movement
occurs at peak dose
what should you consider regarding medications when treating PD
how long it takes for medication to kick in and how long it lasts
when off times occur and severity
PT can occur during on times to teach strategies during off times
what symptoms of PD are not responsive to medications
postural instability
gait freezing
mental changes
ANS dysfunction
what is the goal of deep brain stimulation
minimize “off” times and dyskinesias
reduce medication doses
does not eliminate use of medication all together
what pt characteristics would indicate the pt to be a candidate for deep brain stimulation
idiopathic PD
intact cognition
good response to DA
lack of co-morbidity for brain surgery
realistic expectations
pt age
normal brain MRI
ability to tolerate awake surgery
degree of disabiltiy
ability for follow-up programming
what are the risks association with deep brain stimulation
symptom reduction variability
no impact on postural instability
infection risks associated with brain surgery
what interventions could improve orthostatic hypotension in PD pts while at PT
increase fluid intake and dietary sodium
use of water bolus
raise head of bead
compression garments
instruct in use of physical counter-maneuvers
what are the goals of PT for PD pts
slow disease progression
optimize participation in ADLs
optimize independence and safety for functional tasks
preserve/improve physical functioning
decrease fall risk
what are the parameters for aerobic exercise with pts with PD
F: 3X/week
I: 60-85% HRmax
T: 30-40 mins
T: stationary cycling and treadmill training
what is the impact of treadmill training with pts that have PD
sae and feasible
gait improvements of speed, stride length, symmetry
improved balance and motor performance
reduces fatigue
what are the parameters for balance training with pts with PD
who is balance training most appropriate for
F: 2-3x/week
I: moderate to high
T: 20-120 minutes
T: multi-modal balance training, dynamic gait training, balance with technology
most appropriate for pt with H&Y stages 1-4
what are the parameters for resistance training for pts with PD
F: 2, non-consecutive days/week
I: beginner at 40-60% for strength and 20-30% for power
experienced at 80% for strength and 40% for power
T: 30-60 minutes
T: all major muscle groups with extensors targeted
what are the gait training parameters for pts with PD
F: 3-5 days/weeks
I no specific parameters identified
T: 20-60 minutes
T: treadmill training, robotic-assisted training, over-ground training, nordic walking
what are the parameters for community based exerciese
F: 2x/week
I: maximize intensity while optimizing safety
T: 45-60 minutes for 12 weeks
T: salient task
what are the 3 key features of LSVT BIG
target: amplitude
mode: high intensity and effort
calibration
what are the 5 positions for PWR! moves
quadruped
sitting
standing
supine
prone
who is task specific training indicated for
what is the parameters for task specific training
indicated for pts who have idiopathic pD H&Y stage 1-3 without cognitive impairment
F: 2-5 days/week
I: high intensity
T: 15-45 minutes
T: 1-on-1 training
where in the CPG does LSVT BIG fit?
aerobic exercise
balance training
gait training
behavior change approach
high amplitude of LSVT BIG addresses which cardinal sign of PD
bradykinesia
high intensity targets which neuroplasticity principle
use it or loose it
use it to improve it
repetition matters
intensity matters
callibration targets which symptom of PD
bradykinesia
poor implicit knowledge of performance
calibration targets which neuroplasticity principles
salience
use it and improve it
transference
what is the protocol for LSVT BIG
4 days/week for 4 weeks
1 hour
1-on-1 treatment
homework completed once on therapy days and 2x on non therapy days
training at intensity of 8/10 effort
what exercises are included in LSVT BIG protocol
maximal daily exercises
BIG walking
functional component task
hierarchy tasks
carry-over tasks
describe maximal daily exercises
7 exercises completed for 8-12 repetitions
2 sustained movement
5 multidirectional repetitive movements
list examples of functional component tasks
first exercise is sit to stands for all pts
the motion of sweeping
rolling in bed
reaching overheard
how many functional component tasks does a pt work on at a time
5
how many hierarchy task does a pt work on at a time
3
what are examples of hierarchy tasks
fly fishing
loading and unloading the dishwasher
completing a load of laundry
golfing
what are carry over tasks
a new daily homework assignment that tests transference
different each day
ex) opening the door BIG if pt freezes when walking through the door
