exam #2 PD management

Question 1

What medication is the gold standard for PD
-schedule:
-side effect:
-on time = / off time =

Answer 1

levodopa-carbidopa (sinemmet)
-empty stomach (30 mins before meal or 1hr. after last)
-nausea, drowsiness, orthostatic hypotension. dyskinesia, motor fluctuations, and hallucinations
-function vs not function

Question 2

What is known as abnormal voluntary movement and occurs at peak dose (too much DA)

Answer 2

dyskinesia

Question 3

Why is it important for PT to know on/off times of medications for PD?

Answer 3

PT can occur during on times to teach strategies during off times

Question 4

PT questions to ask regarding medication?

Answer 4

How long does it take for a dose to kick in
How long does a dose last
How severe is off time? Are they predictable or random?

Question 5

Symptoms that are NOT responsive to medications?

Answer 5

postural instability
freezing of gait
mental changes
ANS dysfunction

Question 6

Surgical management for PD?
-mechanism
-goals

Answer 6

Deep brain stimulation
-the mechanism is unclear
-minimize off times and dyskinesia and reduce medication dosages
-not to eliminate the use of medications altogether

Question 7

Is your pt. a candidate for DBS?

Answer 7

idiopathic PD
intact cognition
good response to dopamine (meds)
lack of co-morbidity for brain surgery
realistic expectation (not all symptoms will go away)
pt. age (younger > older)
normal brain MRI
ability to tolerate awake Sx
degree of disability
the ability for follow-up programming

Question 8

RF associated with DBS?

Answer 8

symptoms reduction variability
no impact on postural instability
infection risks associated with brain surgery

Question 9

non-motor considerations include:

Answer 9

depression
cognitive dysfunction
dysautonomia: orthostatic hypotension

Question 10

These are characteristics of ___________
increase fluid intake _____oz. of water min.
increase dietary sodium
consider use of oral water bolus
raise HOB
use compression garments
instruct in use of physical counter-maneuvers
stand gradually

Answer 10

orthostatic hypotension; 60

Question 11

Benefits of Exercise
Improve:
Decrease:

Answer 11

cardiovascular health
motor performance
psychological health
sleep
bone health

fatigue
osteoporosis risk

Question 12

Goals of PT:

Answer 12

slow disease progression
optimize participation in ADLs within the home and community
optimize independence and safety during functional tasks
preserve or improve physical functioning
decrease fall risk

Question 13

Why is aerobic exercise highly recommended in the CPG for PD: pts. have reduced ______ function and reach max _____ capacity at much lower exercise levels.

PT should prescribe_____-______ intensity aerobic exercise.

______ neuroplasticity principle is key here
-F: 3x/week
-I: 60-85% HRmax
-I: 30-40 mins
-T: stationary cycling and treadmill training

Answer 13

cardiovascular/aerobic
moderate to high
salience

Question 14

Treadmill training is safe and feasible –> considerations for high-level _____ stages.

benefits include:

Answer 14

H&Y

gait improvements: speed, stride length, symmetry
balance and motor performance
QOL
reduced fatigue

Question 15

Balance training is MOST appropriate for H&Y stages ___-___
F:
I:
T:
T:

Answer 15

H&Y 1-4
2-3x/week
moderate to high
20-120 min
multimodal balance training, dynamic gait, balance w/technology(sensors/biofeedback)

Question 16

6 balance contributors:

Answer 16

biomechanical constraints
stability limits, verticality
anticipatory postural adjustments
postural adjustments
sensory orientations
stability in gait

Question 17

Resistance training requires ______ for advanced H&Y stages
-F
-I
-T
-T

Answer 17

adaptation
2, non-consecutive days/week
beginner: 40-60% 1RM for strength and 20-30% for power
experienced: 80% 1RM for strength and 40% for power
30-60 mins
all muscle groups (MAINLY EXTENSORS)

Question 18

Gait training:
-F:
-I:
-T:
-T:

Answer 18

3-5x/week
moderate to high
20-60 min
treadmill training, robotic-assisted training, over-ground training, nordic walking → outside therapy

Question 19

Community-based exercise is important, but you should consider appropriateness for those with advanced _____/_____ impairments

Answer 19

balance and cognitive

Question 20

Community-based exercise:
F:
I:
T:
T:

Answer 20

2x/week
Maximize intensity → optimize safety
45-60 min for 12+ weeks
consider salient task → selected based on eval findings (aerobic exercise, balance, boxing, dance, pilates, etc.)

Question 21

4 key external cueing:

Answer 21

visual
auditory
amplitude
somatosensory

Question 22

Examples of dual-task training:

Answer 22

walking and….
carrying a laundry basket
counting backward by 3s
categorical naming
naming items that begin with one letter

Question 23

LSVT BIG
3 key features:
frequency:
time:

Answer 23

-target: amplitude
-mode: high intensity and effort
-calibration
4x/week for 4 weeks
60 mins

Question 24

LVST BIG requires ______ maximal daily exercises + additional functional component tasks and hierarchy tasks. Daily _____ expectations

Answer 24

7/homework

Question 25

What are PWR MOVES?
-________specific functional exercises
-Performed in ___ positions
-________ and _______ parameter adjustments are available for modification and progression
-improve:

Answer 25

PD
5
cognitive and physical
flexibility, strength, and balance

Question 26

positions for PWR MOVES:

Answer 26

quadruped
sitting
standing
supine
prone

Question 27

How to practice:
prepare:
activation:
flow:

Answer 27

performed slowly, increases attention - rigidity

high effort and repetition of big and fast movement - bradykinesia

linked of PWR Moves into sequence - incoordination and imbalance

Question 28

Task-specific training: indicated for those who have ______ PD H&Y stage ___-___ without _____ impairment
F
I
T
T
ex:

Answer 28

idiopathic, 1-3, cognitive

2-5x/week
high
15-45min
1v1 manner (ex. UE turning, dual task, fall prevention, and bladder training)

Question 29

Does flexibility exercise have strong evidence?

Answer 29

no, but may help reduce rigidity and can be used as warm-up/cool-down or HEP

Question 30

Why utilize strategies:
replace _____ cueing mechanisms with ____ curing mechanics to bypass the _____
equivalent to _____ techniques
shifts learning to ______
used to facilitate ____ learning

Answer 30

internal; external; BG
compensatory
explicit
motor

Question 31

Goals of using strategies:

Answer 31

cognitive: more cortex by facilitating conscious thinking
external driven: using a metronome during gait

Question 32

Dieases stage consideration
-early-mid:
-late:

Answer 32

faciliatte motor learning
provide compensation

Question 33

Motor learning neuroplasticity principles (4)

Answer 33

high repetition
used of blocked practice strategies
utilize external cues
close environments as need