exam #2 PD management Flashcards
What medication is the gold standard for PD
-schedule:
-side effect:
-on time = / off time =
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
What is known as abnormal voluntary movement and occurs at peak dose (too much DA)
dyskinesia
Why is it important for PT to know on/off times of medications for PD?
PT can occur during on times to teach strategies during off times
PT questions to ask regarding medication?
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?
Symptoms that are NOT responsive to medications?
postural instability
freezing of gait
mental changes
ANS dysfunction
Surgical management for PD?
-mechanism
-goals
Deep brain stimulation
-the mechanism is unclear
-minimize off times and dyskinesia and reduce medication dosages
-not to eliminate the use of medications altogether
Is your pt. a candidate for DBS?
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
RF associated with DBS?
symptoms reduction variability
no impact on postural instability
infection risks associated with brain surgery
non-motor considerations include:
depression
cognitive dysfunction
dysautonomia: orthostatic hypotension
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
orthostatic hypotension; 60
Benefits of Exercise
Improve:
Decrease:
cardiovascular health
motor performance
psychological health
sleep
bone health
fatigue
osteoporosis risk
Goals of PT:
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
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
cardiovascular/aerobic
moderate to high
salience
Treadmill training is safe and feasible –> considerations for high-level _____ stages.
benefits include:
H&Y
gait improvements: speed, stride length, symmetry
balance and motor performance
QOL
reduced fatigue
Balance training is MOST appropriate for H&Y stages ___-___
F:
I:
T:
T:
H&Y 1-4
2-3x/week
moderate to high
20-120 min
multimodal balance training, dynamic gait, balance w/technology(sensors/biofeedback)
6 balance contributors:
biomechanical constraints
stability limits, verticality
anticipatory postural adjustments
postural adjustments
sensory orientations
stability in gait
Resistance training requires ______ for advanced H&Y stages
-F
-I
-T
-T
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)
Gait training:
-F:
-I:
-T:
-T:
3-5x/week
moderate to high
20-60 min
treadmill training, robotic-assisted training, over-ground training, nordic walking → outside therapy
Community-based exercise is important, but you should consider appropriateness for those with advanced _____/_____ impairments
balance and cognitive
Community-based exercise:
F:
I:
T:
T:
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.)
4 key external cueing:
visual
auditory
amplitude
somatosensory
Examples of dual-task training:
walking and….
carrying a laundry basket
counting backward by 3s
categorical naming
naming items that begin with one letter
LSVT BIG
3 key features:
frequency:
time:
-target: amplitude
-mode: high intensity and effort
-calibration
4x/week for 4 weeks
60 mins
LVST BIG requires ______ maximal daily exercises + additional functional component tasks and hierarchy tasks. Daily _____ expectations
7/homework
What are PWR MOVES?
-________specific functional exercises
-Performed in ___ positions
-________ and _______ parameter adjustments are available for modification and progression
-improve:
PD
5
cognitive and physical
flexibility, strength, and balance
positions for PWR MOVES:
quadruped
sitting
standing
supine
prone
How to practice:
prepare:
activation:
flow:
performed slowly, increases attention - rigidity
high effort and repetition of big and fast movement - bradykinesia
linked of PWR Moves into sequence - incoordination and imbalance
Task-specific training: indicated for those who have ______ PD H&Y stage ___-___ without _____ impairment
F
I
T
T
ex:
idiopathic, 1-3, cognitive
2-5x/week
high
15-45min
1v1 manner (ex. UE turning, dual task, fall prevention, and bladder training)
Does flexibility exercise have strong evidence?
no, but may help reduce rigidity and can be used as warm-up/cool-down or HEP
Why utilize strategies:
replace _____ cueing mechanisms with ____ curing mechanics to bypass the _____
equivalent to _____ techniques
shifts learning to ______
used to facilitate ____ learning
internal; external; BG
compensatory
explicit
motor
Goals of using strategies:
cognitive: more cortex by facilitating conscious thinking
external driven: using a metronome during gait
Dieases stage consideration
-early-mid:
-late:
faciliatte motor learning
provide compensation
Motor learning neuroplasticity principles (4)
high repetition
used of blocked practice strategies
utilize external cues
close environments as need
