Exam 3- Parkinson Flashcards
TBI (some info from the videos on how to work with the pt)
~Write step, verbalizing steps to help make it easier for them to break it down/ process it
~Have to fight with the muscles to speak; might be easier to yell; motor planning and processing is hard for them; lots of tone to overcome; lots of swallowing issues- drooling, etc; don’t make a big deal of the abnormalities (try not to say “what did you say” as much, treat them normal, etc)
~The speak may make them sound less intelligent, but they can still be extremely intelligent; treat them with their prior level of intelligence and adjust after
~Need more than just PT; need emotional support
4 cardinal signs of Parkinson’s
~postural instability
~bradykinesia
~rigidity
~tremor
Tremor in Parkinson’s is normally a _____ tremor
~Resting tremor
~When they are at rest
~4-6 Hz
Details on tremor
~Starts unilateral and becomes bilateral
~If you stand, will get a postural tremor
~Will get a full body sway
~Tremor will be gone when asleep
~Will get worse when stressed
~Can use guided imagery- think their tremor away- will lessen the Hz and amount of tremors
Rigidity vs Spasticity
~Spasticity is there with active movement
~rigidity can be there with passive or active movement
~Spasticity is velocity dependent- if you truly move them passively, you can move them w/o resistance
~Rigidity will be constant amount of resistance
Rigidity (details)
~Will complain of stiffness and heaviness
~Will start in the trunk
~No rotation then start getting more and more kyphosis
~Need to try and move them as much as possible for as long as possible
~Proximal will be rigid first
~Prolong the decrease ROM and functional mobility
Bradykinesia is
Slowness of movement
Akinesis is
difficulty starting and stopping and everything in between (he says no movement)
Bradykinesia (details)
~Reduced speed which leads to increased falls
~Decreased ROM/ amplitude/ step length- increased falls
~Bringman believes that this is most disability part of Parkinson’s
Feasting gait
~Get stuck when trying to walk and they get distracted
~When trying to turn
~When they have a stressor/ distraction
~Need to work on trying to get the walking started again
~Help- Ustep- walkers with lasers, lines/ tape on the floor, something to kick to get the step started again
Postural instability (details)
~Late stage
~Very narrow base of support
~Body sway is huge- will have to move their feet over because they think that they are moving out
~2/3 have falls; 13% are at last once a week
Dysphagia
Swelling and speak problems
Sialorrhea
excessive saliva production; they can choke on it, body image issues
Micrographia
Very, very, very small hand writing
Hypomimia
“masked face”; face just gets pulled down; looks like a flat affect (but they aren’t); don’t know how they are feeling
Hoehn- Yahr Staging is
One of the basic and most widely used staging/ rating for Parkinson’s pts
Hoehn- Yahr Staging: Stage 1 (book)
Minimal or absent; unilateral if present
Hoehn- Yahr Staging: Stage 1 (bringman)
If they have some tremor or rigidity it will minimal or absent; unilateral if present
Hoehn- Yahr Staging: Stage 2 (book and bringman= same)
Minimal bilateral or midline involvement. Balance is not impaired
Hoehn- Yahr Staging: Stage 3 (book)
Impaired righting of reflexed. Unsteadiness when turning or rising form chair. Some activities, but pt can live ind and continue some forms of employment
Hoehn- Yahr Staging: Stage 3 (bringman)
Impairment righting relaxes (like when turning or if pushed); unsteady with turning and rising from a chair; some activities are limited; pt can live independently and continue some forms of employment
Hoehn- Yahr Staging: stage 4 (book and bringman= same)
All symptoms present and severe. Standing and walking possible only with assistance.
Hoehn- Yahr Staging: Stage 5 (book and bringman= same)
Confined to bed or wheelchair
Sinemet is
leva-dopa + carbi-dopa
Sinemet
~gets more dopamine for the brain that will help them move
~have an on-off cycle- will increase and can move well, then tapers down and they cant move well
~on-off will decrease with time and need more; eventually will not work, but can buy some months
deep brain simulator (some details)
~can have a huge behavior change
~have to find out if the behavior changes are worth the changes
LSVT (some details)
~Started out about speak- Yell at me
~Do big, exaggerated movements- you will think you are walking silly
~Muscles can still work so they will work hard to increase how big they can move (help them learn again)
3 systems that maintain balance
~Sensory
~Motor
~CNS
3 parts of sensory
~Vision
~Vestibular
~Somatosensory
Different parts of somatosensory
~Proprioception ~Light touch ~Deep touch ~Kinesthesia ~etc
Details on vision
Vision is the one that we can help with the most/ fastest (get glasses); vestibular can be changed by getting it to react better/ putting the crystals back
Equilibrium details
~When you get off balance, you will start to react a set way
~May need to put in an unbalanced position in Peds, stroke, TBI, etc to start to evoke corrections
Equilibrium orders
~Head righting: Always trying to keep out head level with the horizon- geotropic
~Trunk righting: If you cant right head, you may need to add in the trunk
~Trunk rotation
~Abduction UE/ LE
~DF/ wrist extension
