Exam 3- Parkinson

Question 1

TBI (some info from the videos on how to work with the pt)

Answer 1

~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

Question 2

4 cardinal signs of Parkinson’s

Answer 2

~postural instability
~bradykinesia
~rigidity
~tremor

Question 3

Tremor in Parkinson’s is normally a _____ tremor

Answer 3

~Resting tremor
~When they are at rest
~4-6 Hz

Question 4

Details on tremor

Answer 4

~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

Question 5

Rigidity vs Spasticity

Answer 5

~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

Question 6

Rigidity (details)

Answer 6

~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

Question 7

Bradykinesia is

Answer 7

Slowness of movement

Question 8

Akinesis is

Answer 8

difficulty starting and stopping and everything in between (he says no movement)

Question 9

Bradykinesia (details)

Answer 9

~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

Question 10

Feasting gait

Answer 10

~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

Question 11

Postural instability (details)

Answer 11

~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

Question 12

Dysphagia

Answer 12

Swelling and speak problems

Question 13

Sialorrhea

Answer 13

excessive saliva production; they can choke on it, body image issues

Question 14

Micrographia

Answer 14

Very, very, very small hand writing

Question 15

Hypomimia

Answer 15

“masked face”; face just gets pulled down; looks like a flat affect (but they aren’t); don’t know how they are feeling

Question 16

Hoehn- Yahr Staging is

Answer 16

One of the basic and most widely used staging/ rating for Parkinson’s pts

Question 17

Hoehn- Yahr Staging: Stage 1 (book)

Answer 17

Minimal or absent; unilateral if present

Question 18

Hoehn- Yahr Staging: Stage 1 (bringman)

Answer 18

If they have some tremor or rigidity it will minimal or absent; unilateral if present

Question 19

Hoehn- Yahr Staging: Stage 2 (book and bringman= same)

Answer 19

Minimal bilateral or midline involvement. Balance is not impaired

Question 20

Hoehn- Yahr Staging: Stage 3 (book)

Answer 20

Impaired righting of reflexed. Unsteadiness when turning or rising form chair. Some activities, but pt can live ind and continue some forms of employment

Question 21

Hoehn- Yahr Staging: Stage 3 (bringman)

Answer 21

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

Question 22

Hoehn- Yahr Staging: stage 4 (book and bringman= same)

Answer 22

All symptoms present and severe. Standing and walking possible only with assistance.

Question 23

Hoehn- Yahr Staging: Stage 5 (book and bringman= same)

Answer 23

Confined to bed or wheelchair

Question 24

Sinemet is

Answer 24

leva-dopa + carbi-dopa

Question 25

Sinemet

Answer 25

~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

Question 26

deep brain simulator (some details)

Answer 26

~can have a huge behavior change

~have to find out if the behavior changes are worth the changes

Question 27

LSVT (some details)

Answer 27

~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)

Question 28

3 systems that maintain balance

Answer 28

~Sensory
~Motor
~CNS

Question 29

3 parts of sensory

Answer 29

~Vision
~Vestibular
~Somatosensory

Question 30

Different parts of somatosensory

Answer 30

~Proprioception
~Light touch
~Deep touch
~Kinesthesia
~etc

Question 31

Details on vision

Answer 31

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

Question 32

Equilibrium details

Answer 32

~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

Question 33

Equilibrium orders

Answer 33

~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