L4 Advanced PD Flashcards
1
Q
Late Stage PD is stages (Hoehn and Yahr Scale)…
A
4 and 5
Stage 4: Severe disability, still able to walk or stand unassisted
Stage 5: w/c bound or bedridden unless assisted
2
Q
Carbidopa-levodopa Side effects
A
GI disturbances
orthostatic hypotension
psychiatric problems
3
Q
Levodopa
A
most effective drug for treating PD
broken down into dopamine the brain can use after cross the BBB
4
Q
Carbidopa
A
decarboxylase inhibitor that prevents that breakdown of levodopa to dopamine in PNS
5
Q
Difficulties with levodopa therapies over time
A
- wearing off, decreased effectiveness of the therapies at the end of period between doses
- induced dyskinesias or excessive movement due to abnormal response to dopamine in system
- manage with extended or sustained release versions of levodopa
6
Q
Wearing-off phenomenon for levodopa
A
- describes the recurrence of motor and non-motor s/s during levodopa-free interval
- affects nearly all pts within 10 years of starting meds
7
Q
RF for developing wearing off phenomenon
A
- younger age at presentation of initial s/s
- female
- long-duration of tx w/levodopa
- higher doses of levodopa
- use of dopamine agonists
8
Q
Exam timing in PTs with PD
A
- Time of day should be consistent to establish accurate baseline
- Time of day should be the same for exam of patient for baseline and all other follow up progress notes
- wearing off will be individual for each patient
9
Q
Common off times
A
- 1st thing in the morning
- between doses of levodopa
- can be gradual or like a switch
10
Q
Levodopa Induced Dyskinesia
A
- long-term use can lead to motor fluctuations and dyskinesias
- s/s are more likely to start on side of body first impacted
- starts usually after 6 years of treatment with levodopa for about 50% of patients
- more likely in pts with advanced PD s/s
11
Q
RF for levodopa-induced dysfinesia
A
- developing s/s of PD at younger ages (40s)
- higher cumulative dose
- low body weight
- natives of north american geographic region
- female
- more severe UPDRS Part 2 score
12
Q
DBS for PD
A
- ideal window is when pts are still responding to levodopa but not able to control motor s/s with medication alone
- treats motor s/s like stiffness, tremor, dyskinesias
- allows for lower dose of meds to treat PD
- good for 1-2 years, long term benefit is less clear, but can be up to 10 yrs
13
Q
Who is a candidate for DBS?
A
- pts with uncontrollable tremor for whom meds have not been effective
- pts with s/s that respond well to meds but who, when drugs wear off, experience severe motor fluctuations and dyskinesias, despite medication adjustments
- pts whose movement symptoms might respond to higher or more frequent med doses, but are limited to do so because of side effects
14
Q
Other S/S associated with advanced PD
A
- Dysphagia and aspiration pneumonia
- Depression
- Cognitive Decline
- Sleep dysfunction
- GI dysfunction
- Urinary Tract Dysfunction
15
Q
Dysphagia and aspiration pneumonia
A
- any pt that develops weakness of chewing and swallow muscles due to any a disease will be at risk for dysphagia and aspiration pneumonia
- observing symptoms of aspiration pneumonia and dysphagia would be a reason to refer to a MD/SLP
16
Q
Dysphagia S/S
A
- report of coughing when eating or drinking
- observed coughing with eating or drinking
- silent aspiration
17
Q
Aspiration pneumonia CP
A
- dyspnea
- fever
- hypoxemia
- fatigue
18
Q
Depression
A
- most common nonmotor systems occuring in PD, impacts about 35% of pts
- more frequent in pts with PD than in general elderly population
- key determinant of poor health related QOL
- associated with reduced functioning, cognitive impairment, increased stress for caregivers
19
Q
Cognitive Decline
A
- 75-80% will develop dementia after 20 years
- about 25% of pts suffer from mild cognitive impairment in early stages of PD
- hallucinations occur in 20-40%, etiology is unclear
20
Q
Sleep Dysfunction
A
- 60-98% of PD pts have nocturnal sleep disturbances
- onset of sleep dysfunction before motor impairment
- can include sleep fragmentation, apnea, restless leg syndrome, period limb movement during sleep, REM sleep behavior disorder
- can also have REM sleep behavior disorder, where they reenact dreams or vigorous movements
21
Q
GI Dysfunction
A
- very common in PD, earliest manifestations
- 50% have constipation with increasing frequency with advancing disease
22
Q
Urinary Tract Function
A
- Storage Dysfunction related to an overactive bladder contractiity causing increased frequency, urgency, and nocturia
- result of DA deficiency-induced disinhibition and hyperactivation of micturition reflex
23
Q
Secondary Impairments of PD
A
- Decreased ROM in jts throughout body
- weakness
- flexed posture
- pain
- falls
- bowel and bladder dysfunction
- hypophonia and dysphagia
24
Q
Decreased ROM due to
A
rigidity
bradykinesia
25
Weakness due to
bradykinesia leads to disuse atrophy
26
Flexed posture due to
* bradykinesia, leads to disuse of postural mm
* weakness, gravity pulls into flexed position
* impaired sensory integration, less awareness of posture
27
Falls due to
* rigidity
* bradykinesia
* freezing
* inflexible program selection
* impaired sensory integration
* reduced executive function and attention
28
Bowel and Bladder dysfunction
* constipation from immobility
* bladder incontinence due to pelvic floor weakness from immobility
29
Hypophonia and Dysphagia due to
* voice muscle weakness
* chew and swallow muscle weakness
30
Activity and Participation Limitations for PD
* decline in independence
* decreased ability to perform ADLs
* decreased social interaction due to declining mobility, worsening cognitive function, depression, flat affect
* decreased participation in hobbies and leisure
31
PT Exam for PD
* movement analysis to identify constraints of mobility
* measurement to quantify secondary impairments
* cognitive screening of MOCA/MMSE
* outcome measures
32
outcome measures for stage 4
gait outcomes like 6 MWT, 10MWT, TUG, TUG dual, Freezing of Gait, Four square
33
outcome measures for stage 5
fewer options
care tool, description of assistance, DME
34
PT Treatment for Maintenance
* exercise and mobility training considerations due to progressive declines in cognition and executive function in later stages of PD
* limit dual task, decrease cognitive load, high repetition, blocked practice
* HEP will be with caregiver, and need more external cues
35
Supportive Care for PD
* s/s mangement
* caregiver training
* DME to decrease caregiver burden with mobility tasks
* palliative care team and other supportive services
36
Low Cost external cues
* try another movement
* change direction
* visualize an object on ground in front of you
* use metronome
* humming a song
* count 1-2-3-go
* march in place then step forward
* shift attention then trying harder to avoid freezing
37
External Cues
* no one specific external cueing strategy is superior over another
* continuous auditory or visual cues may be more appropriate in pts with cognitive or visual-spatial impairments
* retention of benefits from cueing has not been established
* external focus cues may improve performance more than internal focus
