MIDTERMS: Parkinson's Disease Flashcards
Stiffness due to simultaneous contraction of opposing muscles, causing resistance to passive movement.
Rigidity
: Slowness of movement, difficulty initiating movements, and reduced arm swing and foot shuffling when walking.
Bradykinesia
Stooped posture, difficulty maintaining balance, and increased fall risk.
Postural Instability
Postural Instability
Resting “pill-rolling” tremors, typically starting in one hand, diminishing during voluntary movement and sleep, but progressing with the disease.
Tremors
Two sybgroups of Parkinson’s
Postural Instability Gait Disturbed (PIGD)
Tremor-Predominant (fewer issues with bradykinesia or postural instability).
What are the non-motor symptoms of Parkinson’s Disease?
Cognitive deficits: Dementia, bradyphrenia (slowed thinking).
Autonomic dysfunction: Excessive sweating, constipation.
Sleep disturbances: Insomnia, REM sleep disorder.
Pathophysiology of Parkinson’s Disease
Caused by the degeneration of dopaminergic neurons in the substantia nigra.
Results in reduced dopamine levels.
Lewy bodies are present in affected neurons.
Clinical symptoms only manifest after 30%-60% of neuron loss.
Motor Planning Issues in Parkinson’s Disease
Start hesitation
Freezing episodes
Poverty of movement
Impaired motor learning
Motor Function Impairments in Parkinson’s Disease
Masked face
Micrographia
Fatigue
Contractures & deformities
Impaired gait
Dysarthria
Dysphagia
Akathisia
Postural Issues in Parkinson’s Disease
Kyphotic posture
Increased risk of falls
Characteristics of Rigidity in Parkinson’s Disease
Increased resistance to passive motion regardless of speed
Felt in both agonist and antagonist muscles
Cogwheel and Leadpipe types of rigidity
Begins in shoulders/neck, progresses to face and extremities
Leads to contractures and postural deformities
Bradykinesia Features
Slowness of movement
Reduced speed, range, and amplitude of movements
Contributes to masked facial expression and micrographia
Decreased arm swing while walking
Cardinal Features of Parkinson’s Disease
Rigidity
Bradykinesia
Tremors
Postural Instability
Postural Instability in Parkinson’s Disease
Narrowing base of support
Rigidity and decreased trunk ROM
Stooped posture due to weakness of trunk extensor muscles
Hoehn & Yahr Classification of Disability in Parkinson’s Disease
(meaning of each stage 1-5)
Stage 1: Unilateral symptoms
Stage 2: Bilateral symptoms, no balance impairment
Stage 3: Balance impairment, still independent
Stage 4: Severe disability, can walk/stand unassisted
Stage 5: Wheelchair-bound or bedridden
What is the gold standard pharmacological treatment for Parkinson’s Disease (PD)?
Carbidopa/Levodopa.
Clinical Course of Parkinson’s Disease
Progressive with preclinical phase of 5-25 years
Mean duration of 10-20 years
Patients with PIGD subtype show more rapid progression
Unified Parkinson’s Disease Rating Scale (UPDRS)
(meaning of each part i-iv)
Part I: Non-motor experiences (e.g., mood, cognitive function)
Part II: Motor experiences (e.g., speech, eating)
Part III: Motor exam (e.g., rigidity, bradykinesia)
Part IV: Complications of therapy (e.g., dyskinesias)
What are some common medications used in the management of PD besides Carbidopa/Levodopa?
Dopamine agonists, COMT inhibitors, MAO-B inhibitors, anticholinergic agents, and Amantadine.
When is the best time to perform physical therapy on a patient with PD taking dopamine replacement therapy?
During the optimal dosing cycle, when motor performance is at its peak.
What is the primary focus of palliative care?
What is the primary focus of palliative care?
Why should physical therapists be aware of the medications a PD patient is taking?
To monitor motor complications, assess optimal performance during peak medication dosage, and report any intolerances or motor fluctuations.
What is the purpose of maintenance therapy in PD rehabilitation?
To maintain the patient’s current level of function, especially for those in the late stages of the disease.
What diagnostic imaging is used to differentiate Parkinson’s Disease from essential tremor?
DaTscan, which measures dopamine transporter activity
What does the Parkinson’s Disease Questionnaire (PDQ-39 or PDQ-8) measure?
Health-related quality of life across eight dimensions: mobility, ADL, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort.
What does the Parkinson’s Fatigue Scale (PFS-16) assess in PD patients?
The presence and impact of fatigue on daily life, focusing on physical and social aspects.
What is the purpose of the Beck Depression Inventory (BDI) in PD?
To assess the severity of depression, including symptoms like hopelessness and physical symptoms like fatigue and loss of interest in daily activities.
What are the core motor features required for a clinical diagnosis of PD?
Bradykinesia plus at least one of the following: resting tremor, rigidity, or postural instability.
What is the purpose of the Hoehn-Yahr Classification Scale?
To chart the progression of PD using motor signs and functional status, from stage I (minimal disease) to stage V (severe deterioration).
What cognitive domains does the Montreal Cognitive Assessment (MoCA) test in PD patients?
Memory, attention, language, visuospatial skills, and executive functioning.
What recommendations are made for exercise in PD rehabilitation?
Short periods of non-fatiguing exercise, low repetitions, and increasing the activity’s difficulty as the patient improves.
What does the Mini-BESTest evaluate in PD patients?
Balance control in conditions such as anticipatory adjustments, reactive postural control, sensory orientation, and dynamic gait.
What type of exercises can help reduce muscle tension caused by rigidity in PD patients?
Relaxation exercises, such as gentle rocking and slow rhythmic rotational movements.
What characterizes the early stage of rehabilitation for PD patients?
Patients are functional and independent with minimal impairments, and early intensive exercise may slow motor decline.
: In the middle stage of PD rehabilitation, what happens to the patient’s independence?
Symptoms become more apparent, activity limitations emerge, and while patients may still be independent in gait and ADLs, their performance is slower and less efficient.
What is a key focus during the late stage of PD rehabilitation?
The therapist needs to focus on preventive care to avoid secondary complications and provide compensatory training to maintain function.
What is the focus of balance training for PD patients?
To improve center of mass (COM) and limits of stability (LOS), enhancing postural alignment and dynamic stability tasks.
What is the goal of flexibility exercises in PD rehabilitation?
To improve range of motion (ROM) and physical function, using both static and dynamic stretching techniques.
What are the goals of locomotor training in PD rehabilitation?
To reduce primary gait impairments and increase the patient’s ability to perform functional mobility activities safely.
How can strengthening exercises benefit PD patients?
They improve muscle force, bradykinesia, functional mobility, balance, gait, fall risk, and quality of life.
What types of activities are included in group and home exercises for PD patients?
Low impact aerobics, marching, recreational activities, and classes like yoga, Pilates, and Tai Chi.
