Module 6 Flashcards
Parkinson’s disease is a progressive neurological disease characterized by a large number of motor and non-motor features.
Describe the pathophysiology of Parkinson’s disease;
Identify and describe four primary motor features of Parkinson’s disease
Parkinson’s disease is characterised by the gradual loss of dopamine-producing neurons in the substantia niagra, a region of the brain that plays a crticial role in regulating motor function. Symptoms do not occur until there is greater than 80% loss of dopaminergic cells.
Bradykinesia: Involves slowness in voluntary movement but also difficulty in initiating and performing these actions.
Muscle Rigidity: Increased resistance throughout the passive ROM of a limb. This kind of rigidity is velocity independent, and can be associated with pain.
Postural Instability: In the later stages of PD postural reflexes are lost or impaired meaning individuals are less able to respond effectively to shifts in balance.
Tremor: Rhythmic, involuntary shaking or oscillation of body parts usually occurring at rest. Can be unilateral and usually most prominent in distal extremities. Lower frequency than essential tremor.
Parkinson’s disease is idiopathic – what does this term mean?
Identify four risk factors for Parkinson’s disease.
Idiopathic refers to conditions that arise spontaneously or where the cause is unknown. While there are theories about potential contributors to increase Parkinson’s Disease, there is no definitive single cause identified for this condition.
1) Age/ageing process
2) Family history
3) Head trauma
4) Sex (males 1.2-1.5 more likely than females)
Identify and describe four non-motor features of Parkinson’s disease
Sleep Disorders: Difficulty falling or staying asleep due to motor symptoms such as tremor and rigidity. Rapid eye movement sleep behaviour disorder (RBD) is a condition where people act out their dreams which occurs during REM sleep, stage when vivid dreaming typically happens, muscle paralysis of REM sleep is lost.
Sensory Abnormalities: Changes in how sensory information is processed by the nervous system due to neurodegenerative changes that affect various brain areas including those controlling dopamine which play a role in modulating sensory input.
Cognitive and Neurobehavioral Abnormalities: Caused by neurodegeneration of brain regions involved in cognition, behaviour, and mood.
Autonomic Dysfunction: Resulting from neurodegeneration of autonomic pathways. E.g orthostatic hypotension due to impaired vasomotor control and decreased BV regulation.
Describe bradykinesia and how you would assess whether it is present. Include in your answer at least one example of a specific test that could be used within the assessment.
Refers to slowness of voluntary movements and encompasses the difficulty with planning, initiating and executing movement, particularly in performing sequential and simultaneous tasks.
Can be assessed by getting them to perform rapid, repetitive, alternating movements of the hands.
E.g finger-tap test - used to record the number of tappings within a certain test period and the average time passed between tappings assess speed and motor control in the upper extremities.
Dancing is seen as a particularly advantageous form of exercise for people with Parkinson’s disease because, in addition to improving cardiorespiratory fitness, muscular strength and flexibility, it confers at least three other important benefits.
Identify what they are and, in each case, give examples.
Balance: Dancing requires frequent weight shifts, rotations, and controlled foot placement which can help PD patients improve their ability to maintain balance in various positions. Rhythmic nature also helps with synchronisation, which further enhances balance control. E.g waltz/foxtrot and tango improve balance as measured with the Berg Scale.
Gait/6MWT: Dancing requires rhythmic repetitive steps which can encourage better movement coordination which can lead to better gait. E.g walts and fotrot both improved 6MWT.
Postural Stability: Dancing requires the use of core muscles and promotes better posture control through dynamic movements that emphasise proper body alignment and stability. Practicing maintaining various postures while transitioning from one movement to another helps develop better postural stability and reduces the risk of falls.
Why might it be unsafe for a person with Parkinson’s disease to use a motorised treadmill? What could you do to increase safety of treadmill walking for a person with PD?
PD can come with gait impairment, postural instability, and freezing episodes in the lower limbs that increase the risk of falls.
To increase safety, patients should be supervised and given assistance where needed, patients should use a safety harness attached to the treadmill, use handrails to further support themselves during gait.
Autonomic dysfunction monitoring could prevent adverse events during exercise.
True or false - the tremor typical of Parkinson’s disease is not easily observed at rest but become easier to see if you ask the person to touch a target (e.g., touch on the nose or reach for a cup).
False
From a clinical perspective, how is the muscle rigidity seen in Parkinson’s disease different from spastic hypertonia seen in cerebral palsy?
The rigidity in PD is velocity independent, meaning the resistance to movement remains constant regardless of the speed at which the limb is moved. Spastic hypertonia in CP is velocity dependent, meaning the resistance to movement changes depending on the speed at which the limb is moved.
