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Semester 5 PMNM Exam 6 > Movement Disorders BG > Flashcards

Movement Disorders BG Flashcards

1
Q

BG - hypokinetic disorders

A

Direct path is not facilitated
Indirect path is not inhibited
Loss of movement

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2
Q

BG - hyperkinetic disorders

A

Indirect pathway lost
GPe inhibits Gpi
Lose Gpi inhibition of thalamus
Movement facilitated/excessive movement

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3
Q

Parkinsonism consists of

A

Idiopathic parkinson’s disease

Parkinson’s plus syndrome

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4
Q

What percentage of parkinsonism is idiopathic

A

75%

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5
Q

Clinical Diagnosis - Step 1

A 
Diagnosis of Parkinsonian Syndrome
Tremor - resting
Rigidity
Akinesia/Bradykinesia = must
Postural instability
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6
Q

Clinical diagnosis - what do you need to get through step 1

A

Slowness plus either T, R, or P

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7
Q

Clinical diagnosis - step 2

A 
Exclusion criteria for PD
Cbm signs
Hx of rx stroke 
Gaze palsies
Early severe dementia
Bilateral onset
Early sever postural instability 
Poor response to levodopa
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8
Q

Clinical diagnosis - step 3

A 
Supportive features (need 3 or more in combination with step 1)
Unilateral onset
Progressive s/s with asymmetry
Rest tremor
Excellent early response to levadopa
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9
Q

Single biggest risk factor for idiopathic PD

A

Age

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10
Q

20 year and 10 year prodrome symptoms

A

20 year - hyposmia, constipation, bladder disorder

10 yr - sleep disorder, obesity, depression

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11
Q

Clinical onset symptoms

A

unilateral tremor, rigidity, akinesia

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12
Q

20 year disease stage (1 is clinical onset symtoms, what are 2, 3, 4 and 5)

A

2 - bilateral disease
3 - poor balance (10 yr)
4 - falls, dependency, cognitive decline
5 - chair/bed bound, dementia

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13
Q

T or F: PD is NOT just a movement disorder

A

TRUE!

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14
Q

Hoehn and Yahr Stages - Stage 1

A 
1 s/s unilateral
2 sx mild
3 sx inconvenient but not disabling
4 tremor in one limb
5 friends comment on changes in posture, locomotion, facial expressions
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15
Q

Hoehn and Yahr Stages - Stage 2

A

1 sx bilateral
2 minimal disability
3 posture and gait affected*

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16
Q

Hoehn and Yahr Stages - Stage 3

A

1 significant slowing of body movements
2 Early impairment of equilibrium with gait and stance
3 Generalized dysfunction that is moderately severe

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17
Q

Hoehn and Yahr Stages - Stage 4

A 
1 severe sx
2 ambulation only with assistance
3 rigidity and bradykinesia
4 loss of ind. living
5 tremors may decrease in severity
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18
Q

Hoehn and Yahr Stages - Stage 5

A

1 cachectic stage
2 confined to bed or wc
3 unable to stand or walk
4 requires constant nursing care

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19
Q

Unified PD Rating Scale (UPDRS)

A

Composite rating scale by interview

6 areas including cognitive, ADLs, motor, neuro

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20
Q

PD subtypes

A

Akinetic/Rigid (50%)
Tremor dominant (40%)
Mixed (10%)

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21
Q

Akinetic/Rigid PD - what do you see (motor)

A 
Akinesia/hypokinesia
Bradykinesia
Rigidity 
FOG
Postural instability 
Resting tremor - often absent
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22
Q

Akinetic/Rigid PD - what do you see (non motor)

A 
Depression
Cognitive dysfunction/dementia
Autonomic dysfunction
Orthostatic hypotension
Constipation
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23
Q

Akinetic/Rigid PD - what do you see - FOG

A

Feet appeared glued to ground

Occurs most commonly when there is a perceived obstacle (turning)

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24
Q

Akinetic/Rigid PD - what do you see - postural instability tested with

A

tested with shoulder pull

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25
Q

Akinetic/Rigid PD - what do you see - gait/posture

A

Slow, shuffling
Festination
Flexed posture

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26
Q

Akinetic/Rigid PD - what do you see - others (handwriting, facial expression, speech)

A

Small handwriting (micrographia)
Decreased facial expression
Decrease speech volume/stuttering

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27
Q

Tremor dominant - what do you see

A

Resting tremor
Action tremor
Rigidity/akinesia mild
Rhythmic firing of neurons in STN correlated with tremor

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28
Q

Tremor dominant - what do you see - cognitive

A

NOT associated with cognitive/psychological symptoms

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29
Q

Tremor dominant - what do you see - resting tremor

A

pill rolling tremor

3-6 Hx

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30
Q

Medical tx for PD

A

Levodopa/Carbidopa (sinemet)
dopamine replacement
helps with bradykinesia/rigidity more so than tremor

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31
Q

Medical tx for PD - levodopa/carpidopa - side effects

A

hallucinations
delusions
psychosis

32
Q

Medical tx for PD - levodopa/carpidopa - therapeutic window

A

4-6 years, after that the benefit wears off

33
Q

Medical tx for PD - levodopa/carpidopa - phenomenons

A

On-Off: even when drug is active, time when mvmn is near normal and times with immobility
Wearing off: end of dose deterioration, worsening of sx

34
Q

Big side effect with levadopa

A

Dyskinesias!

35
Q

Other medical tx for PD besides levadopa

A

Dopamine agonists
Anticholinergics
Monoamine Oxidase B inhibitors
Deep brain stimulation

36
Q

Other medical tx for PD besides levadopa - dopamine agonists

A

Ropinirole, Pramipexole
Mimics dopamine in the brain - directly activates dopamine receptors
Often first line because of narrow therapeutic window with L dopa

37
Q

Other medical tx for PD besides levadopa - dopamine agonists - what do they do and what are side effects

A

Reduce rigidity, bradykinesia, motor fluctuations

Side effects: nausea, dizziness, hallucinations

38
Q

Other medical tx for PD besides levadopa - anticholinergics

A

loss of dopamine/excess cholinergic function

Helps with tremor, little effect on other sx

39
Q

Other medical tx for PD besides levadopa - anticholinergics side effects and examples

A

blurred vision, dry mouth, dizziness

Artane, Cogentin

40
Q

Other medical tx for PD besides levadopa - MAOB

A

MAOB is an enzyme that degrades dopamne - so we inhibit it to keep the dopamine around longer
Selegiline (eldepryl)
Rasagiline (azilect)

41
Q

Other medical tx for PD besides levadopa - deep brain stimulation

A

surgical implantation of a stimulator and electrodes

Electrodes STN or Gpi - stimulator/batteries inferior to clavicle

42
Q

Other medical tx for PD besides levadopa - deep brain stimulation - what does it do when electrodes are on

A

When electrodes are on - inhibit that area
STN - reduce bradykinesia, rigidity, improve gait and postural stability
Reduce tremor - STN or thalamus

43
Q

Other medical tx for PD besides levadopa - deep brain stimulation - problem

A

serious surgery
risks - hemorrhage, infection, malfunction
side effects - seizures, HA, emotional issues
also not a one time surgery and device isn’t turned on until several wks/months after surgery

44
Q

Current model - refer to PT when

A

After an acute event of change in status - multiple falls, ortho problem (rigidity/loss of flexibility), respiratory compromise
Generally not referred to us until stage 2 or 3, we would prefer stage 1

45
Q

Proposed model - refer to PT `

A

Dental model - get baseline assessment when diagnosed
Prevention/Restoration focus
Exercise program with consistent adherence
Continuous monitoring and intervention

46
Q

Proposed model - insurance companies

A

you want 10 sessions over the course of a year

47
Q

Evidence based PT guidelines

A

Make cards?

48
Q

Interventions

A 
Treadmill trainings
Cueing during gait 
LVST/Big
Boxing
Dancing
Forced cycling
Tai chi
49
Q

Interventions for freezing

A 
Change in meds
Imagine line on floor
Hum, count, music 
Put foot in front of pt to step over
Rock side to side
Ask for a hand
Take big step
Imagery
50
Q

Deep brain stimulators are NOT effective for what

A

freezing intervention!

51
Q

Exercise summary - motor learning and neuroplasticity require

A 
Exercise regularly 
Active participation
Intensive with repetition
Task specific
Whole body movement
Timing
52
Q

Exercise summary - motor learning and neuroplasticity require - Exercise regularly

A

Use it and improve it

HEP

53
Q

Exercise summary - motor learning and neuroplasticity require - Active participation

A

Teach pt self monitoring
Teach pt what normal mvmnt feels like
Vary context
Rewarding of tasks activates BG

54
Q

Exercise summary - motor learning and neuroplasticity require - Intensive with repetition

A

Bigger, faster movements
Push beyond self-selected effort
Treadmill
Combine strength and balance

55
Q

Exercise summary - motor learning and neuroplasticity require - Task specific

A

Not just repetition - need to produce significant changes in patterns to affect neural pathways
Dual tasks
Transitional movements

56
Q

Exercise summary - motor learning and neuroplasticity require - Whole body movement

A

Bigger, faster movement

57
Q

Exercise summary - motor learning and neuroplasticity require - timing

A

start before or at diagnosis

58
Q

Parkinsons plus is caused by

A

other neurodegenerative disorders

59
Q

Parkinsons plus - Progressive supranuclear palsy (PSP)

A

Brainstem, Cbm, BG, cortex
Build up of Tau protein
Onset after age 40, usually 60s

60
Q

Parkinsons plus - Progressive supranuclear palsy (PSP) - s/s

A 
Early gait instability with post falls
Depression
Psychosis
Gaze palsy! 
Either vertical gaze palsy or prominent postural instability in first year of dx
61
Q

Parkinsons plus - Diffuse Lewy Body Disease - Dementia

A

Progressive cognitive decline early
Memory impairment at onset is not prominent
Cognitive decline, visual hallucinations, parkinsonism, depression
Often no tremor
Poor response to L dopa

62
Q

Parkinsons plus - multiple system atrophy (MSA)

A

Affects BG, Cbm, autonomic system, PNS, and cerebral cortex
Adult onset, rapidly progressive, fatal
Parkinsonism with cbm signs, autonomic dysfunction
Poor response to L dopa

63
Q

Parkinsons plus - toxic, infectious, traumatic origin

A

Drug induced - parkinsonism side effect of antipsychotic meds
Traumatic encephalopathy - repeated trauma to head

64
Q

Red flags for parkinsonism

A 
Bilateral onset
Early postural instability 
Early dementia
Rapid progression
Early autonomic dysfunction
65
Q

Huntington’s Disease - definition

A

Chronic, progressive disorder that is autosomal dominant

66
Q

Huntingtons disease - autosomal dominant

A

all who carry the gene will manifest ds

50% of offspring will have ds

67
Q

Huntingtons disease - movement

A

abnormal movement patterns - choreiform movements
No pattern or purpose
Ballistic

68
Q

Huntingtons disease - mental

A

mental deterioration

bx changes, depression, suicide

69
Q

Huntingtons disease - pathology

A

targets specific neurons in caudate nucleus and putamen
Also cerebral cortex, particularly frontal lobe
Significant atrophy

70
Q

Personality disorder with Huntingtons disease

A 
Depression
Lack of initiative
Decreased communication
Increasing irritability
Psychosis
71
Q

Mental deterioration with Huntingtons

A

Dec concentration
Dec problem solving, thinking ability
Dementia

72
Q

Muscle disorders with Huntingtons

A 
All mm groupd
Choreic mvmnts 
Mvmnts dec with sleep and increase with stress
Akinesia and bradykinesia
Abnormal postural reactions
Problem with speech and writing
Wide base staggering gait
73
Q

Diagnosis Huntingtons

A 
Clinical lab tests
EEG with diffuse abnormalities 
CT scan - enlarged ventricles
PET scan - hypometabolism putamen and caudate
Family hx
Genetic testing
74
Q

Prognosis and tx Huntingtons

A 
Progressive
Death within 15-17 yrs of dx
Meds for sx
Restore, prevent, compensate
Palliative care
75
Q

Other BG disorders - Tourettes syndrome

A

involuntary movement such as tics

76
Q

Other BG disorders - Focal dystonia

A

sustained mm contractions resulting in abnormal postures, prolonged twisting and repetitive movements

77
Q

Other BG disorders - Hemiballismus

A

wild rapid flinging of proximal muscle/shoulder and hip

Semester 5 PMNM Exam 6 (6 decks)

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