Neuro - PD

Question 1

Briefly describe what causes Parkinsons Disease.

Answer 1

There is a programeddestructionof>70%of neurons resultingin depletion of the neurotransmitter dopamine in the substantianigra in the basal ganglia

Question 2

What are the 3 stages of PD?

Answer 2

1. Preclinical
   neurodegeneration presentbut asymptomatic (no symptoms)
2. Prodromal Parkin’s disease
   motor and non-motorsymptoms arepresent with clinical diagnosis
3. Clinical Parkinson’s Disease
   bradykinesia begins (slowness of movement)

Question 3

What are some clinical features of PD and what causes them to occur?

Answer 3

Large numbers of dopamine-producing neurons are damaged, so communication across neurons in this circuit is disrupted and the motor symptoms of PD appear

1. Bradykinesia (slowness of movement)
2. Rigidity (stiffness)
3. Tremor
4. Postural instability (flexed posture)

Question 4

Name some non-motor features of PD

Answer 4

• Neuropsychiatric symptoms: Depression, Anxiety
• SleepDisorders:restless legs,insomnia
• AutonomicSymptoms: bladder andbowel,excessive sweating
• Gastrointestinal:dibbling,constipation
• Fatigue, weight loss

Question 5

What can physios offer to those with PD?

Answer 5

Muscle weakness
Stiffness
Falls and Fractures
Balance
Functional practice
Pain

Question 6

What is included in a subjective assessment of PD?

Answer 6

1. Expectations, priorities
2. HPC
   - previous treatments,(freezing, stiffness, slowness, falls/ gait,tremor) body function/structures, activities, participation. Non-motorquestions.
3. SH
   - support, carers, environment
4. PMH
   - diabetes, cardiac, depression,surgery
5. DH
   - PD medicationand timings

Question 7

What is included in an objective assessment of PD?

Answer 7

1. Observation during functional activities
   - tremor, bradykinesia, balance, vision, speech, hearing
2. Range of movement and activity/power
   - trunk, LL and UL.
3. Coordination
   - finger tonose
4. Balance
   - sitting balance, standing balance, move outside BoS
5. Gait
   - freezing,dual tasking,outdoor/ uneven
6. Functional
   - on/off floor,rolling, ly-sit,running, cycling

Question 8

What is tone?

Answer 8

Tone is the resistance of muscles to passive stretch.
It is the amount of tension a muscle has at rest
Tone is the internal state of muscle-fibre tension within individual muscles and muscle groups
It is a continuum from low (floppy or flaccid) to high (hypertonus or spasticity)

Question 9

What 3 strategies are there to maintain balance?

Answer 9

Postural Adjustments

1. Ankle strategy
2. Hip strategy
3. Stepping mechanism

Question 10

What headings should you use for a problem list?

Answer 10

1. Body functions and structures
2. Activities
3. Participation

Question 11

How can goals be set in a neuro setting?

Answer 11

Goals should be SMART where possible (specific, measurable, achievable, realistic and time framed)
Goals can be short, medium or long term

Question 12

What are the best methods in neuro to show progression of a task

Answer 12

• Task specificity
• Practice/intensity (1000 reps to learn!!) Allows NEUROPLASTICITY to occur
• Feedback
• Generalisability or transferability
• Mental practice

Question 13

What should the exercises be based on for neuro patients?

Answer 13

Exercises should be aimed at functional tasks and rebuilding movement skills

Question 14

How can muscles change with disuse?

Answer 14

• Reduced cross-sectional area
• Atrophy (muscle wastage) in antigravity muscles - postural muscles
• Changes in length-tension relationship
• Increased tendon stiffness