Neuromuscular 2 Unit 3 Parkinsons Flashcards
What are some Risk Factors for PD?
- Increasing age -> peaks at 80 y.o
- Men > Women
- Evironmental: Pesticides/herbicide exposure, prior head injury, B-blocker use, rural living, agricultural occupation, well-water drinking, tobacco, caffeine, physical activity, NSAIDs, calcium channel blocker and alcohol
What is the current model of care for those with Parkinsons? What does this mean?
Reactive
- This means that patients are coming to us for other things, such as:
–for falls
–Othopedic injury
–Other co-morbidity
- Its not unitl the patient has more overt impairments and activity limitations that a referral to physical therapy is issued
- Once they go to PT or a brief episode of care that typically lasts four to six weeks, the patient is discharged with an HEP but no follow up
This is not the most ideal model
What would a Proactive Model of Care look like for those patients with PD?
- There is preventative care with ongoing assessment over the course of the disease, if a situation were to arise it is taken care of immediately
- Ideally we would want patients to be sent to PT early in their diagnosis so they can get a comprehensive assessment and receive therapy or possible just a referral to a community based program or a support group
- We could educate them on the disease progression and what to expect and arrange to see them in 6 months, we can evalute, assess and determine their needs at that time with this model of care
- In order to make this change, we have to educate out physicians and be advocates for our patients so that they are not waiting for overt Sx or an event to occur to be sent to PT
- And we need to try to push for a more interdisciplinary model
Ideally we would like to start treating them prior to the onset of shuffling gait, partial deformities or an extensive Hx of falls
When treating a patient with PD, what is the Focus of the PT?
Motor Impairments
When treating PD patients, what would happen if the patient has depression, anxiety, apathy and/or cognition issues? What can we (the PTs) do?
They will be low energy, they may have impaired learning and low compliance
- We may need to have simple commands and give them reminders
When treating PD patients, what would happen if the patient has postural hypotension (drop of 20 SBP or 10 DBP and 10% increase in HR) and/or have bladder urgency/infrequency? What can we (the PTs) do?
They may have dizziness, falls with blackouts, and/or injury
- They may need compression stockings, salt on food, hydration, pause with SYS
- They may need pelvic floor exercises, MD referral
When treating PD patients, what would happen if they have sleep disturbances or psychosis? What can we (the PTs) do?
- They may have fatigue
- May require referral for sleep study, medication adjustment for psychosis
PD across the continuum of care
What is considered the Early/Mild stages of the Hoehn and Yahr Scale?
Stage 1 - 2
What is considered the Moderate/Middle stages of the Hoehn and Yahr Scale?
Stage 3 - 4
What is considered the Severe/Late of the Hoehn and Yahr Scale?
Stage 5
With the Hoehn and Yahr Classification of Disability, what is Stage 1?
Minimal disability, unilateral symptoms
With the Hoehn and Yahr Classification of Disability, what is Stage 2?
Bilateral, or midline involvement (no balance impairment)
With the Hoehn and Yahr Classification of Disability, what is Stage 3?
Postural instability present but can still live independently
With the Hoehn and Yahr Classification of Disability, what is Stage 4?
All symptoms present, standing/walking only possible with assistance
With the Hoehn and Yahr Classification of Disability, what is Stage 5?
Wheelchair or bed bound
What is the Treatment focus with the Early/Mild stages (H&Y 1-2)?
Restoration
- The interventions should be focused on strength, execution, task-specific training, preventing inactivity, improving flexibility and preventing possible deformities by working on postural endurance and postural training
- Additionally you want to address any asymmetries in gait, such as arm swing, and also address any impairments that you know at this time
- Fall prevention and disease progression education is ideally started at this stage
What is the Treatment focus with the Moderate/Middle stages (H&Y 3-4)?
Compensation, while also training restoration
- This is the stage where sensory cueing becomes very important and the importance of assistive devices may be warranted
- There is typically more difficulty with dual tasking
- Creating a fall log migh also be benefical at this stage to give you an idea of how falls are affecting their ADLs and how you can help to prevent them
What is the Treatment focus with the Severe/Late stages (H&Y 5)?
Compensation
- We will be providing a lot of caregiver education for transfer safety and skin integrity awareness
- It can take a long time to reach this stage, however its important to prevent things such as contractures, pressure sores, and pneumonia (unfortunately, people with PD die with aspiration pneumonia)
- Emphasis on providing family education especially with transfer training can help improve patient care at home
- This may also be an appropriate time to educate the family and the patient about the possibility of moving to a skilled nursing facility
Should PT implement Aerobic Training to PD patients?
Yes, PTs should implement moderate - to high intensity aerobic exercise
- Evidence Quality = High / Recommendation Strength = Strong
- No one form of aerobic exercise is superior to another, however the emphasis should be placed in intensity
What are the Benefits of Aerobic Training for PD patients?
There are improvements in:
- Oxygen consuption
- Motor and nonmotor impairments
- Functional activities (ex., gait, balance, ADLs)
- QOL
What type of External Cueing is used most commonly for gait training? What can this cue be beneficial for?
Visual Cueing is the most common
- Improve Stride Length
–150% longer than current
–Target = 40% of patient height (24-28in)
- Improves turning
- Improves initiation of Gait
