Parkinson Flashcards
Cardinal Signs of Parkinson Disease- TRiP B
- Tremor
- Rigidity
- Postural Instability- late stage usually don’t happen early, narrow BOS- 2/3 pt will have falls because of this
- Bradykinesia- most disabling part of PD
Resting tremor
4-6 Hz starts off unilateral then progress to bilateral. Will have full postural body sway and tremors goes away when they sleep. Increase when they are stressed.
Parkinson disease starts off as
Unilateral then becomes bilateral
Occurs when pt. stands up can get full body sway
Postural tremor
When should parkinson patients start therapy
from day one of diagnosis
When does tremors get worst?
With fatigue and stress
What could improve tremor? (study shows)
Guided imagery
Rigidity
Pt. complains of heaviness & stiffness, Rigidity present with passive & active ROM. Consistent amount of muscle resistance to movement. Spasticity with active movement but velocity independent.
Difference between rigidity & spasticity
Rigidity- Consistent amount of muscle resistance throughout the entire movement. Occurs with both active & passive movement
Spasticity- Responsive to active movement, resistance to movement is velocity dependent.
Rigidity begins in trunk first
Proximal motion first - Prolonged rigidity will cause decreased ROM try to maintain ROM as long as possible will have contractures if not.
Slow movement- festinating gait, hampers movement in therapy
Bradykinesia
Attach things to walker to get them going, te lazer etc.
Difficulty obtaining/starting and stopping movement
Akinesia
High risk of falls
Reduced ROM Reduced amplitude Reduced
Anthropulsive gait
Lean too much forward
Retropulsive gait
A gait disorder in which the body’s centre of gravity appears to be in front of the patient, who struggles to keep the feet near the centre of gravity.
difficulty swallowing
Dysphagia
Excessive saliva- affects body image
Sialorrhea
Small handwriting
Micrographia
Masked face
Hypomimia
Postural Instibility
Late stage of PD, narrow base of support, huge body sway, 2/3 of patients have falls, 13% > once a week
Staging of PD- Hoehn-Yahr
Stage 1-5
Staging of PD- Hoehn-Yahr- Stage 1
If pt. has some unilateral symptoms present. mild symptoms
Staging of PD- Hoehn-Yahr- stage 2
Balance not impaired yet, minimally bilateral / midline involvement
Staging of PD- Hoehn-Yahr stage 3
Impaired righting reflexes, unsteady when turning, rising from chair, some restricted activity but Pt. can live independently and continue some form of employment
Staging of PD- Hoehn-Yahr stage 4
All symptoms are present and severe, standing & walking requires assistance
Staging of PD- Hoehn-Yahr - Stage 5
Confined to bed or wheel chair
Combination of L-dopa & carbidopa
Sinemet
Treatment of PD- Sinemet meds -“on” “off”
on off cycle when on sinemet patient can move very well, off pt. back to where started.
Treatment for PD- Deep brain stimulation
Works but causes behavioral changes
LSVT- Lee Sylverman Voice Treatment.
Big movements- started with loud speech then evolved into treatments with big movements- make them work at a 8-10 on RPE
