Parkinson

Question 1

Cardinal Signs of Parkinson Disease- TRiP B

Answer 1

• 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

Question 2

Resting tremor

Answer 2

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.

Question 3

Parkinson disease starts off as

Answer 3

Unilateral then becomes bilateral

Question 4

Occurs when pt. stands up can get full body sway

Answer 4

Postural tremor

Question 5

When should parkinson patients start therapy

Answer 5

from day one of diagnosis

Question 6

When does tremors get worst?

Answer 6

With fatigue and stress

Question 7

What could improve tremor? (study shows)

Answer 7

Guided imagery

Question 8

Rigidity

Answer 8

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.

Question 9

Difference between rigidity & spasticity

Answer 9

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.

Question 10

Rigidity begins in trunk first

Answer 10

Proximal motion first - Prolonged rigidity will cause decreased ROM try to maintain ROM as long as possible will have contractures if not.

Question 11

Slow movement- festinating gait, hampers movement in therapy

Answer 11

Bradykinesia

Attach things to walker to get them going, te lazer etc.

Question 12

Difficulty obtaining/starting and stopping movement

Answer 12

Akinesia

Question 13

High risk of falls

Answer 13

Reduced ROM Reduced amplitude Reduced

Question 14

Anthropulsive gait

Answer 14

Lean too much forward

Question 15

Retropulsive gait

Answer 15

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.

Question 16

difficulty swallowing

Answer 16

Dysphagia

Question 17

Excessive saliva- affects body image

Answer 17

Sialorrhea

Question 18

Small handwriting

Answer 18

Micrographia

Question 19

Masked face

Answer 19

Hypomimia

Question 20

Postural Instibility

Answer 20

Late stage of PD, narrow base of support, huge body sway, 2/3 of patients have falls, 13% > once a week

Question 21

Staging of PD- Hoehn-Yahr

Answer 21

Stage 1-5

Question 22

Staging of PD- Hoehn-Yahr- Stage 1

Answer 22

If pt. has some unilateral symptoms present. mild symptoms

Question 23

Staging of PD- Hoehn-Yahr- stage 2

Answer 23

Balance not impaired yet, minimally bilateral / midline involvement

Question 24

Staging of PD- Hoehn-Yahr stage 3

Answer 24

Impaired righting reflexes, unsteady when turning, rising from chair, some restricted activity but Pt. can live independently and continue some form of employment

Question 25

Staging of PD- Hoehn-Yahr stage 4

Answer 25

All symptoms are present and severe, standing & walking requires assistance

Question 26

Staging of PD- Hoehn-Yahr - Stage 5

Answer 26

Confined to bed or wheel chair

Question 27

Combination of L-dopa & carbidopa

Answer 27

Sinemet

Question 28

Treatment of PD- Sinemet meds -“on” “off”

Answer 28

on off cycle when on sinemet patient can move very well, off pt. back to where started.

Question 29

Treatment for PD- Deep brain stimulation

Answer 29

Works but causes behavioral changes

Question 30

LSVT- Lee Sylverman Voice Treatment.

Answer 30

Big movements- started with loud speech then evolved into treatments with big movements- make them work at a 8-10 on RPE