Parkinson Disease Flashcards
1
Q
Resting Tremor
A
- rhythmic oscillatory movement (may decrease with progression)
- 3.5-7 Hz (pill rolling)
- Asymmetric
- disappears w/ voluntary movement
2
Q
What is “resetting”
A
When resting tremor stops for a period of seconds to minutes while posture holding with outstretched arms
3
Q
Parts of the brain involved with resting tremor production
A
- GPi, SubThN, ventral intermediate nucleus
4
Q
What circuit is involved in amplifying the tremor?
A
Cerebello-Thalamo-Cortical circuit
5
Q
What is the tremor generally responsive to?
A
L-Dopa through inhibition of VIM of thalamus
6
Q
Difference between rigidity and spasticity
A
- Spasticity: cortical lesion – velocity dependent increase in spinal stretch reflex
- Rigidity in PD: increase in muscle tone manifested as a speed independent resistance to passive movement
7
Q
two types of rigidity in PD
A
cogwheel or lead pipe
8
Q
Rigidity is no longer considered exclusively a…
A
- dopaminergic dysfunction of basal ganglia
- likely a combination of spinal reflex and brainstem dysfunction including non-dopaminergic NT systems
9
Q
Muscle Stretch Reflexes
A
- Normally there are M1-M3 responses
- M1 20-40ms UE, M1 35-40ms LE
- Longer latency reflexes >40ms thought to be related to rigidity in persons w/ PD
10
Q
Cutaneous-muscular reflexes:
A
- Normally three parts: E1, I1, E2
- Reduced I1 in PD
11
Q
Bradykinesia
A
slowness of movement including “sequence
effect” which is a progressive
decrease in speed and amplitude of repetitive continuous movements (eg, gait, writing)
12
Q
What causes bradykinesia
A
probably a “network” dysfunction in a circuitry of BG, motor cortex, and cerebellum
13
Q
What does bradykinesia look like during a simple discrete movement?
A
- Correct agonist recruited.
- Duration of agonist EMG burst is generally normal.
- Decreased size of the initial agonist burst.
- Movement achieved through a series of small agonist bursts.
- Timing of subsequent agonist / antagonist preserved.
- Rate of force development issues due to changes in motor unit structure / function
14
Q
Posture changes
A
- toward flexion
- can lead to pain
- may contribute to falling
15
Q
Secondary flexibility restrictions
A
- arise as a result of flexed posture, rigidity, and bradykinesia
- causes problems in preserving balance and performing ADLs
16
Q
Steady state standing balance
A
- Generally increased sway in ML direction
- Postural predisposition to loss of balance (forward)
17
Q
Dynamic standing balance
A
- impairments in anticipatory postural adjustment
- too small and can be incomplete or requiring multiple bursts of muscle activity
18
Q
Loss of automatic righting and protective reactive postural control
A
- more likely to co-contract ag/antag around a joint
- less likely to show sequential muscle activation
- less likely to take multiple steps with shorter step lengths
19
Q
cognitive impairment
A
- bradyphrenia
- attention
- executive function
- multi/dual task ability
- impulse control
- dementia develops (but not like Alzheimer because visual hallucinations are more and severe memory problems are less)
20
Q
Walking
A
- Flexed posture with anterior displaced center of mass
- Shorter step length, reduced foot clearance (shuffling) steps due to bradykinesia
- Loss of associated arm movement
- Festinating gait
- Terminated by catching CM, freezing, or fall.
- Freezing: Episodic inability to generate an effective step
21
Q
What is festinating gait a consequence of?
A
decreasing step length and increased cadence
- terminated by catching CM, freezing, fall
22
Q
What is the most typical gait dysfunction in PD
A
freezing
23
Q
where is freezing common
A
during step initiation, moving through barriers, and turning
24
Q
what structure contributes to freezing
A
pedunculopontine nucleus function in brainstem
25
intrinsic factors of falling
posture, balance
26
extrinsic factors of falling
doorsteps, lighting play a small role than intrinsic factors
27
When do non-forward falls occur
sitting, standing, turning
- associated with balance impairment and rigid-akinetic subtype PD
28
when examining sleep problems, what should you do?
identify if it is due to problems of rolling over in bed or other reasons
29
participation is highly related to
mobility- related QoL and may be most impacted by ability to stand up from a chair and freezing of gait
30
Objective of PT for persons with PD
improve QoL
- by improving and preserving independence, mobility, safety and well-being through exercise
31
What guides treatment of PD
the stage
32
PT is indicated if:
* Is limited in one or more activities.
* Has (or is at risk of) decreased physical capacity caused by inactivity
* Has increased risk of falling
* Has the need for information or advice on the disorder, natural course, and prognosis.
* Has increased chance of pressure sores
33
6 aspects to look at during examination process
- movement analysis
- activity
- participation
- freezing of gait
- fatigue
- fear of falling
34
PDQ- 8
participation questionnaire
35
FOG Questionnaire
freezing of gait
36
Early stages of PD
little to no limitations
1 - 2.5 on H&Y
37
Goals for early stages of PD
- prevent inactivity
- prevent fear to move or fall
- advise, educate, individual and/or group exercise, specific attention to balance and physical capacity
38
middle stages of PD
more severe symptoms and limitations of activity
- 2-4 H & Y
39
Goals for middle stages of PD
- Preserve or improve activities (function)
- Address function and incorporate compensatory strategies by the latter parts of this phase
40
Late stages of PD
5 H&Y
mostly confined to WC or bed
41
Goal of late stages of PD
- preserve vital functions and prevent complications such as pressure sores and contractures
- compensation in the form of equipment, information, advice
42
treatment outcome - motor disease severity is positively influenced by:
- aerobic exercise
- resistance training
- external cueing
- community- based exercise
- gait training
43
treatment outcome - falls may be reduced by:
- resistance training with movement strategy training and falls education
- balance training as part of multi-modal exercise
- gait training
- community based exercise
44
treatment outcome - functional outcomes are improved by
- aerobic exercise
- resistance training
- task-specific training
45
what improves freezing of gait
external cueing
46
overall QoL improved by:
- aerobic training
- balance training
- resistance training
- community based exercise
- integrated care
- behavioral change
47
aerobic exercise parameters
* Mod-high intensity
* 60-75% max HR
* 75-85% max HR
* 3 days/week for 30-40 min
* Treadmill Training
48
multi-modal exercise should have....
external auditory cues
49
What are external used to do?
complete or release reduced "internal drive" in PD
50
Patient generated external cueing strategies
bow, stretch, wave - for initiating whole body movements
51
Internal attentional cueing (compensatory strategy)
- large/fast movements
- initial agonist burst of prime mover is larger when making larger movements or moving against greater loads
52
Strategies for complex movement sequences
means making explicit what is normally automatic
53
conscious performance of actions
- complex activities are transformed to a number of separate elements that have to be executed in a set order and which consists of relatively simple movements
- avoid dual tasking
- use to assist with initiation
54
What is the best for balance training and falls prevention
combination of balance training and strengthening and/or functional mobility training
55
what helps with turning
both visual and auditory cues
56
visual cues improve which phases?
preparatory and execution phases
57
auditory cues help with which phase?
they improve APA of first step initiation
58
somatosensory cues improve which phase?
preparation phase (but results are mixed)
59
Visual cues improve....
step length and step frequency
60
Auditory cues may improve....
stride length and minimize sequencing effect
61
attentional cues in combination with rhythmic cues also help...
- instruction for foot take off, stride
- exaggerated arm swing, cue heel contact, wider base
62
when frozen... individual specific cues include:
* Flex or extend the knees
* Shift the weight R or L; sway a bit forward and back
* Suddenly swing the arms and point
* Try to step backwards then forward
* Stretch upright, relax, breathe and go
63
flexibility exercise for axial rotation
- axial rotation in sitting and reaching while maintaining balance
- improves joint mobility through relaxation during movement
- axial structures emphasized
64
3 factors that hamper behavioral change compliance
- the problems that patients experience in following instructions of PT
- lack of positive feedback
- feeling this wont help me
