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Neuro Eval II > Parkinson Disease > Flashcards

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
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2
Q

What is “resetting”

A

When resting tremor stops for a period of seconds to minutes while posture holding with outstretched arms

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3
Q

Parts of the brain involved with resting tremor production

A
  • GPi, SubThN, ventral intermediate nucleus
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4
Q

What circuit is involved in amplifying the tremor?

A

Cerebello-Thalamo-Cortical circuit

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5
Q

What is the tremor generally responsive to?

A

L-Dopa through inhibition of VIM of thalamus

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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
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7
Q

two types of rigidity in PD

A

cogwheel or lead pipe

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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
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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
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10
Q

Cutaneous-muscular reflexes:

A
  • Normally three parts: E1, I1, E2
  • Reduced I1 in PD
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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)

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12
Q

What causes bradykinesia

A

probably a “network” dysfunction in a circuitry of BG, motor cortex, and cerebellum

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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
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14
Q

Posture changes

A
  • toward flexion
  • can lead to pain
  • may contribute to falling
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15
Q

Secondary flexibility restrictions

A
  • arise as a result of flexed posture, rigidity, and bradykinesia
  • causes problems in preserving balance and performing ADLs
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16
Q

Steady state standing balance

A
  • Generally increased sway in ML direction
  • Postural predisposition to loss of balance (forward)
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17
Q

Dynamic standing balance

A
  • impairments in anticipatory postural adjustment
  • too small and can be incomplete or requiring multiple bursts of muscle activity
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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
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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)
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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
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21
Q

What is festinating gait a consequence of?

A

decreasing step length and increased cadence
- terminated by catching CM, freezing, fall

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22
Q

What is the most typical gait dysfunction in PD

A

freezing

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23
Q

where is freezing common

A

during step initiation, moving through barriers, and turning

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24
Q

what structure contributes to freezing

A

pedunculopontine nucleus function in brainstem

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25
Q

intrinsic factors of falling

A

posture, balance

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26
Q

extrinsic factors of falling

A

doorsteps, lighting play a small role than intrinsic factors

27
Q

When do non-forward falls occur

A

sitting, standing, turning
- associated with balance impairment and rigid-akinetic subtype PD

28
Q

when examining sleep problems, what should you do?

A

identify if it is due to problems of rolling over in bed or other reasons

29
Q

participation is highly related to

A

mobility- related QoL and may be most impacted by ability to stand up from a chair and freezing of gait

30
Q

Objective of PT for persons with PD

A

improve QoL
- by improving and preserving independence, mobility, safety and well-being through exercise

31
Q

What guides treatment of PD

A

the stage

32
Q

PT is indicated if:

A
  • 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
Q

6 aspects to look at during examination process

A
  • movement analysis
  • activity
  • participation
  • freezing of gait
  • fatigue
  • fear of falling
34
Q

PDQ- 8

A

participation questionnaire

35
Q

FOG Questionnaire

A

freezing of gait

36
Q

Early stages of PD

A

little to no limitations
1 - 2.5 on H&Y

37
Q

Goals for early stages of PD

A
  • prevent inactivity
  • prevent fear to move or fall
  • advise, educate, individual and/or group exercise, specific attention to balance and physical capacity
38
Q

middle stages of PD

A

more severe symptoms and limitations of activity
- 2-4 H & Y

39
Q

Goals for middle stages of PD

A
  • Preserve or improve activities (function)
  • Address function and incorporate compensatory strategies by the latter parts of this phase
40
Q

Late stages of PD

A

5 H&Y
mostly confined to WC or bed

41
Q

Goal of late stages of PD

A
  • preserve vital functions and prevent complications such as pressure sores and contractures
  • compensation in the form of equipment, information, advice
42
Q

treatment outcome - motor disease severity is positively influenced by:

A
  • aerobic exercise
  • resistance training
  • external cueing
  • community- based exercise
  • gait training
43
Q

treatment outcome - falls may be reduced by:

A
  • resistance training with movement strategy training and falls education
  • balance training as part of multi-modal exercise
  • gait training
  • community based exercise
44
Q

treatment outcome - functional outcomes are improved by

A
  • aerobic exercise
  • resistance training
  • task-specific training
45
Q

what improves freezing of gait

A

external cueing

46
Q

overall QoL improved by:

A
  • aerobic training
  • balance training
  • resistance training
  • community based exercise
  • integrated care
  • behavioral change
47
Q

aerobic exercise parameters

A
  • Mod-high intensity
  • 60-75% max HR
  • 75-85% max HR
  • 3 days/week for 30-40 min
  • Treadmill Training
48
Q

multi-modal exercise should have….

A

external auditory cues

49
Q

What are external used to do?

A

complete or release reduced “internal drive” in PD

50
Q

Patient generated external cueing strategies

A

bow, stretch, wave - for initiating whole body movements

51
Q

Internal attentional cueing (compensatory strategy)

A
  • large/fast movements
  • initial agonist burst of prime mover is larger when making larger movements or moving against greater loads
52
Q

Strategies for complex movement sequences

A

means making explicit what is normally automatic

53
Q

conscious performance of actions

A
  • 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
Q

What is the best for balance training and falls prevention

A

combination of balance training and strengthening and/or functional mobility training

55
Q

what helps with turning

A

both visual and auditory cues

56
Q

visual cues improve which phases?

A

preparatory and execution phases

57
Q

auditory cues help with which phase?

A

they improve APA of first step initiation

58
Q

somatosensory cues improve which phase?

A

preparation phase (but results are mixed)

59
Q

Visual cues improve….

A

step length and step frequency

60
Q

Auditory cues may improve….

A

stride length and minimize sequencing effect

61
Q

attentional cues in combination with rhythmic cues also help…

A
  • instruction for foot take off, stride
  • exaggerated arm swing, cue heel contact, wider base
62
Q

when frozen… individual specific cues include:

A
  • 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
Q

flexibility exercise for axial rotation

A
  • axial rotation in sitting and reaching while maintaining balance
  • improves joint mobility through relaxation during movement
  • axial structures emphasized
64
Q

3 factors that hamper behavioral change compliance

A
  • the problems that patients experience in following instructions of PT
  • lack of positive feedback
  • feeling this wont help me

Neuro Eval II (16 decks)

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