Parkinson Disease PD

Question 1

Parkinson’s disease health condition & BSF Impairments

Answer 1

Chronic, progressive neurodegenerative disease characterized by 4 cardinal signs
Characterized by bradykinesia, rigidity, tremor, postural instability
Substantia nigra loses neuromelanin
The major dopamine nigrostriatal pathway is impacted

Question 2

Parkinson’s Disease Medications

Answer 2

Dopamine replacement:
- Sinemet (carbidopa-levodopa)
- Rytary - longer acting
COMT inhibitors
- Comtan/entacapone
- Tasmar/tolcapone
- Ontgentys/ocicapone
MAO-B inhibitors
- Eldepryl/selegiline
- Azilect/rasagiline
Dopamine agonists
- Mirapex/pramipexole
- Requip/ropinirole
- Rotigotine patch
- Apokyn/apomorphine
Anticholinergics

Question 3

Parkinson’s Disease diagnosis specific tests & measures

Answer 3

Hoehn & Yahr Stages (H&Y)
Unified Parkinson disease rating scale (UPDRS)
Freezing of gait Questionnaire (FOG)
Parkinson Fatigue Scale (PFS)
Schwab & England Functional
PDQ-39

Question 4

Parkinson disease interventions

Answer 4

Aerobic exercise - mod to high intensity, 150min/wk
Balance and gait training - success with challenge (7/10 scale) for multiple reps >30min
Resistance training - individualized 70-80% 1RM, 8-10 exercises, 10-15 reps, 2-3 x/wk
Task-specific training, cuing - individualized flexibility/stretching major muscle groups

Question 5

PD Special considerations

Answer 5

Auditory & visual cues
Lewy Body Dementia is the more common type of dementia associated with this disease
Duopa is a possible drug that can be delivered into the jejunum by tube
Consider biased in strengthening extensors, stretching flexors
PSP - progressive supranuclear palsy
MSA - Multiple systems atrophy

Question 6

Parkinson’s Disease movement system diagnoses

Answer 6

Hypokinesia

Question 7

Parkinson’s disease Hoehn & yahr stages

Answer 7

1. Unilateral symptoms
   1.5 unilateral and axial symptoms
2. Bilateral symptoms, intact balance
   2.5 Bilateral symptoms and mild balance impairment
3. Bilateral symptoms, postural instability
4. Severe disability
5. Wheelchair dependent, bedridden unless assisted

Question 8

Diagnosis of Parkinson’s Disease

Answer 8

Bradykinesia plus
- Resting tremor
- Rigidity
- Postural instability

Question 9

Progressive Supranuclear Palsy (PSP)

Answer 9

Inability to look down
Scared impairments
Postural extension
Backward falls in first year
Over 50

Question 10

Multiple Systems Atrophy (MSA)

Answer 10

Dysautonomia
Parkinsonian
Cerebellar syndrome - ataxia, dysarthria
Orthostatic hypotension
Urinary

Question 11

Lewy Body Dementia

Answer 11

Early dementia
Rigidity more prominent than bradykinesia or tremor
Hallucination
Fluctuating cognitive status
Falls
Motor features may respond to levodopa but with psychiatric side effects

Question 12

Parkinson’s Disease Motor signs & systems

Answer 12

Dyskinesia
Dystonia
Motor fluctuations
Bradykinesia
Rigidity
Festination
Freezing of gait
Lip and tongue movement slowness
Akinesia
Gait pattern: stooped posture, shuffling steps, narrow base of support, foot drag, decreased arm swing, difficulty initiating or turning, slow
Decreased RoM in the LE joints
Posture: flexion
Postural instability
Difficulty timing and scaling anticipatory postural adjustments
Posterior perturbations
Weakness
Fatigue
Smooth performance of motor tasks broken into components

Question 13

Parkinson’s Disease Non-Motor signs & symptoms

Answer 13

Anxiety
Depression
Apathy
Cognitive
Dysautonomia
Hyposmia/anosmia
Fatigue
Excessive sweating
Sialorrhea
Drooling
REM sleep disorders
RLS
Abnormal sleep patterns
Excessive daytime sleepiness
Self movement versus environment movement indistinguishable
Visual dependent for balance and motor control
Impaired color vision & visual perception
Difficulty orienting visually
Intellectual changes
Dementia
Bradyphrenia

Question 14

PD Pain from

Answer 14

MSK issues
Nerve root pain
Pain from dystonia
Extreme restlessness
Primary or central pain from the brain