Parkinson's Flashcards
What are the primary causes of PD?
idiopathic
what are secondary causes of PD
drug induced
stroke
tumors/ trauma
What the atypical syndromes of PD
progressive supra-nuclear palsy
multisystem atrophy
What is progressive supranuclear palsy?
onset over age 50
impaired eye movements: can’t look down
postural exension (extreme)
falls within the first year
What is multiple systems atrophy
Parkinsonism cerebellar symtpoms-- gait ataxia autonomic symptoms -- orthostatic (30mm sys or 15 mm diast. drop) impotence urinary incontinence urinary retention
What are the cardinal signs of PD
TRAP
resting tremor, rigidity, bradykinesia (akinesia), postural instability (usually later in the disease),
What is festinating gait or festination
quickening and shortening of normal strides characterize festinating gait. steps are quicker, stride is shorter, very inefficient gait
What is freezing of gait
freezing of gait is characterized by a hesitation before stepping forward, or difficulties when initiating walking
What % fall a year
70% fall once a year
What % sustain fractures
17.1%
How much more likely are PD patients likely to sustain a facture than those without
3.2x more likely
Multiple studies suggest highly challenging balance training may reduce fall risk in pD. What defines highly challenging?
moving COM
narrowing base of support
used Horak’s framework
What are non-motor signs of PD
cognitive pain depression hallucinations dementia sensory changes autonomic dysfunction fatigue
What prequel and sequelae compund deficit of balance, gait, and function
prior hx of MSK issues before diagnosis
cardio function
flexibility
strength
What does the prognosis of PD depend on
type of PD
presence/absence of co-morbid illnesses
persoality characteristics
socioeconomic factors
What are the types of PD?
tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD
What are the types of PD?
tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD
What is PIGD
postural instability and gait disorder
more problems with instability and gait dysfunction
more likely to have cognitive deficits
faster decline
What are supportice prospective postitive criteria for PD
unilateral onsset
rest tremor present
progressive disorder
persistentasymmetry affecting side of onset most
excellent response (70-100%0 to levodopa
sever levadopa induced chorea
levodopa response for 5 years or more
What is DBS (deep brain stimulation) used for in PD
primarily used to control motor fluctuations
symptom improvement usually last for 3-5 yeards after surgical procedure
What are common response to medications?
on/off wearing off dyskinesia dystonia hallucinations
What is the gold standrad for PD
Unified PD rating scale (UPDRS)
What are the four sections of UPDRS
- mentation, behavior, mood
- activities of daily living
- motor examination
- complication of therapy
total of 176 poitns (motor subscale 108 points)
What part of the brain does PD affect
basal ganglia
What are the modified Hoehn and Yahr stages
- unilateral symptoms
- 5 unilateral and axial symptoms
- bilateral symmptoms, intact balance
- 5, bilateral sumptoms and mild balance impairment
- bliateral symptoms, postural instability (unable to recover on pull test, able to live independent)
- severe diabbility (walk independently )
- w/c dependent, bedridden unless assisted
What does the Schwab and England scale for PD
rates overall function on a ten point scale
100- completely independent
What is the 24 item scale with 96 points total for PD
Profile PD
11 items = body systems
10 items =activities
3 items- memory, depression, involvement
What is a clinician’sbottom line for patients with PD?
benefit from developing long term exercise habits
develop initial intervention program focused on key issues for the patient
transition the program unto activities that emphasize those key issues for long term adherence
What is the axial mobility exercise program?
helps with loss of mobility of axial structures
helps posterure
ROM, deep breathing, and relaxtion are included
What are does deep breathing target in axial mobility
deep breathing– promote relaxation, improve mobility of ribs for increased thoracic expansion
What areas are involved within the the axial mobility for pts with PD
hook lying position to achieve lower trunk rotation
trunk
shoulder
neck
coordinated neck, shoulder, hip or trunk motion
What is stage II of axial mobility training
segmental motion of the spine and upper quadrant, with emphasis on the thorax
helps with bed mobility, reaching for items, preparation for turning
What are the 4 mian components of power for PD wellness recovery
Power Up
power rock
power twist
power step
can be done standing, supine, sitting, quadraped
What does PWR up focus on?
antigravity extension
What does PWR Rock focus on
weight shifting
What does PWR twist focus on
axial mobility
What does PWR step focus on
transitions
How do yo uperform PWR moves for ridgitiy
(prepare) moves are performed slowly, rhythically and with sustained effort
How do you perform PWR moves for bradykinesia
(activate)moves are performed as big and fast as possible with repetitive effort
How do you perform PWR moves for incoordination
(flows) moves are linked together into longer and longer sequences that mimic everyday movement
How do you perofrm PWR moves for reduced self awareness
moves are performed with high attentional focus to engage across multiple motor systems
Whta is freezing in PD
sometimes called motor block, is a sudden, brief inability to start movement or to continue rhythmic, repeated movements such as finger tapping, writing
Whta is freezing in PD
sometimes called motor block, is a sudden, brief inability to start movement or to continue rhythmic, repeated movements such as finger tapping, writing or walking
What are the 5 “s” method for freezing
stop stand tall (bring head back and squeeze shoulders together) shake it off shift weight (from right to left) step with a marching step
What does Parkinsonism include?
PD
progressive supranuclear palsy (PSP)
multiple systems atrophy (MSA)
benign essentil tremor restless leg syndrome lewy body dementia (LBD) wilson disease drug induced Parkinsonism corticobasal syndrome vascular parkinsonism
What are symptoms of PSP (progressive supranuclear palsy)
typical scare appearance
increased falls at onset– typically backwards
difficulty looking down
What are the symptoms of MSA (multiple systems atrophy)
dystonomia
parkinsoninan and/or cerebellar syndrome– ataxia and dysarthria
What are the motor signs of PD
bradykinesia
rigidity
rest tremor
postural instbaility
What is bradykinesia
slowness and progressively smaller movements (hyopkinesia) as an individual repeats a task
What is rigidity?
involuntary, velocity independent resistance to passive movement of a jiont with or without a cogwheel phenomenon
what is a resting tremor in PD
a 4-6 HZ temor in a fully resting limb, which temporarily dissapears when the kumb is outstretched and then returns and is not present during movement
What is postural instability>?
balance impairment affecting a person’s ability to change or maintain pstures such as walking or standing
What are nonmotor signs of PD
olfactory loss sleep dysfunction autonomic dysfunction (constipation, urinary urgency, eretile dysfunction, orthostatic hypotension, BP variables) psychiatric distrubances cognitive impairments
What are the three steps to diagnose PD
classical clinical presentation (TRAP)
opositive response to dopamine replacment
determine the type
What are the dopamine replacment medications
Sinemet– carbidopa/Levodopa
rytary– extended release of carbidopa/levidopa
How is levodopa different than carbidopa?
levodopa crosses the BBB and converts to dopamines
carbidopa inhibits the breakdown of levadopa
What are dopamine agoinists?
act on DA receptors may delay starting dopamine replacement parlodel/bromocriptine mirapex/pramipexole requip/ropinirol
possible adverse effect of shopping, gambling, earing and hypersexuality
What 2 types of medication slows the breakdown of dopamine for PD
COMT inhibitors
comtan/entacapone
tasmar/tolcapone- must check liver regulary
stalevo–
MAO-B inhibitors
may be used early in disease
may have a neuroprotective effect
Where areas can/does deep brain stimulation target
globus pallidus
subthalamic nucleus
thalamus
What are the four buckets of PT interventions?
aerobic exercise
flexibility
strengthening
task specific training (motor control training)
What are the guidelines for aerobic exercise ?
H&Y stage 1-, within 5 yers of dx and not on meds 4 days per/weel 5 min warm up/cool down 30 min at 80% mad HR 26 weeks/6 months
What does the acial mobility program address in terms of flexibility
flexibility with emphasis on rotation
activating and relaxing muscles
incorporates relaxed breathing
incorporates parts of functional task
What are the strengthening guidelines oof progressive resistance exercise for PD
UE– 30-40% of 1RM
LE– 50-60% of 1RM
as long as form and perception was good, progress patient by 5%
What balance interventions for anticipatory postural adjustments for PD
step up (forward and lateral
STS or squats
lunges
SL with reaching
What balance interventions for postural adjustments for PD
standing on foam
pertebation on stable and unstable surfaces
ball toss
standing hip abduction and flexion
What balance interventions for gait
gait at varying speeds with auditory cueing
gait with dual task
gait with head truns, startsm stios
walking backwards
What defines a highly challenging balance program for PD
12 weeks
2x/weel
What is neural priming
priming is defined as a chnage in behavior based on previous stimuli
general theory underlying priming is that the brain, which has been prime by a prior methos of activation , is generally more resposive to the accompanying training
what is movement based priming
includes bilateral or unilateral movements, mirror summetric active or passive movements, or any type of exercise such as aerobic, isometric and balance exercises
What is BIG and LOUD
Lee Silver Voice Treatment program
What does BIG and LOUD do for patients with PD for SLP
incrased loudness of speech improved intelligibility increased facial expression advancements in swallowing work on precise and clear speech sounds
What does BIG and LOUD do for PT/OT for patients with PD
increased walking speed and bigger steps
emphasized movements with patterns
rotational movements through exercise moving
speed of movement
balance
What brain area is the initial source of pathology located in PD
substantia nigra
The diagnosis of PD is most typically made by what?
clinical findings of cardinal signs of PD and positive response to dopamine replacment
descrice the progression of PIGD form of PD
faster delcine than the tremor form of PD
more problems with instability and gait
more likely to have cognitive deficits
Forward flexed posture contributes to what in pts with PD
festinating gait
balance difficulties and increased falls
increased risj for MSK impairments
WHat H&Y stage are describes as unilateral sumptoms only
stage 1
what H &Y stage of PD is described as bilateral symptoms with postural instabiltiy (unable to recover on posterior pull test)
stage 3
