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Neuroconditions 2022 > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What are the primary causes of PD?

A

idiopathic

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2
Q

what are secondary causes of PD

A

drug induced
stroke
tumors/ trauma

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3
Q

What the atypical syndromes of PD

A

progressive supra-nuclear palsy

multisystem atrophy

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4
Q

What is progressive supranuclear palsy?

A

onset over age 50
impaired eye movements: can’t look down
postural exension (extreme)
falls within the first year

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5
Q

What is multiple systems atrophy

A 
Parkinsonism 
cerebellar symtpoms-- gait ataxia 
autonomic symptoms -- orthostatic (30mm sys or 15 mm diast. drop)
impotence
urinary incontinence 
urinary retention
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6
Q

What are the cardinal signs of PD

A

TRAP

resting tremor, rigidity, bradykinesia (akinesia), postural instability (usually later in the disease),

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7
Q

What is festinating gait or festination

A

quickening and shortening of normal strides characterize festinating gait. steps are quicker, stride is shorter, very inefficient gait

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8
Q

What is freezing of gait

A

freezing of gait is characterized by a hesitation before stepping forward, or difficulties when initiating walking

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9
Q

What % fall a year

A

70% fall once a year

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10
Q

What % sustain fractures

A

17.1%

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11
Q

How much more likely are PD patients likely to sustain a facture than those without

A

3.2x more likely

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12
Q

Multiple studies suggest highly challenging balance training may reduce fall risk in pD. What defines highly challenging?

A

moving COM
narrowing base of support
used Horak’s framework

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13
Q

What are non-motor signs of PD

A 
cognitive 
pain 
depression 
hallucinations
dementia
sensory changes
autonomic dysfunction 
fatigue
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14
Q

What prequel and sequelae compund deficit of balance, gait, and function

A

prior hx of MSK issues before diagnosis
cardio function
flexibility
strength

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15
Q

What does the prognosis of PD depend on

A

type of PD
presence/absence of co-morbid illnesses
persoality characteristics
socioeconomic factors

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16
Q

What are the types of PD?

A

tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD

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17
Q

What are the types of PD?

A

tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD

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18
Q

What is PIGD

A

postural instability and gait disorder
more problems with instability and gait dysfunction
more likely to have cognitive deficits
faster decline

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19
Q

What are supportice prospective postitive criteria for PD

A

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

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20
Q

What is DBS (deep brain stimulation) used for in PD

A

primarily used to control motor fluctuations

symptom improvement usually last for 3-5 yeards after surgical procedure

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21
Q

What are common response to medications?

A 
on/off
wearing off
dyskinesia
dystonia
hallucinations
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22
Q

What is the gold standrad for PD

A

Unified PD rating scale (UPDRS)

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23
Q

What are the four sections of UPDRS

A
  1. mentation, behavior, mood
  2. activities of daily living
  3. motor examination
  4. complication of therapy

total of 176 poitns (motor subscale 108 points)

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24
Q

What part of the brain does PD affect

A

basal ganglia

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25
Q

What are the modified Hoehn and Yahr stages

A
  1. unilateral symptoms
  2. 5 unilateral and axial symptoms
  3. bilateral symmptoms, intact balance
  4. 5, bilateral sumptoms and mild balance impairment
  5. bliateral symptoms, postural instability (unable to recover on pull test, able to live independent)
  6. severe diabbility (walk independently )
  7. w/c dependent, bedridden unless assisted
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26
Q

What does the Schwab and England scale for PD

A

rates overall function on a ten point scale

100- completely independent

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27
Q

What is the 24 item scale with 96 points total for PD

A

Profile PD
11 items = body systems
10 items =activities
3 items- memory, depression, involvement

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28
Q

What is a clinician’sbottom line for patients with PD?

A

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

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29
Q

What is the axial mobility exercise program?

A

helps with loss of mobility of axial structures
helps posterure
ROM, deep breathing, and relaxtion are included

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30
Q

What are does deep breathing target in axial mobility

A

deep breathing– promote relaxation, improve mobility of ribs for increased thoracic expansion

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31
Q

What areas are involved within the the axial mobility for pts with PD

A

hook lying position to achieve lower trunk rotation
trunk
shoulder
neck
coordinated neck, shoulder, hip or trunk motion

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32
Q

What is stage II of axial mobility training

A

segmental motion of the spine and upper quadrant, with emphasis on the thorax
helps with bed mobility, reaching for items, preparation for turning

33
Q

What are the 4 mian components of power for PD wellness recovery

A

Power Up
power rock
power twist
power step

can be done standing, supine, sitting, quadraped

34
Q

What does PWR up focus on?

A

antigravity extension

35
Q

What does PWR Rock focus on

A

weight shifting

36
Q

What does PWR twist focus on

A

axial mobility

37
Q

What does PWR step focus on

A

transitions

38
Q

How do yo uperform PWR moves for ridgitiy

A

(prepare) moves are performed slowly, rhythically and with sustained effort

39
Q

How do you perform PWR moves for bradykinesia

A

(activate)moves are performed as big and fast as possible with repetitive effort

40
Q

How do you perform PWR moves for incoordination

A

(flows) moves are linked together into longer and longer sequences that mimic everyday movement

41
Q

How do you perofrm PWR moves for reduced self awareness

A

moves are performed with high attentional focus to engage across multiple motor systems

42
Q

Whta is freezing in PD

A

sometimes called motor block, is a sudden, brief inability to start movement or to continue rhythmic, repeated movements such as finger tapping, writing

43
Q

Whta is freezing in PD

A

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

44
Q

What are the 5 “s” method for freezing

A 
stop
stand tall (bring head back and squeeze shoulders together)
shake it off
shift weight (from right to left) 
step with a marching step
45
Q

What does Parkinsonism include?

A

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
46
Q

What are symptoms of PSP (progressive supranuclear palsy)

A

typical scare appearance
increased falls at onset– typically backwards
difficulty looking down

47
Q

What are the symptoms of MSA (multiple systems atrophy)

A

dystonomia

parkinsoninan and/or cerebellar syndrome– ataxia and dysarthria

48
Q

What are the motor signs of PD

A

bradykinesia
rigidity
rest tremor
postural instbaility

49
Q

What is bradykinesia

A

slowness and progressively smaller movements (hyopkinesia) as an individual repeats a task

50
Q

What is rigidity?

A

involuntary, velocity independent resistance to passive movement of a jiont with or without a cogwheel phenomenon

51
Q

what is a resting tremor in PD

A

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

52
Q

What is postural instability>?

A

balance impairment affecting a person’s ability to change or maintain pstures such as walking or standing

53
Q

What are nonmotor signs of PD

A 
olfactory loss
sleep dysfunction 
autonomic dysfunction (constipation, urinary urgency, eretile dysfunction, orthostatic hypotension, BP variables)
psychiatric distrubances 
cognitive impairments
54
Q

What are the three steps to diagnose PD

A

classical clinical presentation (TRAP)
opositive response to dopamine replacment
determine the type

55
Q

What are the dopamine replacment medications

A

Sinemet– carbidopa/Levodopa

rytary– extended release of carbidopa/levidopa

56
Q

How is levodopa different than carbidopa?

A

levodopa crosses the BBB and converts to dopamines

carbidopa inhibits the breakdown of levadopa

57
Q

What are dopamine agoinists?

A 
act on DA receptors
may delay starting dopamine replacement 
parlodel/bromocriptine
mirapex/pramipexole
requip/ropinirol

possible adverse effect of shopping, gambling, earing and hypersexuality

58
Q

What 2 types of medication slows the breakdown of dopamine for PD

A

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

59
Q

Where areas can/does deep brain stimulation target

A

globus pallidus
subthalamic nucleus
thalamus

60
Q

What are the four buckets of PT interventions?

A

aerobic exercise
flexibility
strengthening
task specific training (motor control training)

61
Q

What are the guidelines for aerobic exercise ?

A 
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
62
Q

What does the acial mobility program address in terms of flexibility

A

flexibility with emphasis on rotation
activating and relaxing muscles
incorporates relaxed breathing
incorporates parts of functional task

63
Q

What are the strengthening guidelines oof progressive resistance exercise for PD

A

UE– 30-40% of 1RM
LE– 50-60% of 1RM

as long as form and perception was good, progress patient by 5%

64
Q

What balance interventions for anticipatory postural adjustments for PD

A

step up (forward and lateral
STS or squats
lunges
SL with reaching

65
Q

What balance interventions for postural adjustments for PD

A

standing on foam
pertebation on stable and unstable surfaces
ball toss
standing hip abduction and flexion

66
Q

What balance interventions for gait

A

gait at varying speeds with auditory cueing
gait with dual task
gait with head truns, startsm stios
walking backwards

67
Q

What defines a highly challenging balance program for PD

A

12 weeks

2x/weel

68
Q

What is neural priming

A

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

69
Q

what is movement based priming

A

includes bilateral or unilateral movements, mirror summetric active or passive movements, or any type of exercise such as aerobic, isometric and balance exercises

70
Q

What is BIG and LOUD

A

Lee Silver Voice Treatment program

71
Q

What does BIG and LOUD do for patients with PD for SLP

A 
incrased loudness of speech 
improved intelligibility 
increased facial expression 
advancements in swallowing 
work on precise and clear speech sounds
72
Q

What does BIG and LOUD do for PT/OT for patients with PD

A

increased walking speed and bigger steps
emphasized movements with patterns
rotational movements through exercise moving
speed of movement
balance

73
Q

What brain area is the initial source of pathology located in PD

A

substantia nigra

74
Q

The diagnosis of PD is most typically made by what?

A

clinical findings of cardinal signs of PD and positive response to dopamine replacment

75
Q

descrice the progression of PIGD form of PD

A

faster delcine than the tremor form of PD
more problems with instability and gait
more likely to have cognitive deficits

76
Q

Forward flexed posture contributes to what in pts with PD

A

festinating gait
balance difficulties and increased falls
increased risj for MSK impairments

77
Q

WHat H&Y stage are describes as unilateral sumptoms only

A

stage 1

78
Q

what H &Y stage of PD is described as bilateral symptoms with postural instabiltiy (unable to recover on posterior pull test)

A

stage 3

Neuroconditions 2022 (14 decks)

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