Parkinson's Flashcards
what is Parkinsons disease?
a slowly progressive degenerative disorder of the extrapyramidal system from an imbalance between excitatory and inhibitory striatal influences which is caused by low dopamine levels
differentiate between parkinsons disease and -syndrome
DISEASE:
- unknown cause
- older people affected
- slow, insiduous onset
- progressive
SYNDROME:
- multiple known causes
- any age group
- sudden onset
- progression can be haltered if cause is identified
what 5 nuclei make up the basal ganglia?
-substantia nigra
- caudate nucleus
- putamen
- globus pallidus
- subthalmic nucleus
what is the function of dopamine?
dopamine is involved in movement control, regulation of posture, and planning & execution of complex motor performances by inhibiting inappropriate movements. it stimulates direct pathways and inhibits indirect pathways.
what are the direct pathways?
pathways that travel from cortex - striatum - int globus pallidus - thalamus - cortex. they produce disinhibition of the thalamus and exitation of the cortex.
INCREASES MOVEMENT
what are the indirect pathways?
pathways that travel from the cortex - striatum - ext globus pallidus - subthalmic nucleus - int globus pallidus - thalamus - cortex. They produce an inhibitory effect and serve as a brake to direct activity.
DECREASES MOVEMENT
what are the functions of the basal ganglia?
they turn off automatic postural activity so that voluntary movement can occur
- execution of sequences
- change from one subunit of a sequence to another
- performance of most automatic movement
- influences the internal decision to move (supplementary motor cortex)
what are the main characteristics of parkinsonism?
unilateral onset of:
- tremor
- rigidity
- brady/akinesia
- loss of postural reflexes (Simian Posture)
- gait problems
list the gait problems seen in PD
- lack of arm swing
- difficulty initiating walking
- festinant gait with WBOS
- difficulty stopping
- ‘freezing’
- propulsion/retropulsion/lateropulsion
what is ‘freezing’?
transient, involuntary blocks of movement that occur primarily with initiating walking, turning, navigating narrow spaces or approaching obstacles. a patient may describe their feet feeling glued to the ground
outline the physiotherapy management of PD: strength
STRENGTHENING:
- normally not a major problem (just disuse and immobilisation)
- limb and trunk extensors, abdominals, trunk side flexors and rotators
- PNF patterns
- may decrease coactivation and improve brady/akinesia
outline the physiotherapy management of PD: brady-/a-/hypokinesia
- rhythmic initiationand slow reversals
- external stimulation
- watching legs of somebody next to them
- momentum
- high long steps
- trunk mobilisation and arm swing
- break up movements
- conscious effort
- avoid multitasking
outline the physiotherapy management of PD: tremor
- limited rx
- distal muscle stimulation by giving pt something to grip
- weight bracelets with caution
outline the physiotherapy management of PD: Simian posture
- facilitate extensor response through repetitive exercises
prone position - hanging from a bar
- sleep in prone
- mirror
outline the physiotherapy management of PD: Respiratory and vocal problems
- general respiratory rehabilitation
- thoracic mobility for vital capacity
