Parkinson's Flashcards
which pathway facilitates movement?
direct
which pathway inhibit movement?
indirect
Name 2 medications for parkinson
levo dopa and carbidopa
why do you typically use levo dopa and carbidopa togeher?
prevent l dopa conversion prior to entering the brain
What does dopamine medication help with in parkinsons
bradykinesia/rigidity
what is parkinsons meds not as effective for
trempr and postural instability
side effects of parkinsons meds
DA receptors lose responsiveness
involuntary movements (dyskinesia)
On off phenomenon (on becomes shorter and shorter)
a precursor of dopamine (meds)
L dopa
combination of levodopa and carbidopa(meds)
sinemet
important dosage insrtuction
30 mins before bed
not right before bed
consistent timing is important
Common medication side effects
orthostatic hypotension
dyskinesia
confusion/memory loss
hallucinations (scary things)
HA, agitation, psychosis
hallmarks of PD
resting tremor
akinesia
rigidity
postural instability
TRAP
what is usually the first sign of PD
tremor
what is cogwheel / lead pipe rigidity?
cogwheel : rigidity over tremor
lead pipe–all aspects of movement are difficult (both directions)
Bradykinesia testing
rapid alternating movements (finger tapping, open close fist, pronation supination, toe typing)
BIG fast movements
look for: change in speed and amplitude
Observation/testing for tremor
resting – hands
postural tremor – shoulders flexed at 90 elbows straight / fingers wide
Kinetic Tremor:
rigidity testing
passive wrist circles, elbow flexion/extension
LE support knee flexion/ext or ankle circles
technique to activation maneuver (if meds are working or subtle)
gait and balance defecit tests
sit to stand
pull test (brisk pull back to see how recover)
gait: symmetry, reduced heel strike/foot clearance. turns, arm swing
common gait issues
increased knee flexion in stance
decreased hip and knee flexion early swing, decreased hip and knee ext in late swing
decreased clearance and pushoff
goot contact w entire foot
decreased trunk and pelvic rotation, armswing asymmetry
decreased stride length/walking speed
ROM and strength deficits in PD
STIFF: decreased trunk ext w thoracic kyphosis, trunk rotation, hip and knee extension
gradual weakening - atrophy of T2 fibers, hypertrophy in T1
weak ankle mm and quads…
non motor features of PD (6)
psych, cognitive disorders, sleep abnormalities, autonomic dysfunction (constipation, ortho hypotension!!!!!!), sensory–olfactory, misc (fatigue weight loss)
SLP issues with PD (3)
motor speech–coordination and weakness (forming words/quiet)
Cognition–repeat phrases, minimize distractions
Dysphagia– swallowing/timing with breathing and swallowing, positioning food in mouth
MSK changes in PD
BOS
everything flexed!
forward head, trunk,m rounded shoulders, kyphosis, down gaze,
short hip flexors/knee flexors, elbow flexors
strength–hip ext/PF…trunk ext
dec trunk pelvic rotation
Cardio pulm function in PD
Ortho Hypotension!
reconditioning
Flexed posture: restricted lung function due to decreased chest expansion (PNEUMONIA!)
4 measures of severity PD
Hoehn and Yahr stages of PD
UPDRS (rating scale)
MDS-UPDRS (movement disorder…rating scale)
PDQ-8 PDQ-39 (participation level)
Which stage of Hoehn & Yahr
tremor in one hand
rigidity
clumsy leg
one side face affected impacting expression
1
Which stage of Hoehn & Yahr
loss of facial expression in BOTH SIDES
decreased blinking
speech abnormalities
rigidity of trunk mm
2
Which stage of Hoehn & Yahr
BALANCE COMPROMISED
inability to make rapid automatiuc and involunatry adj
3
Which stage of Hoehn & Yahr
may be able to walk and stand but noticibly impacted
unable to live independently
4
Which stage of Hoehn & Yahr
pt fall when standing or turning
might be bedbound
freeze or stumble with walking
hallucinations/delusions
5
Typical Course of PD
UPDRS 5 parts
- mentation/behavior mood
- ADLS
- Motor examination
- Complications of therapy
- hoehn and yahr staging
- schwab and england ADL scale\
higher score = worse
outcome measures that recommended for PD
Body structure and function–
MDS UPDRS revision part 3
MDS UPDRS part 1
montreal cognitive assessment
outcome measures that recommended for PD
activity
6MWT, 10MWT, BESTest, MDS-UPRDS part 2, FGA, 5TSTS, 9 hole peg test
outcome measures that recommended for PD
participation
PDQ-8 or PDQ-39
outcome measures that recommended for PD
fear of falling
ABC scale
outcome measures that recommended for PD
dual task
timed up and go
BESTest looked at/assesses…
anticipatory/reactive balance, sensory organization, dynamic gait, times up and go cognitive
FOGQ has ___items to assess FOG severity, ___ items to assess gait. it is a ___point scale
4, 2, 5
If a patient has FOG, what could be a reason/what should we consider?
they may not have enough meds
10 areas of treatment for PD
aerobic, resistance, balance, flexibility, external cueing, community based ex, gait training, task specific, behavior change, integrated care, telehealth
what intesity should aerobic exercise be for PD?
mod to high
benefits of aerobic ex in PD
improve O2 consumption
reduce motor disease severity
improve functional outcomes
MOST IMPORTANT
reduction in tremor/bradykinesia, balance/gait, QOL
benefits of resistance training in PD
reduce severity
improve strength and powr
non-motor symptoms (anxiety/depression)
funcitonal outcomes/QOL (GAIT SPEED, MOBILITY, BALANCE, REDUCE FALLS)
Recommendations for resistance training
progressive resistance + instability (unstable environments)
CPG Mild-mod PD aerobic exercise dosage
3-5 days
mod intensity 60-70 HRmax
high int 75-85 HRmax
RPE: mod = 13/20 high = 15/20
30-40 progressing to 60 mins
start progression with duration or frequency – intensity as tolerable
type: bike/TM
resistance training dosage
freq, time, intensity, set/reps, type
freq - 2 non consecutive days
time - 30-60 mins ber session (4-12 hrs month)
intensity - as tolerated with good form
strength -
beginner: 40-60 1 RM, 1 set 20-30 reps progress to 2 sets of 15
experienced: 80% (3 x 12 to m fatigue)
POWER
beginner 20-30 1RM
Experienced 40 1 RM
ALL muscle groups, EXTENSOR mm (trunk/glutes)
Strong recommendations for balance
multimodal balance
balance w dynamic gait on TM (mod to vigorous)
Balance w tech
balance vs resistance training (balance better for post control/balance outcomes/spatiotemportal gait impairments
aquatics: (may improve FEAR of falling not balance outcomes)
CPG gait training recommendations (interventions/dosage)
TM with/without BW support, robo assist/overground
3-5d/wk 20-60 min 4-12 wks
Benefits of gait training CPG
reduced motor severity
step length
walking speed
falls and FOF
fatigue
Moderate evidence CPG
external cueing
benefits of external cueing
reduce severity of motor disease
FOG
Gait and functional mobility (TOG/dual task TUG)
20 mins 1 hour 2-5x/wk 3-8 wks
weak recommended
- flexibility exercise
- flexibility exercise CPG benefits
spinal flexibility, axial rotation, (not studies - extremity)
- flexibility exercise recommendations
general stretching/flexibility
incorporate into warm up (dynamic) and cool down )static) or first thing in the morning
all major muscle groups but particularly trunk rotation
Community based exercise dosage
1 hr
2x week
12-13 wks
community based exercise benefits
depression anxiety and cognition
function – TUG, turning, 3D motion analysis
task specific training examples
turning training, fall prevention (caregiver ed, movement stragtegies, external cuing, strength training)
dual task training
what type of PD treatment caused a lower requirement of med dosage in pts over time
integrated care
benefits of integrated care (STRONG EVIDENCE)
reduced motor sx, non motor improvements, functional outcomes, QOL
benefits of behavior change approach (mod evidence)
(health behavior theories, goal setting, action plans)
QOL, PA, walking capacity
WEAK evidence: Telehealth
improved activities:
may be better suited for…
balance and participation
no cognitive impairments and low fall risk
Early stages of treatment should include:
- est. a baseline of function
- design exercise program (strength/aerobic/balance/stretch)
- maximize fitness and mobility
guidance for community resources
moderate stages of treatment should include:
- modify exercises to maintain high level of intensity
- focus to improve balance and prevent falls
- problem solve mobility difficultiwes (bed, chair, freezing)
- introduce strategies such as listening to music to make movement faster
later stages of treatment should include:
introduce and help obtain equipment
