Parkinson's Flashcards
explain the incidence of parkinsons
2nd most common
men 1.2-5x more likely
average age of onset of PD
50-60 years
what is parkinsonism
umbrella term used to describe bradykinetic syndromes that disturb the dopamine systems of basal ganglia
what exactly causes PD
don’t exactly know
genetic and environmental causes
what environmental factors can cause parkinsons
chemicals
- occupational exposure / pesticides
what produces dopamine
substantia nigra
what is the most common form of PD
idiopathic PD
what are the subtypes of idiopathic PD
postural instability gait disorder
tremor dominant
what can cause idiopathic PD
unknown things
gene mutation
substantia nigra degeneration
what can cause secondary PD
drug induced
hydrocephalus
infections
toxins
trauma
tumors
what toxins are listed specific to secondary PD
CO
pesticides
manganese
what are the forms of atypical parkinsons that cognitive dysfunction is seen in
alzheimers
fronto-temporal dementia
lewy body disease
what can be observed in an individual with cerebellar ataxia compared to PD
atax - wider base of support (drunk walking)
PD - small BOS and less mvmt
what is the main difference between idiopathic PD and atypical PD
bradykinetic mvmts are due to other neurodegenerative disease in atypical
– will have s/s that are not associated with idio PD
lack of dopamine production affects the
motor and non motor loops
what is dopamine responsible for
producing smooth purposeful movements
where does dopamine bind
caudate and putamen of striatum
when PD is diagnosed, explain the status of cells in the basal ganglia as well as dopamine receptors
50-60% cell death
70-80% loss of dopamine receptors
relation between symptoms and diagnosis of PD
symptoms typically precede diagnosis by 5-6 years
what non-motor loops can be damaged by PD
visual and emotional
what is the mean duration of PD and how does that affect life expectancy?
10-20 years
– people diagnosed typically live close to normal expectancy due to later age of diagnosis
what typically causes mortality in those with PD
CVD disease
pneumonia
how is the rate of progression in idiopathic PD described
variability
– PIGD is seen to have faster progression as well as neurobehavioral disturbances/dementia
how is PD classified
hoehn - yahr classification
what does the hoehn yahr classification tell us
estimation of stage and severity via motor signs and elements of functional status
Hoehn-Yahr 1
minimal / absent disability
unilateral disability
Hoehn-Yahr 2
minimal bilateral/midline involvement
balance in tact
Hoehn-Yahr 3
impaired righting reflexes
unsteadiness turning/standing from seated
can live independently / continue forms of employment
Hoehn-Yahr 4
all symptoms present and severe
standing / walking only possible with assistance
Hoehn-Yahr 5
confined to bed/WC
what would intervention look like in Hoehn-Yahr 1
education with a possible maintenance exercise program
what could intervention look like in Hoehn-Yahr 2
may need DME
exercise plan
at what stage of the Hoehn-Yahr classifications does PT become absolutely necessary
3 and on
what is the gold standard of measuring PD progression
unified parkinson’s disease rating scale
how long does the UPDRS take to be administer? what can it be used for / what does it include
30 min
provide evidence of impairments outside of PT scope
Hoehn-Yahr stages
what are the motor signs associated with PD
weakness
apraxia
bradykinesia
akinesia
rigidity
postural instability
gait abnormalities
explain weakness seen in PD? is it motor neuron weakness?
not UMN weakness, instead weakness due to disuse and rigidity of muscle
what’s apraxia in PD due to
difficulty with automatic and voluntary movements directed through the pyramidal system
why is postural instability very important to address
those with PD are 2x more likely to fall
what gait abnormalities are seen in PD
festination
trouble initiating/terminating
no arm swing
no trunk rotation
shortened step length
what outcome measures can be used to assess PD patients
MCTSIB
Stand and Reach
what is a typical presentation of akinesia in those with PD
mask-like facial expression
what is the definition of rigidity
equal resistance in agonists / antagonists
what is the symptom reported of rigidity
heaviness and stiffness in limb
explain rigidity in relation to progression of PD
starts proximally in shoulders and neck and moves distally as progression occurs
how is LOS affected by PD
reduced, more so forward than backward directions
how do those with PD respond to perturbations
not well
– will not use postural control strategies due to abnormal coactivation of musculature / poor sensorimotor integration
how does dual tasking affect postural control in those with PD
worsens
why may a patient with PD experience dysphagia or dysarthria
rigidity in musculature leading to reduced ROM
- can cause speech disorders
what are non motor clinical signs of PD
depression anxiety apathy
_________ dysfunction
cognitive
autonomic
olfactory
visual / visuospatial perception
vestibular
auditory
what is sialorrhea
excessive drooling
what can lead to dementia in those with PD
depression
what autonomic dysfunction can be seen in those with PD
hypotension
bowel/bladder
blurry vision
dyspnea
orthostatic hypotension
how is visual and visuospatial perception dysfunction observed in those with PD
impaired postural control
abnormal vestibulospinal reflexes
impaired sensory integration
what is the pharmacological agent that is used to treat PD
levadopa/carbidopa (sinemet)
what is levodopa/carbidopa
gold standard for dopamine replacement
what is something to keep in mind when working with those on levadopa/carbidopa
needs to be on a fixed schedule
&
on and off times when the drug is active
– want to do PT with patient when they are “on”
how long after dosage does “on time” begin on levodopa/carbidopa
20-60 min
side effects of levodopa/carbidopa
hypotension
nausea
dry mouth
dizziness
fluctuations
dyskinesia during “off times”
what do dopamine agonists do
stimulate dopamine receptors in basal ganglia
what is deep brain stimulation
multi-electrode leads implanted into thalamus
where is deep brain stimulation implanted
subthalamic nucleus
globus palladis internus
what is deep brain stimulation effective for? what are the side effects
advanced PD
depression, paresthesia, paresis, loss of balance, dystonia
what are the cardinal signs of PD? what qualifies a diagnosis
rigidity
resting tremor
bradykinesia
postural instability
3 or more
how would an exam look in those with PD
cognitive screen
msk screen
cardiopulm screen
movement analysis
postural control assessment
what can be used to assess cognition
MMSE
MOCA
geriatric depression scale
what posture is seen typically in those with PD? how could that affect MSK screen?
flexed / stooped
- kyphotic
limit shoulder, spine and hip ROM
what is common pain wise in those with PD? why?
low back and neck pain
postural abnormalities
what could indicate PD via cardiopulmonary screen
orthostatic hypotension
what outcome measures can be used to test cardiopulmonary system
2/6 MWT
what is looked at during movement analysis
if movements are bradykinetic
if the tremor affects ADLs
gait abnormalities
UE function
what is used to test UE function
9 hold peg test
what is the most recommended postural control assessment in PD populations
miniBEST test
downward gaze palsy during neuro exam would indicate
progressive supranuclear palsy
what symptoms may mimic PD but are instead atypical parkinsonism
freezing of gait and/or frequent falls early in the disease
what would a patient present with that would cause one to think normal pressure hydrocephalus vs parkinson
urinary incontinence
freezing of gait
cognitive impairment
(wet wobbly wacky)
what H&Y stage of PD is freezing of gait typically seen
3 into the late stages
what typically causes normal hydrocephalus
older adults that have brain tissue atrophy and CSF is allowed to build up in the ventricles over time
explain the difference between the current model of PD rehab and potential model
rehabilitation typically occurs once disability or acute events occur
– can be too late in the progression to really slow it down, more reactive than proactive
when physical therapy is applied early in progression, what is each interval of care assessed by
progression of disease and its effect on mobility, ADLs and quality of life
what H-Y classification is associated with early PD rehab? what is focused on intervention wise
1
restorative and preventative intervention strategies
what H-Y classification is associated with middle PD rehab? what is focused on intervention wise
2-4
restorative and preventative intervention (may be some compensatory)
what H-Y classification is associated with late PD rehab? what is focused on intervention wise
5
preventative and compensatory
what is under the physical capacity umbrella in PD rehab
exercise tolerance
flexibility
strength (power)
what manual activities are focused on in PD rehab
UE reach
dexterity
what transfers are focused on during PD rehab
sit to/from stand
in/out bed
turning over
additional areas to be focused on during PD rehab
pain management
respiratory function
education
CPG guidelines suggest
aerobic exercise
resistance training
balance training
external cueing
community based exercise
gait training
task specific training
what is the recommended level of aerobic exercise
moderate to high
60-75% max HR
what is important to monitor during aerobic exercise?
vitals, RPE, exertional intolerance
what can long term L-dopa administration produce
arrhythmias
orthostatic hypotension
does the mode of resistance training make a significant difference in those with PD
no
- machines may be safer than free weights / may be easier to do body weight or bands
recommended dosage of resistance training in PD patients
2 days per week
what is recommended during gait training
- dosage
- cueing
- progressions
high repetition
block practice
external cues (visual and auditory)
varying directions/obstacle courses
how is freezing gait solve
reset clock
weight shifts
what is the focus on during gait training, in relation to automatic and intentional tasks
move from automatic tasks (cant do due to extrapyramidal system damage) and toward intentional tasks
