Parkinson's disease❗️❗️❗️

Question 1

Occupational performance issues (Early stage)

Answer 1

Early stage:
Postural instability
a. Stooped posture, with a lack of arm swing during mobility and loss of postural reflexes
b. Increased fall risk
pull test: examiner stands behind the patient and pulls back sharply on the patient’s shoulders
(*retropulsion: able to correct himself to keep balance)

Communication difficulties
smaller and smaller handwriting (micrographia), reduced volume of speech (hypophonia) and reduced facial expression or flat affect (hypomimia)

Able to do ADL; assistance in IADL

Question 2

Occupational performance issues (Middle stage)

Answer 2

Middle stage:
Tremor
a. Resting tremor (100%): affects one side, described as a “pill rolling” movement of the hand
disappear when the person is asleep or calm, increases with stress or cognitive tasks
absent with voluntary movement
b. Postural tremor occurs when a posture is sustained, e.g. an outstretched arm
c. Action/intention tremor occurs when performing a task, e.g. reaching for a cup

Muscle rigidity or stiffness
a. Tone is increased, adversely affecting movement
b. Cogwheel motions: jerky; inconsistent resistance
c. ‘lead-pipe’ motions: resistance didn’t change; feel increased tone throughout the range
c. Fatigue: caused by the increased effort needed to produce voluntary movement; becomes
a barrier to occupational performance

Bradykinesia
Extreme slowness when the person initiates or performs volitional movements
Examples: shuffling gait, difficulty moving from sitting to standing, freezing, and increased time required for fine motor tasks such as shaving or fastening clothes.
- sustaining repetitive movements with progressive reduction in speed and amplitude

ADL (difficulties in manual dexterity tasks)

Question 3

Occupational performance issues (Late stage)

Answer 3

Late stage:
- more visible rigidity and bradykinesia
- assistance in ADL and IADL
- limited walking

Question 4

Characteristics of Parkinsons

Answer 4

4 hallmark characteristics:
* Resting tremor
* Rigidity
* Postural instability
* Bradykinesia/akinesia

Gait: loss of reciprocal arm swing and trunk rotation, shuffling gait, festinating gait (abnormal, uncontrolled increase in speed), shorter steps, narrow BOS, freezing episodes

Other motor disturbances: impairments of voice, dexterity, masked face, micrographia (hypokinesia), cogwheel rigidity