Parkinson's disease Flashcards
What is parkinson’s disease?
Progressive neurodegenerative condition that causes a variety of symptoms
Caused by dopamine containing cells in the mid brain and part of gasal ganglia dying.
What are symptoms of parkinson’s?
· Tremor
· Rigidity – not velocity dependent- 2-way stiffness.
· Slowness of movement – bradykinesia
· Cognitive and mood disorders
· Pain and sleep disturbances
· Loss of trunk rotation
· Postural instability
· Festination – small steps and freezing of gait- door ways.
· Dysphagia
· Reduced cough reflex
· Drooling
· Fatigue
· Depression
· Dementia
· Dizziness
What are risk factors for parkinsons?
Age
male
Prior head injury
Beta blocker use
Rural living
20% have a family history of PD
What gait is expected in parkinsons?
Flexed posture
reduced arm swing
Reduced trunk rotation
Freezing
Festination - small cadence
What are contraindications to exercise in parkinsons?
- Recent MI
- Unstable angina
- Recent infection
- Orthostatic hypotension
- Osteoporosis
- No sleep
- Haven’t taken meds
what is the importance of the basal ganglia?
Basal ganglia controls preparation and initiation of movement and maintains muscle tone.
What assessments should be done for parkinsons?
PROM - rigidity
Gait assessment looking at posture, stride length, BOS, foot clearance, arm swing e.g. gait speed test / observations
Timed up and go for functional mobility
5 time sit to stand for strength
Balance assessment
How is the Timed up and go performed?
- Pt in chair with back on back of chair
- Command go
- Walk 3 meters at comfortable pace, turns and walks back to chair and sits down
- Should have a practice trial
- Can use assistive device
For 65+
Has excellent test-retest reliability in stroke according to Flasnbjer et al 2005)
What are the cut-off scores for populations in the timed up and go test?
Community adults: >13.5s
Older stroke patients: >14s
Older adults at falls clinic: >15s
Frail elderly: >32.6s
LE amputees: >19s
PD: >11.5 /7.95
Hip OA: >10
Vestibular disorder: >11.1
How is the 2 minute walk test performed
- Walk as far as possible in 2 minutes
- Can use walking aids
- Should be independently mobile
~ 15m course
What are predicted distances for populations in the 2-minute walk test?
Women 257.177 - (0.723 x age) - (1.688 x BMI)
Men 279.096 - (0.998 x age) - (1.426 x BMI)
How is the 5-minute sit to stand test performed?
Pt in chair with arms folded across chest and back against chair (with stroke can have affected arm supported or hanging to side)
- Chair should be free from wall
- Say go and measure how long to do 5 stands
- If concern for fatigue can demonstrate to patient what plan is
What are the norms for the 5 sit to stand test?
Minimal detectable time for test is 3.6-4.2 s
60-69 normal 11.4 s
70-79 normal 12.6 s
80-89 normal 14.8 s
How is the gait speed test performed?
Gait speed test: Patient walks at a comfortable pace with appropriate walking-aid, straight path and flat surface, 9 metre total distance, with the first and last 2.5 meters used for acceleration and deceleration.
Time recorded for the middle 4 meters, fastest of 2 trials recorded, speed calculated using
Speed = distance/time
How is the functional reach test performed?
In standing stand close but not touching wall, and arm closer to wall at 90 degrees flexion. Record initial point of 3rd digit, measure difference between start and end.
- Modified version for those that can’t stand
- Yard stick taped to wall, and make final position.
What does the result of a functional reach test mean?
25cm/greater = low fall risk
15-25cm = 2x greater fall risk
15cm or less = risk of falling is 4x greater than normal
Unwilling to reach: risk of falling is 8x greater than normal
What mobility exercises can be done for PD?
Trunk rotations
Gait training
Side-to-side weight shifts
Marching
Sit-to-stands with posture
Increased stepping
Step ups
Balance exercises
What are the goals of strengthening exercises
Improve strength balance and coordination
What exercises can be used to increase strength in parkinsons’s
Seated marching
standing side leg lifts
Sit to stand
Bicep curls
Toe taps
wall push-up
Heel raises
step ups
Hold leg raises
Seated calf raises to standing calf raises
Mention strengthening throughout
What education may be provided to parkinson’s patients?
Self-care at home and in the community via community services is very important with PD. As a PD patient may only see their neurologist once or twice a year.
How often should sessions be for parkinson’s patients?
2.5 hrs of physio a week can slow PD progression
Hydrotherapy interventions- have been found to have a large effect on the TUG test and reducing fear of falling.
What community based programmes can be recommended?
Dance, tai chi, boxing are recognised by international guidelines as intervention options to improve balance and gait impairment and motor symptoms.
What goals should be established with parkinsons patients?
Plan for function in flare-ups – community teams to contact.
Healthy living
Balanced diet
Staying hydrated
staying active
