Parkinson's disease Flashcards
what is parkinsons disease?
- progressive neurodegenerative disease
-caused by a loss of nerve cells in the substantial nigra which leads to a reduction in dopamine
what is secondary Parkinsonism?
-result of other condition or medication
eg drug induced Parkinsonism
describe the clinical presentation of Parkinsons?
-resting tremor
-bradykinesia
-rigidity
-postural instability
-shuffling and freezing gait
-voice and swallow changes
what are the 4 cardinal signs of parkinsons?
-rigidity
-resting tremor
-bradykinesia
-postural instability (ie gait / balance)
describe rigidity
resistance to passive movement
-not speed dependent
-visible on attempted active movement
where is the resting tremor seen in parkinsons?
-hands
-legs
-chin
-mouth or tongue
what is bradykinesia?
-slow, small movements
-shuffling gait
describe the aetiology
-loss of dopaminergic neurons in the substantial nigra which affects the “motor loop” in the brain
-idiopathic (no known cause)
- genetic and environmental influences
what are examples of secondary Parkinsonism?
-infections eg epstein-barr virus, HIV
-drug induced
-vascular - eg MRI with extensive sub cortical white matter lesions
describe the epidemiology of parkinsons
-2nd most common neurodegenerative disease (after Alzheimers)
- higher incidence in males
-generally diagnosed in 60s
-prevalence increases with age
what is a DaT scan?
a dopamine transporter scan
what is the modified Hoehn and Yahr scale?
- a scale used for classifying PD based on motor symptoms and functional impairment
-involves 5 stages
describe the stages of Hoehn and Yahr
-stage 1: unilateral involvement
-stage 1:5: unilateral and axial involvement (trunk)
-stage 2: bilateral symptoms but no impairment
-stage 2.5: mild bilateral disease with recovery on pull test
-stage 3: mild to moderate disease, physically independent
-stage 4: severe disability, still able to walk or stand unassisted
-stage 5: wheelchair bound, bedridden unless assisted
what causes postural instability (ie altered gait and balance) in PD?
-combined effect of rigidity and bradykinesia
-loss of postural reflexes - loss of anticipatory and reactive balance strategies (cant react quickly to perturbations)
describe the gait of a parkinsons patient
-slow gait
-difficulty with gait initiation
-shuffling gait
-uneven step lengths
-festination (small steps)
-reduced arm swing
in what situations might you see “freezing” in PD?
-initiation of movement
-turning
-distractions
-dual tasks (eg talking and walking)
what are examples of non motor symptoms?
-sleep disturbances
-autonomic dysfunctions eg hypotension, urinary disfunction
-gastrointestinal eg nausea, drooling, dysphagia
-sensory eg pain, p+n’s
–cognitive impairment, depression, anxiety
in what way can PD affect executive functions?
-planning is affected
-worse concentration
-dual task performance
-retaining information
-problems with control of attention
-patient’s may find it hard to changing attention between 1 or more stimuli
what is the main medication for PD?
levodopa eg sinemet (brand name)
a agonist for dopamine
what are examples of surgical options for PD?
-thalamotomy (creating a lesion in the thalamus): for tremor
-palliotomy (destruction of a part of the globes pallidus)
-deep brain stimulation (planting electrodes in the brain to improve movement )
what are some side effects of levodopa?
-wears off over time
-medication weakens so needs to be topped up and dose may need to be increased
other than levodopa, what other medications can PD patients take?
- dopamine agonists eg rigotine, agomorphine
- COMT inhibitors (medication that inhibits an enzyme to help more levadopa medication cross the blood brain barrier)
discuss the physiotherapy management of a parkinsons patient
subjective: what symptoms are they describing eg reduced balance, tremors etc, sleep, other symptoms, medications (dose), asking what works for them eg audio cue or counting or visual cues
objective: speech, tremor, face, posture, gait, ROM, tone, strength, falls
what are examples of outcome measures for PD?
-Berg
-TUG
-modified parkinsons activity scale
-5XSTS
-mini BesTest
what could physio Rx involve for PD?
-exercise - on medication NB
-cues eg visual or auditory
-dual tasking
-functional performance eg transfers STS etc
-movement strategies
what kind of exercise can be prescribed for PD patients?
-strengthening exercises - NB underusing is important, 2-3 times a week, 60-70% of 1rm 8-12 reps, concentric then eccentric
-aerobic - low intensity and high intensity etc eg treadmills
-flexibility and stretching to help rigidity
