Parkinson's Disease

Question 1

What is PD?

Answer 1

chronic, progressive neurologic condition that affects the motor system

Question 2

Risk Factors

Answer 2

increasing age
affected family member
environmental factors

Question 3

Parkinsonism

Answer 3

NOT PARKINSONS

group of disorders involving dysfunction of basal ganglia

Question 4

Secondary Parkinsonism

Answer 4

occurs as a result of other conditions like alcoholism exposure to certain toxins, TBI, vascular insult and psychotropic medications

Question 5

Parkinson-Plus syndrome

Answer 5

disorders as multi-system atrophy, progressive supranuclear palsy and Shy-Drager syndrome

Produces other neurologic signs of multiple symptoms degeneration

Question 6

Pathophysiology

Answer 6

70-80% loss of neurons before symptoms occur

dopamine is either inhibitory or excitatory

more dopamine loss= more exacerbated symptoms

loss of neuroms= loss of neurons that produce dopamine

Basal Ganglia plays a role in initiation of movements and in releasing one movement sequence in order for another to begin

Decreased dopamine-insufficient activation of pathways and slower movements or hyperactivity of pathways and rigidity occurs

Question 7

Clinical Signs

Answer 7

Bradykinesia

Rigidity

Resting Tremor

Postural Instability
Akinesia

Fatigue

Gait

Question 8

Rigidity

Answer 8

increased resistance to passive movement

occurs in agonist and antagonist

• *Cogwheel=jerky, ratchet like
• *leadpipe: constant and uniformed resistance

trunk impairs breathing and phonation by resricting chest wall motion
increases energy expenditure

Question 9

Bradykinesia

Answer 9

slowness and difficulty maintaining movement

increased reacting time: time between desire and initiation of movement

increased movement time: time to complete task
impaired coordination

**AKINESIA=severe and no movement

very evident in ADL’s

Can speak in soft monotone voice

Question 10

Tremor

Answer 10

Involuntary oscillation of a body part at a rate of 4-6 oscillations per second
70% occurrence

Resting: occurs at rest and disappears with movement

• *pill rolling, prontation/sup of forearm
• may begin unilaterally and spread to all 4 limbs
• postural trunk, head and neck affected

Question 11

Postural Instability

Answer 11

usually begins to present 5 years after initial diagnosis

abnormal and inflexible postural responses along with increased body sway are seen

narrowing of BOS or competing attentional demands increases postural instability

increasing difficulty during dynamic destabiliazing activities like self-initated movements

Question 12

intention tremor

Answer 12

occurs with active movement and disappears at rest

Question 13

postural tremor

Answer 13

occurs when head, limb or limb maintained vs. gravity

Question 14

akinesia

Answer 14

inability to initiate movement

difficultly to rise from chair accentuated forward flexion

Question 15

fatigue

Answer 15

constant rigidity increases fatigue

contributes to postural instability

lethargy as day progresses

Question 16

Gait characteristics

Answer 16

slow narrow BOS
reduced stride length-increase in step-to-step variability
reduced speed of walking
cadence intact but may reduce with progression

increased time: double limb support

insufficient hip, knee and ankle flexion-shuffling steps

insufficient heel strike with increased forefoot loading

reduced trunk rotation and decreased or absent arm swing

FESTINATING GAIT: progressive increase in speed with shortening of stride, anterpulsion is common

increased steps per turn

difficulty dual tasking and attentional demands

Question 17

Motor Planning issues

Answer 17

start hesistation
freezing episodes
poverty of movement
masked face
micrographia-abnormally small handwriting

Question 18

Motor Learning

Answer 18

procedural learning deficits for complex and sequential tasks

Question 19

Posture Issues

Answer 19

Kyphosis with forward head

Lean to one side with tonal asymmetries

increased fall risk

Question 20

Sensation issues

Answer 20

Paresthesias

Pain

Akathisia-sense of inner restlessness and need to move

Question 21

SPpech voice and swallowing disorder

Answer 21

dysphgia-impaired swallowing

hypokintetic dysarthria-decreased volume, slurred, mono tone speech, difficult to initiate and maintain

Question 22

Cognition function and behavior

Answer 22

dementia

bradyphrenia-slowing of thought and information processing

visuospatial deficits

depression

dysphric mood-anxiety and panic

Question 23

Autonomic Nervous System

Answer 23

excessive sweating/ perspiration

thermoregulatory abnormalities, abnormal sensation

seborrhea-greasy skin

sialorrhea-increased salivation and drooling

constipation

urinary and bladder dysfunction

Question 24

Cardiopulmonary Function

Answer 24

sorthostatic hypotension with low resting BP

compromised cardiovascular response to exercise

impaired respiratory function

Question 25

5 stages of PD

Answer 25

1: minimal or absent, unilateral if present
2: minimal bilateral or midline involvement. Balance not impaired

3. impaired righting reflexes. unsteadiness when turning or rising from chair. some activities are restricted, but patient can live independently and continue some forms of employment
4. all symptoms present and severe. standing and walking possible only with assistance
5. confined to bed or WC

Question 26

Anticholinergics

Answer 26

block the increase in Ach that results in decrease in available dopamine
-help reduce resting tremor

Question 27

Levodopa

Answer 27

Main medicaiton
replaces the lost dopamine

decreases rigidity and makes movement easier

**Sinemet-brand name

*body acclimates and can only be given so much usually after 5-7 years

Question 28

dopamine agonists

Answer 28

Nervousness

dyskinesis
insomnia
hallucinations
nausea, confusion

Question 29

Seligiline

Answer 29

first medication given

thought to slow the progression of PD and delays the need for Levodopa

Question 30

Surgical Management

Answer 30

Only for patients who do not respond to medication

Deep brain stimulation-implants electrodes to block nerve signals that cause symptoms

Neural Cell Transplantation: fetal cells used to replace destroyed substantia nigra cells to become source of dopamine

Option for severe tremors, bradykinesia and rigidity

Question 31

Nutritional Management

Answer 31

high calorie, low protein - high protein blocks L-dopa

Increase water intake and dietary fiber to help with constipation

Question 32

PT: Motor learning strategies

Answer 32

long and complex movements should be avoided
blocked order practice patterns work best
minimize competing attentional demands

reduce clutter and attentional demands

external cues help trigger movements

visual cues like floor markings or lights help with decreased freezing episodes

Question 33

Primary goal of PT

Answer 33

maximize function in the face of progressing pathology

gait hypokinesia or slowness will affect everyone

stride length begins to shorten

early intervention works best

Question 34

Second goal to prevent secondary issues

Answer 34

keep them mobile to prevent respiratory issues

focus on slowing the onset of predictable changes in posture, locomtoion and general activity

Question 35

relaxation exercises

Answer 35

slow rhythmical rotation rocking movements
diaphragmatic breathing
Jacobson progressive relation technique beneficial

Question 36

Strength Training

Answer 36

has shown to improve strength and motor function in pts. with mild to mod. PD

isometric training may be contraindicated

Question 37

FUnctional Training

Answer 37

segmental rolling patterns should be practiced rather than log rolling

Question 38

Cardiopulmonary Training

Answer 38

Diaphragmatic breathing
symmetrical UE D2 PNF Flex/Ext

manual contacts

Inspiration sit to stand
Expiration: stand to sit

Question 39

compensation techniques for bradykinesia/freezing

Answer 39

early am warm-up
slow rhythmical rocking and rotation
neutral warmth
maintained touch
slow stroking
prolonged stretch
realistic time schedule for completion  of daily BADL and IADL