Parkinson's Disease Flashcards
What is PD?
chronic, progressive neurologic condition that affects the motor system
Risk Factors
increasing age
affected family member
environmental factors
Parkinsonism
NOT PARKINSONS
group of disorders involving dysfunction of basal ganglia
Secondary Parkinsonism
occurs as a result of other conditions like alcoholism exposure to certain toxins, TBI, vascular insult and psychotropic medications
Parkinson-Plus syndrome
disorders as multi-system atrophy, progressive supranuclear palsy and Shy-Drager syndrome
Produces other neurologic signs of multiple symptoms degeneration
Pathophysiology
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
Clinical Signs
Bradykinesia
Rigidity
Resting Tremor
Postural Instability
Akinesia
Fatigue
Gait
Rigidity
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
Bradykinesia
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
Tremor
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
Postural Instability
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
intention tremor
occurs with active movement and disappears at rest
postural tremor
occurs when head, limb or limb maintained vs. gravity
akinesia
inability to initiate movement
difficultly to rise from chair accentuated forward flexion
fatigue
constant rigidity increases fatigue
contributes to postural instability
lethargy as day progresses
Gait characteristics
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
Motor Planning issues
start hesistation freezing episodes poverty of movement masked face micrographia-abnormally small handwriting
Motor Learning
procedural learning deficits for complex and sequential tasks
Posture Issues
Kyphosis with forward head
Lean to one side with tonal asymmetries
increased fall risk
Sensation issues
Paresthesias
Pain
Akathisia-sense of inner restlessness and need to move
SPpech voice and swallowing disorder
dysphgia-impaired swallowing
hypokintetic dysarthria-decreased volume, slurred, mono tone speech, difficult to initiate and maintain
Cognition function and behavior
dementia
bradyphrenia-slowing of thought and information processing
visuospatial deficits
depression
dysphric mood-anxiety and panic
Autonomic Nervous System
excessive sweating/ perspiration
thermoregulatory abnormalities, abnormal sensation
seborrhea-greasy skin
sialorrhea-increased salivation and drooling
constipation
urinary and bladder dysfunction
Cardiopulmonary Function
sorthostatic hypotension with low resting BP
compromised cardiovascular response to exercise
impaired respiratory function
5 stages of PD
1: minimal or absent, unilateral if present
2: minimal bilateral or midline involvement. Balance not impaired
- 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
- all symptoms present and severe. standing and walking possible only with assistance
- confined to bed or WC
Anticholinergics
block the increase in Ach that results in decrease in available dopamine
-help reduce resting tremor
Levodopa
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
dopamine agonists
Nervousness
dyskinesis
insomnia
hallucinations
nausea, confusion
Seligiline
first medication given
thought to slow the progression of PD and delays the need for Levodopa
Surgical Management
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
Nutritional Management
high calorie, low protein - high protein blocks L-dopa
Increase water intake and dietary fiber to help with constipation
PT: Motor learning strategies
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
Primary goal of PT
maximize function in the face of progressing pathology
gait hypokinesia or slowness will affect everyone
stride length begins to shorten
early intervention works best
Second goal to prevent secondary issues
keep them mobile to prevent respiratory issues
focus on slowing the onset of predictable changes in posture, locomtoion and general activity
relaxation exercises
slow rhythmical rotation rocking movements
diaphragmatic breathing
Jacobson progressive relation technique beneficial
Strength Training
has shown to improve strength and motor function in pts. with mild to mod. PD
isometric training may be contraindicated
FUnctional Training
segmental rolling patterns should be practiced rather than log rolling
Cardiopulmonary Training
Diaphragmatic breathing
symmetrical UE D2 PNF Flex/Ext
manual contacts
Inspiration sit to stand
Expiration: stand to sit
compensation techniques for bradykinesia/freezing
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
