Parkinson's Disease Flashcards

1
Q

What is PD?

A

chronic, progressive neurologic condition that affects the motor system

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2
Q

Risk Factors

A

increasing age
affected family member
environmental factors

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3
Q

Parkinsonism

A

NOT PARKINSONS

group of disorders involving dysfunction of basal ganglia

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4
Q

Secondary Parkinsonism

A

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

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5
Q

Parkinson-Plus syndrome

A

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

Produces other neurologic signs of multiple symptoms degeneration

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6
Q

Pathophysiology

A

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

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7
Q

Clinical Signs

A

Bradykinesia

Rigidity

Resting Tremor

Postural Instability
Akinesia

Fatigue

Gait

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8
Q

Rigidity

A

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

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9
Q

Bradykinesia

A

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

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10
Q

Tremor

A

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
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11
Q

Postural Instability

A

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

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12
Q

intention tremor

A

occurs with active movement and disappears at rest

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13
Q

postural tremor

A

occurs when head, limb or limb maintained vs. gravity

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14
Q

akinesia

A

inability to initiate movement

difficultly to rise from chair accentuated forward flexion

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15
Q

fatigue

A

constant rigidity increases fatigue

contributes to postural instability

lethargy as day progresses

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16
Q

Gait characteristics

A

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

17
Q

Motor Planning issues

A
start hesistation
freezing episodes
poverty of movement
masked face
micrographia-abnormally small handwriting
18
Q

Motor Learning

A

procedural learning deficits for complex and sequential tasks

19
Q

Posture Issues

A

Kyphosis with forward head

Lean to one side with tonal asymmetries

increased fall risk

20
Q

Sensation issues

A

Paresthesias

Pain

Akathisia-sense of inner restlessness and need to move

21
Q

SPpech voice and swallowing disorder

A

dysphgia-impaired swallowing

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

22
Q

Cognition function and behavior

A

dementia

bradyphrenia-slowing of thought and information processing

visuospatial deficits

depression

dysphric mood-anxiety and panic

23
Q

Autonomic Nervous System

A

excessive sweating/ perspiration

thermoregulatory abnormalities, abnormal sensation

seborrhea-greasy skin

sialorrhea-increased salivation and drooling

constipation

urinary and bladder dysfunction

24
Q

Cardiopulmonary Function

A

sorthostatic hypotension with low resting BP

compromised cardiovascular response to exercise

impaired respiratory function

25
5 stages of PD
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
26
Anticholinergics
block the increase in Ach that results in decrease in available dopamine -help reduce resting tremor
27
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
28
dopamine agonists
Nervousness dyskinesis insomnia hallucinations nausea, confusion
29
Seligiline
first medication given | thought to slow the progression of PD and delays the need for Levodopa
30
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
31
Nutritional Management
high calorie, low protein - high protein blocks L-dopa Increase water intake and dietary fiber to help with constipation
32
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
33
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
34
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
35
relaxation exercises
slow rhythmical rotation rocking movements diaphragmatic breathing Jacobson progressive relation technique beneficial
36
Strength Training
has shown to improve strength and motor function in pts. with mild to mod. PD isometric training may be contraindicated
37
FUnctional Training
segmental rolling patterns should be practiced rather than log rolling
38
Cardiopulmonary Training
Diaphragmatic breathing symmetrical UE D2 PNF Flex/Ext manual contacts Inspiration sit to stand Expiration: stand to sit
39
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 ```