Parkinson's Disease

Question 1

Etiology

Answer 1

Progressive degeneration in the basal ganglia including depigmentation (demeyelination) of the substantia nigra. Causes decreased production of dopamine which influences the speed and accuracy of motor skills, postural stability, cognition, and affect/expression

Question 2

Signs and Symptoms

Answer 2

1. Resting Tremor - pill rolling movement that affects one side first. Decreased with calm/sleep; increase with stress
2. Muscle Rigidity - from increased tone causing ‘cogwheel motions’ that are jerky and occasionally painful. Can cause fatigue to produce voluntary movement
3. Bradykinesia - extreme slowness with initiation or performing volitional motions
4. Postural Instability - Stooped , decreased arm swing, decreased postural reflexes, decreased balance and increased fall risk

Secondary symptoms include: festinating gait, bimanual impariment, freezing episodes, decreased cognition, reduced speech volume, mood changes, sensory changes, dysphagia

Question 3

Diagnosis

Answer 3

People with initial symptoms (usually tremor) are referred to neurologist who use process of elimination and comprehensive medical review. At least one primary symptom must be present. Confirmation via autopsy.

Question 4

Prognosis

Answer 4

5 clinical stages

1. unilateral symptoms an no-minimal loss of function
2. bilateral symptoms, balance not affected
3. impaired balance, moderate functional impairment
4. decreased postural stability, decreased balance, need for assistance with ADLs, poor fine motor/dexterity
5. total dependence for mobility/ADLs usually bedridden

Question 5

Team Management

Answer 5

Medications = Levodopa, dopamine replacement,
Surgical options
SLP
PT

Question 6

OT evaluation

Answer 6

OT plays a role when functional impairments are present
Occupational profile followed by assessing mine motor; mobility; ADL/IADL deficits; self-feeding/eating; sexual dysfunction; sleep patterns, social participation, medication routine on and off times

Question 7

OT intervention

Answer 7

Energy conservation and coordination of activities around medication on-time; cargiver training; support and advocacy groups; functional mobility and transfers; freezing episode reduction; feeding and ADLs; communication adaptations; sex; bowel/bladder; cognition; recommend group participation and stress reduction

Question 8

Feeding and ADL adaptations

Answer 8

encourage smaller portions, remove distractions, eat slowly, use AE; allow for increased time; modify clothing to eliminate fasteners; distal wrist weights may help with tremors, DME for shower/toilet; use UE support on a table during fine motor tasks to increase proximal stability