Parkinson's Disease Flashcards
What does the cardinal signs ultimately lead to
Postural instability
1. Develops later in the disease 2. Characteristic flexed posture 3. Flexed hips and knees 4. Unable to access balance reactions
This leads to a high risk of falls in PD patients
Medical management of PD
people with Parkinson’s frequently have ‘on’ and ‘off’ times during the day where there symptoms are either less or more significantly impacting. This is due to medication they take either taking action or wearing off
Levodopa (with benserazide or carbidopa) e.g Sinemet or Madopar - side effects can be Dyskinesias, confusion, hallucinations and delusions, mood swings, psychological changes, sleepiness, fainting or dizziness
Anticholinergics - Block the action of Acetylcholine that has the opposite effect of dopamine. Can be used early on in the disease before the need for dopamine: side effects can be confusion, a dry mouth, constipation and blurred vision
Physiotherapy management for postural instability
Targeting flexed knees and hips - Specific stretches
Balance exercises to target balance
Cueing - improve movement pattern (gait)
Explain the striatum
Caudate nuclei and Putamen
An inhibitory system
What is cueing and what are the principles of cueing
Cueing is a type of treatment technique that uses visual, auditory or kinaesthetic feedback to allow a movement pattern to be accessed and used in a functional way.
Execution of movement - primary motor cortex. Executing and planning movement - Premotor area (PMA) and Supplementary motor area (SMA). In PD the Supplementary motor area (SMA) is affected which is involved in internally generated, automatic movement
BUT
The Premotor area (PMA) is intact which is involved in sensor-guided movement
THEREFORE –
‘ the automatic subconscious basis of posture and movement is lost (i.e. SMA) but abnormalities can often be overcome by voluntary effort (use of PMA) ’
Clinically this will mean that you can incorporate the use of external cues as a coping strategy in treatment
What are the early stages of the Hoehn & Yahr Scale
Stage 0 - no signs of disease
•Stage 1 – unilateral involvement with minimal functional disability
•Stage 1.5 –unilateral involvement also involving the neck and spine
•Stage 2 –bilateral) disease but no impairment of balance
•Stage 2.5 - mild bilateral symptoms with recovery when the ‘pull’ test is given (the doctor stands behind the person and asks them to maintain their balance when pulled backwards)
What are the 3 cardinal signs of PD
- Bradykinesia - Paucity or slowness of movement – with a slower and difficulty initiation of movement and a progressive reduction in the speed and amplitude of repetitive actions; Akinesia = no movement
- Resting Tremor (pill rolling) - Lack of dopamine leads to a release of inhibition of tremor. This tremor is normally inhibited during movement. One of the first signs of PD but may not always be present
- Rigidity - Lack of dopamine also results in rigidity:
- Stiff or inflexible muscles
- Resistance to passive movement
Lead pipe rigidity (resistance throughout all of movement) or Cog wheel rigidity (gives little bit of way then provided resistance)
Symptoms of PD
Effects of Rigidity
•Feeling stiff and achy
•Moving is hard work
•Lack of movement results in weakness
•Facial expression (communicating with others)
•Sedentary lifestyle
•Flexed Trunk – can’t stand straight, COG is forward, difficulty walking, turning, reaching, standing from sitting positions (chair, toilet, bed)
Effects of Tremor •Embarrassing •Annoying •Tiring •Hand function •Balance
Effects of Akinetic Syndrome •Cant move •Slow •Get stuck / freeze •Balance problems - Difficulty walking, getting out of a chair / off the toilet, Falls •Depressing •Can’t look after yourself •Can’t cook meal •Cant go out and about •Reduced fitness levels
What are the output neurones of the basal ganglia
Globus pallidus (GPi) and substantia nigra (SNpr)
These are inhibitory neurones
State the stages of the scale that can be used to determine the progression of PD
Hoehn & Yahr Scale
Difference between rigidity and spasticity
Rigidity VS spasticity - spasticity is velocity dependent so quick PROM will kick in spasticity by feeling for resistance; spasticity is felt in Biceps, wrist and finger flexors for CVA, etc whereas rigidity in PD will feel resistance in both flexors and extensors throughout movement
What are the 5 nuclei of the basal ganglia
- Caudate nucleus
- Putamen
- Globus pallidus - internal and external
- Subthalamic nucleus (STN)
- Substanstia nigra (SN) - pors compacta, pors reticulat
What is the role of the basal ganglia
Believed to be storage of movement memory
1. Regulate planning, initiation & termination of movement 2. Regulate muscle tone required for specific body movements 3. Control subconscious or stereotyped contractions of skeletal muscles 4. Act to inhibit antagonistic or unnecessary movements - reciprocal inhibition
Basal ganglia part of a series of parallel loops involving the thalamus and cerebral cortex. Classic model proposes two pathways:
1. Direct pathway – promotes movement 2. Indirect pathway – inhibits movement.
Explain key features of the causes of PD
Neurodegeneration in the substantia nigra in the basal ganglia leading to a lack of dopamine
The basal ganglia contains parallel loop systems which usually produce movement – they are called the Direct Pathway and the Indirect Pathway.
Lack of dopamine leads to:
- Lack of excitement of the direct pathway leading to lack of movement
- Lack of inhibition of the indirect pathway leading to lack of movement
Therefore an overall lack of movement = bradykinesia or no movement =akinesia
Define PD
Parkinson’s Disease is a chronic, progressive neurodegenerative disorder resulting from the degeneration of dopamine producing neurones in the substantia nigra of the basal ganglia
Parkinson’s Disease and the ‘Parkinsonian syndrome’ comprise a group of disorders characterised by tremor and disturbance of voluntary movement, posture and balance
