Parkinson's Disease - BG disorders Flashcards
what is BG’s role in movement and posture
- movement scale
- movement initiation
- movement preparation
- identify’s one’s own body position relative to environment
- longer loop postural reflexes
- perceptual and cognitive
PD is associated with what type of movement scale?
hypokinesia (movements are small)
When PD patients try to complete complex tasks, what happens?
stuck with movement; freezing of movement
what are the common s/s of BG disorders?
- decreased movement coordination, motor control and postural stability
- changes in muscle tone
- presence of extraneous movements (ex: tremors)
what is the etiology of PD?
unknown; small percentage heriditary
affects men = women > 50 years
1 in 3 > 85 years old
what is the most common BG disorder?
PD
what are the s/s associated with PD? (9)
- rigidity (cogwheel or leadpipe)
- bradykinesia (slow movement)
- micrography (small hand writing)
- masked face
- postural abnormalities (flexed posture)
- lack of equilibrium reactions = falls
- resting tremor
- decreased trunk rotation
- talking softly
what are some PD non-motor symptoms (cognitive)
- anxiety and depression
- bradyphrenia/ MCI
- decreased attention/increased distractibility
- decreased executive functioning
- decreased multi or dual tasking
- decreased organizational ability
what are some other PD non-motor symptoms (related to the physiologics of the body)
- sleep disturbances
- bladder urgency/frequency
- orthostatic hypotension
- hyposmia (LOW ENERGY)
- pain/paraesthesia
what are secondary problems/complications associated with PD? (6)
- decreased vital capacity
- nutritional changes
- osteoporosis
- contracture/deformity
- decubiti
- muscle atrophy
why do PD experience decreased vital capacity but increased energy consumption?
decreased VC = chest expansion, posture, rigidity, and UE positioning
why are there nutritional changes with PD patients?
good appetite BUT problems with eating, chewing, and swallowing
what are causes of osteoporosis in PD patients?
- diet
- age
- decreased activity
what are some common contractures associated with PD
hip and knee flexors, plantarflexors, toe flexors, hip ADD
neck flexors
shoulder ADD and IR
what does 0 on modified Hoehn and Yahr Scale mean?
no signs of disease
what does 1 on modified Hoehn and Yahr Scale mean?
unilateral disease
what does 1.5 on modified Hoehn and Yahr Scale mean?
unilateral disease with axial involvement
what does 2 on modified Hoehn and Yahr Scale mean?
bilateral disease without postural instability
what does 2.5 on modified Hoehn and Yahr Scale mean?
early signs of postural instability (recovery on Pull Test)
what does 3 on modified Hoehn and Yahr Scale mean?
bilateral disease with postural instability; physically I
what does 4 on modified Hoehn and Yahr Scale mean?
severe disability but still able to sit to stand or walk unassisted
what does 5 on modified Hoehn and Yahr Scale mean?
confinement to w/c or bed
what are the 5 treatment options for PD
pharmacological/medical management surgery (deep brains stimulation) nutrition exercise Physical Management of Symptoms (PT referral)
what pharmacological medicines used for PD
dopamine agonist/ replacement;
symptom management: tremors
where is deep brain stimulation implanted into?
subthalamic nucleus
what does DBS allow?
faster movement; gait deviations respond well to stimulation
what is the onset of symptom relief after implantation of DBS?
PD: minutes
Dystonia: days to weeeks
why is nutrition part of the treatment plan?
high protein diet = bad
can block the effectiveness of dopamine replacement
-recommend no more that 15% of calories to be protein
-shift protein to evening meal time
why is exercise important for PD patients?
aerobic exercise found to reduce PD dysfunction!
- additional pulmonary benefits
- improved QOL with decreased depression
IMPORTANT: get patient to move faster than their self-selected pace
when is the best time for a PT referral for PD
initially diagnosed for PREVENTION
- become a daily exerciser
- maintain normal movement
- prevent secondary complications
what are some impairments related to PD gait?
decreased: velocity, stride length, foot clearance, and arm swing.
flat footed progression
festination
what are some freezing in gait triggers?
- sudden direction change
- doorways/thresholds
- approaching furniture
- turning around
- change in floor patterns
- confined spaces
- crowds
- stress/anxiety/hurrying
what are some retropulsion triggers?
- backing up to sit down
- reaching overhead
- stepping away from sink/counter
- opening door
- carrying items close to body with both hands
- being approached closely/suddenly jostled
what are some main functions of PT rehabilitation?
aerobic exercise, flexibility, strength, rhythmic exercise, and functional activity
what is the leading cause of death among PD patients?
pneumonia
what improves motor function in PD patients?
forced, not voluntary, exercise
what is the program related to PD patients only?
LSVT big and LOUD
what are the goals for early phase PD
prevention of inactivity, fear of falling, and improve physical capacity
what are the goals for mid-phase PD
same as early phase (prevention) plus:
-maintain/improve activities = transfers, posture, reaching/grasping, balance, and gait
what are the goals for late phase PD
same as mid phase plus:
-maintain vital functions and prevent: pressure sores and contractures
what is Parkinson Plus Syndrome? (PPS)
“progressive supranuclear palsy” - similar to PD, more cognitive impairment, more rapid progression
what does PPS not respond to?
L-dopa
related to PPS, what is multiple system atrophy (MSA)
- cortical, BG, and cerebellar
- frontal loabe and autonomic dysfunction
- does not respond to L-dopa
what is huntington’s disease a result of?
BG hyperactivity
how is huntington’s disease inherited?
autosomal dominant trait
what are some s/s of huntington’s disease?
- abnormalities in postural reaction
- decreased trunk rotation
- abnormal tone
- extraneous movements (TOO MUCH MOVEMENT)
what is wilson’s disease also known as?
hepatolenticular degeneration
what is wilson’s disease caused by?
abnormal copper metabolism (toxic copper levels and degeneration of liver and BG)
what is tardive dyskinesia?
drug induced disorder - overmedication
what is dyskinesia?
inability to perform voluntary movement
- series of rhythmical extraneous movements
- associated with extension of spine/trunk
what is dystonia
movement disorder characterized by sustained muscle contraction in the extreme end range of a movement, frequently with a rotational component
what does dystonia involve?
generalized, involving entire body
what is focal dystonia associated with?
related to repetitive movement produced under high cognitive restraints and attention
what is the most common focal dystonia?
spasmodic torticollis
what is the management of dystonia?
botox and rehab
what are the components of rehab for dystonia
use normal, tension free movements, sensory integration, relearning techniques performed with attention, huge amounts of practice, and relaxation program
excessive co-activation of agonists and antagonists that occurs interferes with: (3)
- timing
- execution
- loss of I joint movements
is there abnormal tone or reflexes associated with dystonia?
no
what are some common drugs used for PD?
- Amantadine
- bromocriptine pramipexole
- Anticholinergics
- MAO-inhibitors
- Dopa decarboxylase inhibitor combined with levodopa
- Catechol-O-methyl transferase
What is the mechanism for amantadine?
unknown; appears to improve available dopamine action
what is the action of bromocriptine pramipexole?
dopamine agonist; stimulates dopamine receptors directly
what is the action of anticholinergics?
blocks action of transmitter acetylcholine, which competes with dopamine
what is the action of MAO-inhibitors
anti-depressant; blocks monoamine oxidase and its removal of dopamine from the brain
what is the action of dopa decarboxylase inhibitor combine with levodopa
dopamine replacement therapy; blocks conversion of levodopa to dopamine outside brain while allowing conversion inside brain
what is the action of catechol-0-methyl transferase inhibitors with levodopa
dopamine replacement therapy; COMT- inhibitors block the enzyme breakdown of levodopa and thus allows more levodopa to reach the brain
which drug helps with tremors, lessens rigidity and drooling
anti-cholinergics
