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Adult Neuro Exam 3 > Parkinson's Disease - BG disorders > Flashcards

Parkinson's Disease - BG disorders Flashcards

1
Q

what is BG’s role in movement and posture

A
  1. movement scale
  2. movement initiation
  3. movement preparation
  4. identify’s one’s own body position relative to environment
  5. longer loop postural reflexes
  6. perceptual and cognitive
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2
Q

PD is associated with what type of movement scale?

A

hypokinesia (movements are small)

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3
Q

When PD patients try to complete complex tasks, what happens?

A

stuck with movement; freezing of movement

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4
Q

what are the common s/s of BG disorders?

A
  1. decreased movement coordination, motor control and postural stability
  2. changes in muscle tone
  3. presence of extraneous movements (ex: tremors)
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5
Q

what is the etiology of PD?

A

unknown; small percentage heriditary
affects men = women > 50 years
1 in 3 > 85 years old

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6
Q

what is the most common BG disorder?

A

PD

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7
Q

what are the s/s associated with PD? (9)

A
  1. rigidity (cogwheel or leadpipe)
  2. bradykinesia (slow movement)
  3. micrography (small hand writing)
  4. masked face
  5. postural abnormalities (flexed posture)
  6. lack of equilibrium reactions = falls
  7. resting tremor
  8. decreased trunk rotation
  9. talking softly
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8
Q

what are some PD non-motor symptoms (cognitive)

A
  1. anxiety and depression
  2. bradyphrenia/ MCI
  3. decreased attention/increased distractibility
  4. decreased executive functioning
  5. decreased multi or dual tasking
  6. decreased organizational ability
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9
Q

what are some other PD non-motor symptoms (related to the physiologics of the body)

A
  1. sleep disturbances
  2. bladder urgency/frequency
  3. orthostatic hypotension
  4. hyposmia (LOW ENERGY)
  5. pain/paraesthesia
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10
Q

what are secondary problems/complications associated with PD? (6)

A
  1. decreased vital capacity
  2. nutritional changes
  3. osteoporosis
  4. contracture/deformity
  5. decubiti
  6. muscle atrophy
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11
Q

why do PD experience decreased vital capacity but increased energy consumption?

A

decreased VC = chest expansion, posture, rigidity, and UE positioning

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12
Q

why are there nutritional changes with PD patients?

A

good appetite BUT problems with eating, chewing, and swallowing

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13
Q

what are causes of osteoporosis in PD patients?

A
  1. diet
  2. age
  3. decreased activity
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14
Q

what are some common contractures associated with PD

A

hip and knee flexors, plantarflexors, toe flexors, hip ADD
neck flexors
shoulder ADD and IR

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15
Q

what does 0 on modified Hoehn and Yahr Scale mean?

A

no signs of disease

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16
Q

what does 1 on modified Hoehn and Yahr Scale mean?

A

unilateral disease

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17
Q

what does 1.5 on modified Hoehn and Yahr Scale mean?

A

unilateral disease with axial involvement

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18
Q

what does 2 on modified Hoehn and Yahr Scale mean?

A

bilateral disease without postural instability

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19
Q

what does 2.5 on modified Hoehn and Yahr Scale mean?

A

early signs of postural instability (recovery on Pull Test)

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20
Q

what does 3 on modified Hoehn and Yahr Scale mean?

A

bilateral disease with postural instability; physically I

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21
Q

what does 4 on modified Hoehn and Yahr Scale mean?

A

severe disability but still able to sit to stand or walk unassisted

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22
Q

what does 5 on modified Hoehn and Yahr Scale mean?

A

confinement to w/c or bed

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23
Q

what are the 5 treatment options for PD

A 
pharmacological/medical management
surgery (deep brains stimulation)
nutrition
exercise
Physical Management of Symptoms (PT referral)
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24
Q

what pharmacological medicines used for PD

A

dopamine agonist/ replacement;

symptom management: tremors

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25
Q

where is deep brain stimulation implanted into?

A

subthalamic nucleus

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26
Q

what does DBS allow?

A

faster movement; gait deviations respond well to stimulation

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27
Q

what is the onset of symptom relief after implantation of DBS?

A

PD: minutes
Dystonia: days to weeeks

28
Q

why is nutrition part of the treatment plan?

A

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

29
Q

why is exercise important for PD patients?

A

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

30
Q

when is the best time for a PT referral for PD

A

initially diagnosed for PREVENTION

  • become a daily exerciser
  • maintain normal movement
  • prevent secondary complications
31
Q

what are some impairments related to PD gait?

A

decreased: velocity, stride length, foot clearance, and arm swing.
flat footed progression
festination

32
Q

what are some freezing in gait triggers?

A
  1. sudden direction change
  2. doorways/thresholds
  3. approaching furniture
  4. turning around
  5. change in floor patterns
  6. confined spaces
  7. crowds
  8. stress/anxiety/hurrying
33
Q

what are some retropulsion triggers?

A
  1. backing up to sit down
  2. reaching overhead
  3. stepping away from sink/counter
  4. opening door
  5. carrying items close to body with both hands
  6. being approached closely/suddenly jostled
34
Q

what are some main functions of PT rehabilitation?

A

aerobic exercise, flexibility, strength, rhythmic exercise, and functional activity

35
Q

what is the leading cause of death among PD patients?

A

pneumonia

36
Q

what improves motor function in PD patients?

A

forced, not voluntary, exercise

37
Q

what is the program related to PD patients only?

A

LSVT big and LOUD

38
Q

what are the goals for early phase PD

A

prevention of inactivity, fear of falling, and improve physical capacity

39
Q

what are the goals for mid-phase PD

A

same as early phase (prevention) plus:

-maintain/improve activities = transfers, posture, reaching/grasping, balance, and gait

40
Q

what are the goals for late phase PD

A

same as mid phase plus:

-maintain vital functions and prevent: pressure sores and contractures

41
Q

what is Parkinson Plus Syndrome? (PPS)

A

“progressive supranuclear palsy” - similar to PD, more cognitive impairment, more rapid progression

42
Q

what does PPS not respond to?

A

L-dopa

43
Q

related to PPS, what is multiple system atrophy (MSA)

A
  1. cortical, BG, and cerebellar
  2. frontal loabe and autonomic dysfunction
  3. does not respond to L-dopa
44
Q

what is huntington’s disease a result of?

A

BG hyperactivity

45
Q

how is huntington’s disease inherited?

A

autosomal dominant trait

46
Q

what are some s/s of huntington’s disease?

A
  1. abnormalities in postural reaction
  2. decreased trunk rotation
  3. abnormal tone
  4. extraneous movements (TOO MUCH MOVEMENT)
47
Q

what is wilson’s disease also known as?

A

hepatolenticular degeneration

48
Q

what is wilson’s disease caused by?

A

abnormal copper metabolism (toxic copper levels and degeneration of liver and BG)

49
Q

what is tardive dyskinesia?

A

drug induced disorder - overmedication

50
Q

what is dyskinesia?

A

inability to perform voluntary movement

  • series of rhythmical extraneous movements
  • associated with extension of spine/trunk
51
Q

what is dystonia

A

movement disorder characterized by sustained muscle contraction in the extreme end range of a movement, frequently with a rotational component

52
Q

what does dystonia involve?

A

generalized, involving entire body

53
Q

what is focal dystonia associated with?

A

related to repetitive movement produced under high cognitive restraints and attention

54
Q

what is the most common focal dystonia?

A

spasmodic torticollis

55
Q

what is the management of dystonia?

A

botox and rehab

56
Q

what are the components of rehab for dystonia

A

use normal, tension free movements, sensory integration, relearning techniques performed with attention, huge amounts of practice, and relaxation program

57
Q

excessive co-activation of agonists and antagonists that occurs interferes with: (3)

A
  1. timing
  2. execution
  3. loss of I joint movements
58
Q

is there abnormal tone or reflexes associated with dystonia?

A

no

59
Q

what are some common drugs used for PD?

A
  1. Amantadine
  2. bromocriptine pramipexole
  3. Anticholinergics
  4. MAO-inhibitors
  5. Dopa decarboxylase inhibitor combined with levodopa
  6. Catechol-O-methyl transferase
60
Q

What is the mechanism for amantadine?

A

unknown; appears to improve available dopamine action

61
Q

what is the action of bromocriptine pramipexole?

A

dopamine agonist; stimulates dopamine receptors directly

62
Q

what is the action of anticholinergics?

A

blocks action of transmitter acetylcholine, which competes with dopamine

63
Q

what is the action of MAO-inhibitors

A

anti-depressant; blocks monoamine oxidase and its removal of dopamine from the brain

64
Q

what is the action of dopa decarboxylase inhibitor combine with levodopa

A

dopamine replacement therapy; blocks conversion of levodopa to dopamine outside brain while allowing conversion inside brain

65
Q

what is the action of catechol-0-methyl transferase inhibitors with levodopa

A

dopamine replacement therapy; COMT- inhibitors block the enzyme breakdown of levodopa and thus allows more levodopa to reach the brain

66
Q

which drug helps with tremors, lessens rigidity and drooling

A

anti-cholinergics

Adult Neuro Exam 3 (7 decks)

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