Parkinson's Disease [Guest Lecture]

Question 1

Describe the cardinal features of PD

Answer 1

• Resting tremor
• Rigidity
• Bradykinesia
• Postural instability

Question 2

Describe the other sx of PD

Answer 2

• Masked face
• Stooped, shuffling gait
• Decreased arm swing w/gait
• Dementia
• Kyphosis/scoliosis

(micrographia, slowing of ADLs, incoordination)

Question 3

Term: Slowness of movement

Answer 3

Bradykinesia

Question 4

Term: difficulty initiating movement

Answer 4

Akinesia

Question 5

Describe what akinesia looks like in PD

Answer 5

Moments of “freezing may occur”

Sudden break or block in movement

Deficit in the preparatory phase of movement control

Question 6

Describe the combined effect of bradykinesia and akinesia in PD

Answer 6

• Inability to initiate/perform purposeful movement
• Tendency to assume/maintain fixed postures
• Ability to start, stop, alter direction is diminished
• Can’t multitask: must complete one motor task at a time

Question 7

Describe the effect of PD on performing simultaneous/sequential tasks

Answer 7

• One motor task must be completed before the next
• Movement impaired as more movements are strung together
• Series of movement is more difficult than repetitive movement

Question 8

Describe resting tremor

Answer 8

• 4-7 cycles/sec
• pill rolling of hand most common
• unilateral > bilateral
• disappear with voluntary movement

Question 9

Term: resistance to passive motion that is unifrom on both sides of the joint and in both directions of movement

Answer 9

Rigidity (lead pipe, cogwheel)

Affects prox mm 1st > face, extremities

Can effect respiration

Question 10

Describe why those with PD are more likely to fall

Answer 10

Ineffective sensory processing (kinesthetic and proprioceptive)

Unable to activate mm force in proportion to displacement

Lack of anticipatory postural reactions

Question 11

Describe the PD gait

Answer 11

Decreased velocity, stride length (due to lack of trunk/pelvic motion) with lack of extension in the LE, decreased arm swing, and stooped posture and festinations

Question 12

Term: Mutliple small steps as if the pt. is trying to cath up with his/her center of gravity

Answer 12

Festination

Question 13

Term: Forward festination

Answer 13

Propulsion

Question 14

Retropulsion

Answer 14

Backward festination

Question 15

Describe the cause of festination

Answer 15

• decreased equilibrium response
• bradykinesia
• changes in gait kinematic: flat foot toe heel progression, decreased ability to step over obstacles or walk on carpet

Question 16

Term: abnormally small handwriting that is difficult to read

Answer 16

Micrographia

Question 17

Symptom: infrequent blinking, irritated eyes, lack of expression

Answer 17

Masked face

Question 18

Describe the changes in perception with PD

Answer 18

Deficits in vertical perception

Loss of body scheme (ex. don’t know knees are above ankles)

Loss of topographic orientation

Question 19

List the 3 dopamine agonists

Answer 19

Bromocriptine and pergolide

Question 20

List the surgical options for PD

Answer 20

• Thalamotomy: destructive lesion w/in thalamus (reduce tremor)
• Pallidotomy: destructive lesion w/in basal ganglia (reduce tremor/dyskinesia)
• Deep brain stimulation
• Neural transplantation