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DM Neuro 1 > Parkinson's Disease Interventions > Flashcards

Parkinson's Disease Interventions Flashcards

1
Q

what are the general intervention goals for early stages of PD (H&Y 1-2)?

A
  1. Promotion of active lifestyle
  2. encouragement of continued engagement in home, work, and leisure activities
  3. initiation and monitoring of exercise program
    • CV training
    • strengthening
    • balance stretching
  4. Dual-task activities, complex motor tasks
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2
Q

what are the general intervention goals for middle stages of PD (H&Y 3-4)?

A
  1. Promotion of active lifestyle
  2. continued engagement in home, work, and leisure activities
    • mod of tasks and/or environment when appropriate to optimize participation
  3. continued monitoring of exercise program
  4. encourage participation in activities and exercises during “ON” times
  5. Initiate strategy training/cueing strategies w/increased focus on cog movement strategies
  6. Fall reduction interventions and edu
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3
Q

what are the general intervention goals for late stages of PD (H&Y 5)?

A
  1. Caregiver edu and training
    • Assistance training
    • cuing training
  2. optimize sitting posture and tolerance
    • skin breakdown prevention and edu
    • risk reduction for postural abnormalities and contractures
  3. Implementation of exercise program w/caregiver involvement (PROM and AROM)
    • main focus = prevent contractures
    • secondary focus = strengthening
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4
Q

T/F: the OFF times for PD get longer as the disease progresses

A

TRUE

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5
Q

how does cueing with PD pts work?

A

use of attentional cues

  • can we override the loss of BG input to the SMA/PMC by using other systems in our brain?
    • Frontal-Cortical control via premotor cortex
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6
Q

describe when the cardinal symptom of bradykinesia is seen in PD pts

A
  1. seen with initiation, execution and stoppage of tasks
  2. Common presentations in gait (temporal):
    • gait speed
    • arm swing
    • step duration
    • DLS duration
  3. Focus on increasing speed with these pts
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7
Q

describe when hypokinesia is seen in PD pts

A
  1. seen with initation, execution, and stoppage of tasks
  2. Common presentations in gait (spatial)
    • arm swing
    • trunk rotation
    • step length
    • step height
    • weight shifting
    • base of support
  3. Focus on
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8
Q

how is edu important relating to increasing gait speed and amplitude of movements in PD pts?

A

increasing speed and/or amplitude may feel TOO big to the pt, when in fact the now correted speed and amplitude is appropriate. They need to learn this

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9
Q

T/F: STM will help reduce rigidity in PD pts

A

FALSE

similar to spasitcity, there is nothing PT can do to fix rigidity

medications like levadopa may be given and surgical procedure such as DBS may help some

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10
Q

describe secondary managment of rigidity in PD pts

A
  1. Contracture prevention and management
    • sig more at risk than w/spasticity
      • stretching program crucial
      • positioning crucial
  2. Joint integrity maintenance
    • joint mobilizations
  3. Skin integrity considerations
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11
Q

how is each aspect of postural stability impacted by PD?

A
  1. Acheiving balance
    • difficulties with self-initated movements
    • reduced anticipatory postural adjustments and control
  2. Maintaining balance
    • smaller functional limits of stability
    • midline disorientation
  3. Restoring balance
    • abnormal and inflexible postural responses
    • abnormal patterns of coactivation
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12
Q

which aspect of postural stability is most impacted by PD?

A

restoring balance

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13
Q

how can we help remediate midline disorientation in PD pts?

A
  1. encouragement of forward weight shift over balls of feet/toes
    • activities on wedges
    • rocker board activities
    • forward displacement of COG over BOS (ex reaching)
    • walking on tip toes
  2. encourage flexor moment at hips, knees, ankles
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14
Q

what are some compensation strategies for midline disorientation in PD pts?

A
  1. heel wedges
  2. activity modifications
    • ex → stand to side of kitchen appliances when opening, intead of directly in front
    • ex → “power stance” when opening a door
  3. AD considerations/modifications
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15
Q

when is breakdown in complex motor tasks in PD pts most noticable?

A
  1. sequential movements
  2. transitioning between movements
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16
Q

List some complex motor interventions

A
  1. Dual Task
    • +cognitive task
    • +motor task
  2. Multi-step activities
  3. Obstacle course
17
Q

Give an example of a dual task outcome measure

A
  1. TUG - Cognitive
    • TUG while counting backwards in 3s from random start time
  2. TUG - Motor
    • TUG while holding a glass of water
18
Q

what are the steps to deal with freezing of gait?

A
  1. ID common trigers
  2. Internal Cues
  3. External Cues
19
Q

Give some examples of common triggers for freezing

A
  1. competing stimuli in environment
    • small spaces
    • changes in flooring type or pattern
    • doorways
    • thresholds
    • approaching people, furniture, objects
  2. weight displacement on feet
  3. stress/anxiety/fear
  4. anticipatory FOG
  5. turning around/changing direction
  6. cog tasks, attention-splitting tasks
  7. crowds
20
Q

Why do we see festinating gait and what does it lead to?

A
  1. why we see it
    • gait kinematics
    • initiation problems
    • disequilibrium problems
  2. what does it lead to
    • COG ant to BOS → LOB
    • FOG
    • sig reduced economy of walking
21
Q

during the early stages of PD (H&Y 1-2) what does gait and functional training look like?

A
  1. primary focus → amplitude and symmetry
  2. neuroprotective strategies
  3. add dual-task w/cognitive and motor loads
  4. vary environment and task
  5. these pts can be pushed!!
22
Q

during the mid stages of PD (H&Y 3) what does gait and functional training look like?

A
  1. primary focus → festination, retropulsion, LOBs
  2. continue to address amplitude
  3. strategies for “on” and “off” times
23
Q

during the mid-late stage of PD (H&Y 3-4) what does gait and functional training look like?

A
  1. primary focus → FOG, fall risk management
  2. more involvement of family training/caregiver assistance
  3. increase in “off” times, strategies crucial
24
Q

Describe PD checklist you could go through when performing a task analysis

A
  1. Initiation issues?
  2. Execution issues?
    • Bradykinesia or hypokinesia?
    • Postural instabilities?
    • Additional S/S?
      • tremor or rigidity?
      • weakness?
    • festinating gait?
    • freezing?
    • turning issues?
    • complex motor task breakdown?
  3. Stoppage issues
25
Q

why is aerobic conditioning important in PD pts?

A

decreased economy of movement is common, even in early stages of PD

aerobic conditioning shown to improve VO2 max in individuals with PD

26
Q

Describe some methods for aerobic conditioning, recommendations, and outcome measures

A
  1. methods
    • treadmill walking, overground ambulation, cycling
  2. recommendations
    • 5x/week for at least 30 min (150 min/week)
  3. outcome measures
    • 2 MWT
    • 6 MWT
    • RPE/mRPE
27
Q

why is strengthening important for PD pts?

A

PD-related weakness has been tied to balance deficts, falls, and overall functional decline

caused by → altered descending central drive, deconditioning, aging or as secondary effects of postural abnormalities and changes in muscle length tension

28
Q

list some guidelines and outcomes measures for strengthening in PD pts

A
  1. Guidelines
    • 2-3x/week; 8-12 reps x 1-3 sets for general strengthening
  2. Outcome measures
    • MDS-UPDRS
    • 5x STS
    • No current evidence on use of hand dynamometry in PD
29
Q

why is stretching important for PD pts? what areas are most impacted?

A
  1. Most impacted:
    • common ROM deficits at neck, trunk due to altered posture (forward trunk flexion, lack of spinal extension and rotation)
  2. Important b/c:
    • increasing flexibility has been shown to improve balance, gait and ADLs
30
Q

how should stretching be focused in PD pts? What are some guidelines

A
  1. Focus:
    • spinal extension and rotation
    • Iliopsoas
    • hamstrings
    • gastrocnemius
    • pec major
  2. Guidelines:
    • 3x/week (easy HEP to incoorporate)
31
Q

List some possible secondary orthopedic sequale to PD

A
  1. Orthopedic considerations
    • forward head, rounded shoulders, kyphosis lead to sig postural changes
    • shadow pillow → supine postures
  2. CV considerations
    • reduced CV function leads to reductions in activity tolerance
  3. Pulmonary considerations
    • due to kyphotic posture, lung compliance often reduced

DM Neuro 1 (16 decks)

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