Parkinson's Disease (PD)

Question 1

What is Parkinson’s Disease?

Answer 1

Slowly progressive disease as a result of degeneration of the substantia nigra (basal ganglia) resulting in a mvmt disorder

Question 2

What are the general characteristics of Parkinson’s? (4)

Answer 2

1. Resting tremor
2. Muscular rigidity
3. Slow & decreased mvmt
4. Postural instability

Question 3

Name more detailed signs of Parkinson’s (10)

Answer 3

1. Resting tremor
2. Bradykinesia
3. Rigidity
4. Balance difficulties
5. Micrographia
6. Stiff facial expression (mask-like)
7. Festinating gait (shuffling walk)
8. Dysarthria (muffled speech)
9. Dysphagia (difficulty swallowing)
10. Depression (50%)

Question 4

What is Parkinsonism?

Answer 4

Symptoms similar to Parkinson’s, however caused by another condition - Med induced (anti-psychotics), vascular, Dementia w/ Lewy Bodies

Question 5

What do meds target? What’s the difference between on/off?

Answer 5

Precursors to dopamine
ON = meds are working, greatest freedom of mvmt
OFF = meds worn off, rigidity/freezing/tremors persists

Question 6

Stages of Parkinson’s (brief overview)

Answer 6

5 stages - progress from mild involvement to complete immobility.

Question 7

Stages of Parkinson’s: Stage I (Symptoms & OT Tx)

Answer 7

Symptoms: Mild, one side of body involved, decreased endurance, fatigue
MD Mgmt: Little/no rx mgmt,
OT Mgmt: OT eval & con’t throughout - work eval, work simplification (work & home), develop habit of taking frequent breaks, use of utensils w/ enlarged handles

Question 8

Stages of Parkinson’s: Stage II (Symptoms & OT Tx)

Answer 8

Symptoms: Both sides of body involved, mild rigidity, some difficulty w/ executive function, no balance impairment
MD Mgmt: Rx begins
OT Mgmt: Energery conservation techniques re: ADLs, exercises for trunk flexibility, driving assessment & alternatives, activity analysis to structure sequential tasks

Question 9

Stages of Parkinson’s: Stage III (Symptoms & OT Tx)

Answer 9

Symptoms: Moderate impairment. Delayed reactions Balance & walking impairment (lost righting reactions)
MD Mgmt: Rx increased
OT Mgmt: Ct is still independent, *home modifications (e.g. raised toilet seats, chairs w/ armrests, removal of throw rugs), use of visual cues/supports for sequential tasks

Question 10

Stages of Parkinson’s: Stage IV (Symptoms & OT Tx)

Answer 10

Symptoms: Severe, bilateral impairment. Fine motor control severely impaired. Balance & walking markedly impairment (decreased rotation around body axis). Oral motor deficits.
MD Mgmt: Rx increased
OT Mgmt: Ct is ambulatory, but requires assistance with ADLs. Modifications to support participation in self-care tasks, changes in food textures

Question 11

Stages of Parkinson’s: Stage V (Symptoms & OT Tx)

Answer 11

Symptoms: Marked/advanced disease results in complete immobility
OT Mgmt: Ct is dependent - Use of enviro controls to allow access to enviro

Question 12

Common home modifications for Parikinson’s (6)

Answer 12

1. Railings on staircase (both sides)
2. Grab bars in bathroom, near bed
3. Shower grab bars, bench, non-skid mat, hand-held shower
4. Move furniture to eliminate obstacles
5. Built-up handles
6. Gait monitors, walkers, or wc’s

Question 13

General Parkinson’s Interventions (3)

Answer 13

1. Exercise - focus on full ROM, postural flexibility, & relaxation/breathing techniques
2. Fall Prevention - exercise, rx mgmt, home mods
3. Sleep/Fatigue Mgmt - sleep hygiene, rest breaks