Parkinson's Evaluation

Question 1

What are the functional status stages of PD?

Answer 1

Hoehn and Yahr stages of PD

Question 2

What is seen in stage 1 of H & Y scale?

Answer 2

sx only on one side
- slight tremor
- some stiffness
- slow movement

Question 3

What is seen on stage 2 of H & Y scale?

Answer 3

sx on both sides of the body AND walking is easy
- same as stage 1 but with speech and face masking starting

Question 4

What is seen on stage 3 of H & Y scale?

Answer 4

sx on both sides of body and min walking difficulty
- included balance issues

Question 5

What is seen on stage 4 of H & Y scale?

Answer 5

sx on both sides of the body and mod walking difficulty
- ↑ assistance for ADLs

Question 6

What is seen on stage 5 of H & Y scale?

Answer 6

sx on both sides of the body and unable to walk
- W/C dependent

Question 7

What are some specific standardized test for Parkinson’s?

Answer 7

United parkinson’s disease rating scale (UPDRS)
Parkinson’s disease questionnarie (PDQ 39 / PFQ 8 / QOL)
Schwab and England ADL

Question 8

Examples of general standarized tests for PD

Answer 8

Berg, Tinetti, TUG
6MWT
10m walk test

Question 9

What are some ADLs we look at during evaluation?

Answer 9

Bed mobility
sit to stand
dynamic and static balance
gait

Question 10

What are some qualitative things we look at during evaluation?

Answer 10

looking at motor performance
- phases of motion (start, performance, stop)
- reaction time
- quality
- kinematics
- any compensations
- balance issues ???

Question 11

What are the problems that are indicated with bed mobility issues?

Answer 11

Patient might be having rigidity
trouble with initiating
spine immobility
flexor domination
forward head
decreased trunk rotation

Question 12

What are the problems that are indicated with sit to stand issues?

Answer 12

patient has postural issues: forward head, kyphosis
posterior pelvic tilt = hard time placing weight to the front

Question 13

What are we assessing regarding bed mobility issues?

Answer 13

reaction and movement time
how are they able to start, execute and stop the movement
quality
kinematics
any compensation

Question 14

What are we assessing regarding sit to stand issues?

Answer 14

reaction and movement time
phases of movement
compensations
balance issues??

Question 15

What are the common gait problems associated with PD?

Answer 15

↓ movt (hypokinesis)
↓ posture adjustments (forward head, kyphosis)
slower balance reactions
festinating gait
more time in double support
↓ trunk rotation and arm swing

Question 16

What are we assessing regarding gait issues?

Answer 16

how fast and far are they goin
stride length
how often, when and what area are they freezing

Question 17

What are the problems that disrupt motor planning?

Answer 17

↓ internal self cueing
hard time intiating
execution
hard time stopping
can’t multitask
sudden onset of freezing and festination

Question 18

What are the two goal approaches for PD?

Answer 18

1. look at the underlying cause within rigidity, ROM and reactions
2. go through ADLs

Question 19

What are other goal considerations?

Answer 19

make sure its functional and relevant
- have repetitive practice of these functional activities

EDUCATION (!!!!)
- look at long term goals and strats
- support support support (!!)

Question 20

What are the primary objectives for PD?

Answer 20

we want to improve their life and functional status no matter the stage

working and adjusting to the progression of the disease

how to handle sx therapies

Question 21

What is the primary inhibitory NT?

Answer 21

dopamine

Question 22

What is the primary excitatory NT?

Answer 22

acetylcholine

Question 23

What are the medications used for PD?

Answer 23

Levodopa/carbidopa
Dopamine agonist

Question 24

How does levodopa work in the body?

Answer 24

becomes metabolized into dopamine which is needed due to the ↓ amount

mainstay of therapy with the best therapeutic index

Question 25

How does levodopa-carbidopa work together?

Answer 25

Levodopa = more dopamine
Carbidopa = prevents levodopa from being broken down before it gets to the brain

Meaning lower dose of levodopa = less nausea and vomitting