Parkinson's Evaluation Flashcards
What are the functional status stages of PD?
Hoehn and Yahr stages of PD
What is seen in stage 1 of H & Y scale?
sx only on one side
- slight tremor
- some stiffness
- slow movement
What is seen on stage 2 of H & Y scale?
sx on both sides of the body AND walking is easy
- same as stage 1 but with speech and face masking starting
What is seen on stage 3 of H & Y scale?
sx on both sides of body and min walking difficulty
- included balance issues
What is seen on stage 4 of H & Y scale?
sx on both sides of the body and mod walking difficulty
- ↑ assistance for ADLs
What is seen on stage 5 of H & Y scale?
sx on both sides of the body and unable to walk
- W/C dependent
What are some specific standardized test for Parkinson’s?
United parkinson’s disease rating scale (UPDRS)
Parkinson’s disease questionnarie (PDQ 39 / PFQ 8 / QOL)
Schwab and England ADL
Examples of general standarized tests for PD
Berg, Tinetti, TUG
6MWT
10m walk test
What are some ADLs we look at during evaluation?
Bed mobility
sit to stand
dynamic and static balance
gait
What are some qualitative things we look at during evaluation?
looking at motor performance
- phases of motion (start, performance, stop)
- reaction time
- quality
- kinematics
- any compensations
- balance issues ???
What are the problems that are indicated with bed mobility issues?
Patient might be having rigidity
trouble with initiating
spine immobility
flexor domination
forward head
decreased trunk rotation
What are the problems that are indicated with sit to stand issues?
patient has postural issues: forward head, kyphosis
posterior pelvic tilt = hard time placing weight to the front
What are we assessing regarding bed mobility issues?
reaction and movement time
how are they able to start, execute and stop the movement
quality
kinematics
any compensation
What are we assessing regarding sit to stand issues?
reaction and movement time
phases of movement
compensations
balance issues??
What are the common gait problems associated with PD?
↓ movt (hypokinesis)
↓ posture adjustments (forward head, kyphosis)
slower balance reactions
festinating gait
more time in double support
↓ trunk rotation and arm swing
What are we assessing regarding gait issues?
how fast and far are they goin
stride length
how often, when and what area are they freezing
What are the problems that disrupt motor planning?
↓ internal self cueing
hard time initiating and stopping
execution
can’t multitask
sudden onset of freezing and festination
What are the two goal approaches for PD?
- look at the underlying cause within rigidity, ROM and reactions
- go through ADLs
What are other goal considerations?
make sure its functional and relevant
- have repetitive practice of these functional activities
EDUCATION (!!!!)
- look at long term goals and strats
- support support support (!!)
What are the primary objectives for PD?
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
What is the primary inhibitory NT?
dopamine
What is the primary excitatory NT?
acetylcholine
What are the medications used for PD?
Levodopa/carbidopa
Dopamine agonist
How does levodopa work in the body?
becomes metabolized into dopamine which is needed due to the ↓ amount
mainstay of therapy with the best therapeutic index
