Parkinson's & LSVT-Test 2 Flashcards
What is Parkinson’s Disease?
Degenerative disease of middle age Marked degenerative changes & dopamine deficiency in substantia nigra Either idiopathic (primary) or symptomatic (secondary)
Who 1st described PD?
James Parkinson in 1817
Primary/Idiopathic PD
No known cause
Where most research is done
Secondary/Symptomatic PD
Arises from another neurological impairment: drugs, trauma, etc. (Muhammad Ali-basal ganglia trauma)
Theories of cause: Pesticides, genetics, etc.
Extrapyramidal System
Consists of basal ganglia, lateral to internal capsule
Contributes to control of posture, tone, & facilitation of movement:
-automaticity of walking/running
-cooperation of independent movements of extremities
-freedom of movement
-suppress unwanted, involuntary movements (tremor)
Prevalence/Incidence of PD
1.5 million in US 1 in every 100 over age of 75 6 million worldwide 25.6 per 100,000 per year 2020=40 million worldwide 50-60,000 will be diagnosed this year Becoming more prevalent esp. b/c people are living longer Research shows we can slow progression & improve QOL through therapy
Who gets PD?
More common in males (slightly)
Typical age of onset: 55-60
African Americans & Asians are less likely than Caucasians to develop
Early vs. Late Onset
Earlier in life tends to have quicker progression than later in life onset
Pathological Findings & PD
Loss of pigmented, dopaminergic neurons in the SNpc
50-60% cell death at diagnosis
70-80% loss of DA terminals at diagnosis
Proceeds diagnosis ~5-6 years
1 1st sx of PD
Loss of smell
Motor Circuit through Basal Ganglia
Basal Ganglia-thalmo-cortico circuit
Cortical drive is overall under-scaled & timing scales are inconsistent
Cortical drive to periphery
BG controls all cortical drive to motor output
Incomplete activation=
inconsistent output=timing issues (akinesia)
PD has ____ amplitudes of movements
decreased
____ in inhibition so there’s a _____ in movement
Increase; Decrease
PD characterized by…
Rigidity Tremor Bradykinesia Postural instability Dysarthria
2 Types of Rigidity
Cogwheel rigidity
Lead pipe rigidity
Cogwheel Rigidity
Jerky, ratchet-like resistance to passive movement as muscles alternately tense & relax
Will mostly see weird posturing
Lead Pipe Rigidity
Sustained resistance to passive movements
Tremor
Can be unilateral or bilateral (usually start unilateral & move bilateral)
Medications can help (significant side effect is dyskinesias)
Is present in 70% of Pts
Resting vs. action–resting with this
Increases with distress/fatigue
Fluctuations are very common
Energy conservation & decreasing anxiety important
Chorea
rhythmic movements (essential tremor, Huntington’s)
Dyskinesia
When they’re doing an activity; more rhythmic
Bradykinesia/Hypokinesia
Decreased movement/amplitude
Freezing: sudden break or block in movement
Akinesia
Absence of movement: presents a deficit in preparatory phase of movement control & can be related to rigidity (counting, rhythmical, music)–designs hard for them, visual cues can help, laser pointers, can have it in their speech too
PD is an ____ disorder
amplitude
Decreased amplitude; arms, speech
amplitude of what they go to do decreases
Common Motor Sx’s Related to
Inadequate scaling of motor output
Inadequate time signals
Multifactorial
Common Motor Sx’s of PD at Time of Diagnosis
Bradykinesia, gait hypokinesia, resting tremor, micrographia, hypophonia, stooped posture, decreased dexterity, masked face
Common Motor Sx’s of PD at Time of Referral
Generalized weakness, akinesia, festinating gait (walk forward/stooped, shuffle as they go/speed up), freezing episodes, postural instability, rigidity, adaptive responses (weakness, contractures, decreased aerobic capacity), dysphagia
Common Speech & Voice Sx’s and PD
Harsh, breathy phonation; monopitch; monoloud; decreased intensity; excessive pausing; short rushes of speech; variably fast & slow AMR’s; reduced ROM of musculature; alternating fast & rates of artic; imprecise consonant & vowel production; masked facies; decreased intonation
Sensory Deficiencies in PD
Lack of awareness across body & space
Decreased ability to internally cue or trigger movements themselves: due to decreased activation of the SMA
For therapy: Show them in mirror or record them-recalibrate system
Parkinson’s Plus
Axial rigidity is more prominent with less in extremities
More backwards lean
PT tx limited info for prevention as w/ idiopathic PD
Focus on QOL
Present like PD but not
Dystonia
Abnormal posturing or tone
Increased output to muscle (so much tone); can be result of PD
Multiple system atrophy (MSA)
Progressive, idiopathic degenerative process beginning in adulthood
Pt’s present with various degrees of parkinsonism, autonomic failure, cerebellar dysfunction, & basal ganglia signs that are poorly responsive to levadopa or dopamine agonists
(1st sx’s look like PD pt, but will progress much more rapidly)
Progressive supranuclear palsy (PSP)
Pt develops bradykinesia, rigidity, dysarthria, dysphagia, & dementia, as in Pt’s w/ idiopathic PD
Tremor is rare, Pt has severe postural instability
Axial rigidity appears to be more prominent than limb rigidity
Occular paresis (vertical gaze palsy) and gait instability are cardinal signs
Telltale sign of PSP
Don’t have vertical gaze–can’t track up & down
“PD version of ALS”–cognitive deficits, AAC, if early enough can do LSVT
Diffuse Lewy body disease (DLBD)
Progressive neurodegenerative disorder characterized by presence of parkinsonian sx’s & neuropsychiatric disturbances commonly accompanied by dementia
Progressive dementia often first & predominant sx
(the worst—mostly caused Lewy body dementia—very progressive—must have cognitive sign be first sign—quick)—can’t tell unless upon autopsy for sure—OCD, other psychiatric disturbances
