Parkinson's Practical Flashcards
3 motor deficits common in PD
Rigidity- resistance to passive movement.
Hypokinetic- movement does not occur when it should.
Hyperkinetic- movement occurs when it should not
impaired initiation of movement
akinesia
decreased amplitude and velocity of movement
bradykinesia
hyperkinesias typically occur
at rest
difference between rigidity and spasticity
rigidity is not velocity dependent
pts with akinesia may have trouble with transitional movements such as
sit to stand, going through a doorway
characterized by SLOW movements
bradykinesia
characterized by SMALL amplitude movement, small size
hypokinesia (small steps with gait, voice production is low/low volume of speech, difficulty with swallowing
PT related motor problems common in PD
slowed or absent rhythmic and rotary movements
abnormal or delayed sequencing of tasks,
delayed prep of movement (poor APAs),
Abnormal RPAs
Tests and measures for gait in PD
Cognitive/motor TUG (dual task)
6MWT
10 m walk test
Gait parameters- cadence, stride length, and velocity
Tests and measures for sit to stand in PD
Observation (appears slow, difficulty with flexion momentum, may take several tries, difficulty with falling back from extension phase)
Outcome (5x sit to stand)
Turning with PD
observation (may take up to 20 steps to turn)
Impairment level testing for PD
A. tone- look for rigidity B. tremor- resting or intentional C. finger tapping, toe tapping D. Rapid alternating movements E. Finger to nose (EO/EC) F. sensory screen G. Strength (shouldn't see deficits early on) H. Facial expression I. Oculomotor screen J. Vestibular screen
Pull test for postural instability
Stand behind pt and tell them to keep their balance when pulled back
positive if pt takes 2 or more steps backwards
People with PD can move more easily with external cues
(visual, auditory, or proprioceptive)
3 Types of Rhythmic Auditory Stimulation
- rhythmic motor cueing- metronome (count number of steps in 15s, multiply by 4 and then increase.
- patterned sensory enhancement - sit to stand, reach and grasp (uses acoustical patterns or melodic (auto-harp)
- Therapeutic instrumental music performance (playing musical instruments to exercise and stimulate functional movement patterns
Hypokinesia
think BIG
What secondary impairment is very important to treat in PD
axial rotation (improvement in 6MWT and functional reach distance)
Example PT diagnosis for a pt with PD regarding gait
pt presents with a shortened stride length and reduced gait speed due to hypokinesia related to PD
external cueing with gait training
Auditory (long big steps)
Visual (targets on ground or tredmill)
Cognitive (avoid talking and walking)
Proprio (weighted techniques)
For initiation of walking if frozen (say or think GO, visual cues-look ahead at target, shift weight side to side and twist trunk)
For walking through a doorway or over a threshold (look ahead and beyond target, think STOP, give them something to step over if shuffling)
intervention strategy for turning
clock turn - consciously think of stepping with your R foot, then your L, put one foot on 12, 3, 6, 9, lift your feet to step, don’t swivel or shuffle
when considering postural instability/balance
vestibular rehab has long-term effects on balance with PD, APAs are decreased (practice reaching rapidly in standing, stepping activities, toe rises)
PT diagnosis for sit-to-stand with PD patient
pt presents with difficulty arising from chair secondary to hypokinesia.
Task analysis for sit to stand in PD
common problem- inadequate forward trunk lean, downward gaze, and loss of momentum due to akinesia
Intervention for sit to stand
mental rehearsal of sequence,
think-come up like a rocket,
think-forward and up
external cues for sit to stand
verbal- count or say the steps out loud
auditory- GO
visual cues- target for forward lean
proprio- gentle rocking
