Parkinson's Practical

Question 1

3 motor deficits common in PD

Answer 1

Rigidity- resistance to passive movement.
Hypokinetic- movement does not occur when it should.
Hyperkinetic- movement occurs when it should not

Question 2

impaired initiation of movement

Answer 2

akinesia

Question 3

decreased amplitude and velocity of movement

Answer 3

bradykinesia

Question 4

hyperkinesias typically occur

Answer 4

at rest

Question 5

difference between rigidity and spasticity

Answer 5

rigidity is not velocity dependent

Question 6

pts with akinesia may have trouble with transitional movements such as

Answer 6

sit to stand, going through a doorway

Question 7

characterized by SLOW movements

Answer 7

bradykinesia

Question 8

characterized by SMALL amplitude movement, small size

Answer 8

hypokinesia (small steps with gait, voice production is low/low volume of speech, difficulty with swallowing

Question 9

PT related motor problems common in PD

Answer 9

slowed or absent rhythmic and rotary movements
abnormal or delayed sequencing of tasks,
delayed prep of movement (poor APAs),
Abnormal RPAs

Question 10

Tests and measures for gait in PD

Answer 10

Cognitive/motor TUG (dual task)
6MWT
10 m walk test
Gait parameters- cadence, stride length, and velocity

Question 11

Tests and measures for sit to stand in PD

Answer 11

Observation (appears slow, difficulty with flexion momentum, may take several tries, difficulty with falling back from extension phase)
Outcome (5x sit to stand)

Question 12

Turning with PD

Answer 12

observation (may take up to 20 steps to turn)

Question 13

Impairment level testing for PD

Answer 13

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

Question 14

Pull test for postural instability

Answer 14

Stand behind pt and tell them to keep their balance when pulled back
positive if pt takes 2 or more steps backwards

Question 15

People with PD can move more easily with external cues

Answer 15

(visual, auditory, or proprioceptive)

Question 16

3 Types of Rhythmic Auditory Stimulation

Answer 16

1. rhythmic motor cueing- metronome (count number of steps in 15s, multiply by 4 and then increase.
2. patterned sensory enhancement - sit to stand, reach and grasp (uses acoustical patterns or melodic (auto-harp)
3. Therapeutic instrumental music performance (playing musical instruments to exercise and stimulate functional movement patterns

Question 17

Hypokinesia

Answer 17

think BIG

Question 18

What secondary impairment is very important to treat in PD

Answer 18

axial rotation (improvement in 6MWT and functional reach distance)

Question 19

Example PT diagnosis for a pt with PD regarding gait

Answer 19

pt presents with a shortened stride length and reduced gait speed due to hypokinesia related to PD

Question 20

external cueing with gait training

Answer 20

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)

Question 21

intervention strategy for turning

Answer 21

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

Question 22

when considering postural instability/balance

Answer 22

vestibular rehab has long-term effects on balance with PD, APAs are decreased (practice reaching rapidly in standing, stepping activities, toe rises)

Question 23

PT diagnosis for sit-to-stand with PD patient

Answer 23

pt presents with difficulty arising from chair secondary to hypokinesia.

Question 24

Task analysis for sit to stand in PD

Answer 24

common problem- inadequate forward trunk lean, downward gaze, and loss of momentum due to akinesia

Question 25

Intervention for sit to stand

Answer 25

mental rehearsal of sequence,
think-come up like a rocket,
think-forward and up

Question 26

external cues for sit to stand

Answer 26

verbal- count or say the steps out loud
auditory- GO
visual cues- target for forward lean
proprio- gentle rocking