Parkinsonism

Question 1

Cardinal Features (TRAP)

Answer 1

Tremor
Rigidity
Akinesia/ bradykinesia
Postural instability

Question 2

Tremor

Answer 2

• absent in 25% of pt
• brought about when patient distracted (asked to close eyes and count backward) or with stress, anxiety or fatigue
• can be a postural tremor
• often begins in one hand and remains more severs on that side throughout
• may also affect chin, lips and tongue but not usually the head
• often not a disabling feature

Question 3

PD temor vs. essential tremor

Answer 3

1. family history common with ET not with PD
2. Never unilateral in ET
3. head tremor in ET

Question 4

Rigidity

Answer 4

• resistance to passive movement in both flexors and extensors throughout whole ROM
• patients may complain of feeling muscle stiffness, weakness or fatigue
• reduction in arm swing during gait often early sign
• may also begin unilaterally and remain asymmetric
• may be brought about by augmentation maneuvers

Question 5

Bradykinesia

Answer 5

• slowness of movements
• speech becomes hypophonic and swallowing slowed (saliva pools, drooling)
• trouble with buttons and fine finger movements
• takes longer to get dressed and do ADLs
  Micrographia

Question 6

Akinesia

Answer 6

• poverty of movement and trouble initiating movements

- Facial- hypomomia- lack of facial expressions and amimia- decreased eye blinking

Question 7

Posture and Gait

Answer 7

• short, shuffling gait (bradykinesia and rigidity)
• stooped posture
• may appear to drag one leg if asymmetric
• decrease in arm swing
• hesitancy in initiating and freezing
• may fesinate- centre of gravity forward so take show increasingly rapid steps to catch up
• postural instability as disease progresses

Question 8

Other Secondary Common symptoms

Answer 8

1. Cognitive dysfunction- dementia in 30%
2. Depression- 30-40%
3. sleep disturbance- due to rigidity, tremor, dystonia, restless leg syndrome, depression
4. Sexual dysfunction
5. excessive salivation 75%
6. Olfactory hypofunction
7. Autonomic dysfunction- constipation, hypotension, nausea
8. urinary dysfunction
9. Sensory- pain and cramps
10. Dystonia
    11.

Question 9

Hoehn and Yahr Scale

Answer 9

Commonly used to describe the progression of Parkinson’s Disease

Stage 0- no signs of disease
Stage 1- Unilateral symptoms only
Stage 1.5- Unilateral and axial involvement
Stage 2- Bilateral symptoms. No balance impairments
Stage 2.5- Mild bilateral disease with recovery on pull test
Stage 3- Balance impairment. Mild to Moderate disease. Physically independent.
Stage 4- Severe disability., but still able to walk or stand
Stage 5- Needing a wheelchair or bedridden unless assisted

Question 10

CMOP-E

Answer 10

Person- affective, cognitive, physical and spiritual
Occupation- self-care, productivity, leisure
Environment- physical, institutional, cultural and social

Question 11

Primary assessment areas

Answer 11

1. ADL
2. Upper limb strength and ROM
3. Balance
4. Ambulation
5. Tone and rigidity
6. coordination
7. vision
8. writing

Question 12

Secondary Assessment Areas

Answer 12

1. Fatigue
2. Sleep
3. Cognition
4. Depression
5. Quality of Life

Question 13

Challenges in Self-care

Answer 13

• ADLS take more time
• one and off times affect performance
• safety is compromised
• decreased desire or motivation to complete ADLs

Question 14

Treatment Overview

Answer 14

1. Patient-centered goals
2. Make observations
3. environment
4. blocked practice techniques
5. Self vocalization techniques
6. energy conservation and work simplification techniques

Question 15

Managing tremors and rigidity

Answer 15

• stretching and ROM exercises
• Use of non affected UE
• Positioning techniques and splinting
• Energy conservation and work simplification
• relaxation
• pain management

Question 16

Feeding

Answer 16

• weighted utensils
• built up utensils
• scoop plates
• rocker knives
• adaptive strategies

Question 17

Dressing and bathing

Answer 17

• reacher
• sock aid
• long shoehorn
• elastic or velcro
• long sponge
• robe for drying

Question 18

Housekeeping and meal prep

Answer 18

• electric gadgets
• dycemto to prevent slipping
• trolley cart or walker trays

Question 19

Computer Work

Answer 19

Adapted keyboards
hands free software
one handed typing
seating and positioning

Question 20

Micrographia

Answer 20

• Print
• use lined paper
• adaptive writing aids
• practice

Question 21

Challenges in functional mobility

Answer 21

• bed mobility
• sit to stand
• turning
• stairs

due to:

bradykinesia
- smaller movements
- freezing
- rigidity
- safety concerns
postural instability

Question 22

Challenges in Rigidity

Answer 22

• Increase in muscle tone
• Cogwheel, lead pipe- dystonia
• often increases with active movement- mental concentration- emotional tension
• Stooped forward posture
• pain

Question 23

Treatment for Walking

Answer 23

• Cues
• Lines taped to floor
• Improve carry over
• Focused attention
• Reduced distraction
• auditory and verbal cues
• counting steps
• music

Question 24

Treatment Overview

Answer 24

• simplify treatment
• max. change with minimal cognitive effort
• Visual cueing and demonstrations
• repetitive activities
• Focus on increasing functional communication

Question 25

Treatment for dyphagia

Answer 25

• strengthening exercises for muscles used for eating and swallowing
• compensatory strategies for safe swallowing
• diet modifications
• patient and family education

Question 26

Treatment for Cognition

Answer 26

• increase awareness
• compensatory strategies
• auditory processing and retention strategies
• daily planner, routine, schedule
• take notes or use tape recorder
• doing one thing at a time
• repetition/rehersal
  allow extra time