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Neuromotor II > Parkinsonism > Flashcards

Parkinsonism Flashcards

1
Q

Group of neurological disorders that affect basal ganglia function and cause slowness of movement

A

Parkinsonism

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2
Q

What are the classifications that fall under Parkinsonism?

A
  1. Parkinson’s Disease (idiopathic parkinsonism) - Most common form 78% of patients
  2. Secondary Parkinsonism - Results from different causes: Virus, toxins, drugs, tumors
  3. Parkisonism-Plus Syndromes - Conditions that mimic PD (e.g., progressive supranucular palsy, cortical basal degeneration); More serious and less treatable
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3
Q

What is the role of the BG?

A
  1. Planning and programming of movement (initiation and speed)
  2. Willed movements, muscle tone, and muscle force
  3. Cognitive processes – awareness of body in space, ability to adapt behavior, and motivation
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4
Q

What happens to the BG in PD?

A

Cells in the substantia nigra (midbrain) stop producing dopamine
- Brain doesn’t receive messages about when and how to move

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5
Q

What are the cardinal features of PD?

A
  1. Rigidity
  2. Bradykinesia
  3. Resting tremor (pill rolling)
  4. Postural instaiblity
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6
Q

What are the features of rigidity?

A
  1. Increase resistance to slow passive movement
  2. Constant regardless of amplitude or speed of movement (NOT velocity-dependent)
    - Cogwheel rigidity – jerky resistance as muscles tense and relax
    - Leadpipe rigidity – maintained resistance
    - Usually affects proximal muscles first
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7
Q

What are the features of bradykinesia?

A
  1. Slowness and difficulty maintaining movement
  2. Akinesia – freezing episodes
  3. Movement is reduced in speed, amount, and amplitude
  4. Most disabling symptom in early PD
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8
Q

What are the features of postural instability in PD?

A
  1. Changes in posture and balance
  2. Narrow BOS
  3. Flexed stooped posture - weak trunk extensors and flexors
  4. Increased risk of falls
  5. Fear of falling often increases level of immobility
  6. Develops later in the disease
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9
Q

Other than the 4 cardinal features, what’re are other symptoms of PD?

A
  1. Fatigue
  2. Kyphosis
  3. Contractures
  4. Masked face
  5. Difficulty initiating movement
  6. Freezing episodes
  7. Difficulty with complex and sequential tasks (motor planning)
  8. Difficulty with dual tasking
  9. Loss of automaticity
  10. Dyskinesia
  11. Pain
  12. Paresthesias
  13. Daytime sleepiness
  14. speech and swallowing - dysphagia and hypo kinetic dysarthria
  15. Cognitive function - dementia, depression, bradyphrenia, hallucinations
  16. ANS - UI, sweating, greasy skin, increased salivation, abnormal sense of hot and cold, consitpation
  17. CP fxn - ortho hypotension, low BP, reconditioning, impaired respiratory fxn (obstruct, restrict)
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10
Q

What is the typical gait presentation of someone PD?

A
  1. Reduced stride length
  2. Reduced speed
  3. Shuffling steps
  4. Insufficient heel strike
  5. Reduced trunk rotation
  6. Decreased arm swing
  7. Festinating gait
  8. Freezing of gait
  9. Difficulty turning
  10. Difficulty with dual tasking
    - TUG is a good assessment, along with a longer distance assessment
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11
Q

What tests are used to document severity and progression of PD?

A
  1. Hoehn-Yahr Classification of Disability Scale (Table 18.1) – estimate stage of disease
  2. Unified Parkinson’s Disease Rating Scale (UPDRS - Appendix A)
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12
Q

What are the stages of PD according to Hoehn and Yahr?

A

Stage 1 - mild/early - unilateral symptoms
Stage 2 - mild/early - Bilateral symptoms without impaired balance
Stage 3 - moderate/ middle - Mild/moderate bilateral symptoms; some postural instability; can live independently
Stage 4 - Moderate/ middle - Severe disability; can walk independently
Stage 5 - Depends on W/C for mobility; bedridden unless assisted

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13
Q

What are the types of clinical presentation for PD?

A
  1. Postural instability and gait disorder predominant (PIGD) - Faster disease progression; poorer prognosis (determined later on)
  2. Tremor predominant
  3. Mixed
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14
Q

What are medications for PD?

A
  1. Levodopa/ carbidopa (L-dopa)
  2. Monamine oxidase inhibitors (MAOI’s)
  3. Dopamine agonists
  4. anticholinergic drugs - helps with tremor
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15
Q

Gold standard drug for PD; Raises level of dopamine in the BG; Controls bradykinesia and rigidity; High doses are necessary; Numerous side effects; Off-on periods if taken for more than 2 years; Optimal benefit from drug wears off in 4-6 years; Dyskinesias emerge at end of timeframe

A

Levodopa/ caridoa (L-dopa)

  • dyskinesia and dystonia are a side effect
  • often metabolized before it reaches by the brain, so used in conjunction with dopamine agonists
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16
Q

Drug used in early stages; Improves metabolism of dopamine; Seligiline; Has been shown to slow the disease progression

A

MAOI’s

17
Q

Electrodes implanted into the brain; Pulse generator placed in chest; Impulses interfere with and block the electrical signals that cause PD symptoms; Can help reduce rigidity, tremors, and bradykinesia

A

Deep brain stimulation

18
Q

What kind of diet may be used to manage PD?

A

High calorie low protein diet

  • Protein blocks effectiveness of L-dopa
  • Less than 15% of calories should come from protein
19
Q

What impairments should be included in the examination?

A
  1. Cognition
  2. Psychosocial function
  3. MSK
  4. Neurological
  5. CV - orthostatic hypotension
20
Q

What should be used to assess psychosocial function?

A
  1. Geriatric Depression Scale

2. Beck Depression Inventory

21
Q

What should be assessed in MSK?

A
  1. Overall postural alignment
  2. Flexibility of torso (functional axial rotation)
  3. Hamstring and gastroc length
22
Q

What activities should be examined?

A
  1. Bed mobility and transfers
  2. Stability
  3. Gait - Level surfaces, uneven surfaces, cluttered spaces, around obstacles, turning
    4, Reaching
  4. Dual-task performance - 2 motor tasks, motor and cognitive task
  5. Fine motor performance
  6. ADLs
23
Q

What should you use to assess participation?

A
  • Disease specific outcome measure:

Parkinson’s Disease Questionnaire (PDQ- 39) - Measures degree of participation in daily life activities

24
Q

What should be included in your neurological assessments?

A
  1. DTR’s
  2. Proprioception of foot and 3. ankle
  3. Rigidity
  4. Bradykinesia - timed movements, reaction time
  5. Tremor - location, persistence, severity
  6. Pain
25
Q

What are the best outcome measures for gait and balance in PD?

A
  1. Functional Reach Test
  2. Berg Balance Scale
  3. Functional Gait Assessment**
  4. BESTest (also miniBESTest)**
  5. TUG Test**
  6. TUG cognitive – dual tasking
  7. ABC scale – self report fear of falling
  8. Freezing of gait questionnaire
  9. 360 Degree Turn Stand
  10. 2 0r 6 Minute Walk Test
26
Q

What are the different types of rehabilitative strategies in PD?

A
  1. Restorative (Early) = Remediating
  2. Preventative (Middle) = Minimizing
  3. Compensatory (Late) = Modifying
27
Q

What should PT look like with mild/early stage of PD?

A
  1. Vigorous exercise
  2. Maintenance of flexibility
  3. strength and CV fxn
  4. Promote active lifestyle with continued involvement in home, work, and leisure
  5. strategy training - task specific practice of relevant skills; capacity to learn motor skills retained
  6. instruction on exercise program containing elements of CV, strength, and stretching
  7. prevent falls
28
Q

What are mobility intervention ideas?

A
  1. Prone on elbows
  2. Neck extension
  3. Standing with hands on wall and elbows extended
  4. Rhythmic and reciprocal movements
  5. Rocking to initiate movement
  6. Pelvic tilting
  7. Rotation of trunk in standing
  8. Facial movements
29
Q

What are balance intervention ideas?

A
  1. Dynamic mobility tasks
  2. Movement transitions
  3. Alter surface, visual inputs, and environment
  4. Standing exercises
30
Q

What are gait training intervention ideas?

A
  1. Upright posture - Overhead harness
  2. Use visual and auditory cues - Footprints on floor; Metronome; Use music to improve pace
  3. Braiding - Trunk rotation
  4. Alter surface, visual inputs, and environment
31
Q

What are common adaptations for PD?

A
  1. Elevate HOB
  2. Something to pull on to get up
  3. Stable and firm mattress
  4. Firm chairs with armrests
  5. Raised toilet seat
  6. Loose fitting clothing
  7. Velcro closures
  8. Shoes that slide
32
Q

What should PT look like with moderate/ middle stage of PD?

A
  1. more compensatory
  2. less focused on remediation of underlying impairments
  3. promotion of an active lifestyle with continued involved in home, work, and leisure - makes changes to the task or the environment
  4. encourage activities and exercise during an “on” state
  5. Strategy training - compensatory cuing strategy that is task specific
  6. prevention or reduction of falling - fall diaries
  7. reduction in multitasking
  8. exercise to reduce secondary sequelae of CV and MSK systems
33
Q

What should PT look like with severe/ late stage of PD?

A
  1. emphasis on compensation
  2. safety
  3. instruction of caregiver in how to provide assistance with fxn’l mobility
  4. instruction of caregiver in how to provide compensatory cues to assist with function
  5. active-assisted exercise to prevent worsening of secondary sequelae (contractures
  6. change in positions regularly to prevent skin breakdown, contractures, and postural deformities

Neuromotor II (13 decks)

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