Parkinsons Flashcards
What is the pathology of Parkinson’s disease
Not enough dopamine, imbalance between dopamine and acetylcholine
Is Parkinson’s insidious or does it have a sudden onset?
Insidious, progressive, chronic
What are the cardinal features of Parkinson’s
Resting tremor that can decrease with purposeful activity, muscle rigidity, Brady kinesia, postural instability
Does the resting tremor resolved with activity
Yes
Do tremors occur/start bilaterally or unilaterally
Starting unilaterally that spreads contralaterally over several years
What is muscle rigidity
Increased resistance to passive range of motion that is a jerking quality, also started unilaterally than spreads
What is Brady kinesia
Generalize slowness in movement, Can be described as a weakness, and coordination, and tiredness
What is the major cause of disability in Parkinson’s patients? Which symptom
Brady kinesia
What are some non-motor clinical manifestations of Parkinson’s that could be considered neuropsychiatric
Cognitive dysfunction, dementia, psychosis, hallucinations, mood disorders, or factory dysfunction, sleep disturbance,
Autonomic dysfunction including orthostasis constipation dysphasia diaphoresis urinary difficulties and sexual dysfunction.
Pain and sensory disorders including face abdomen genitals and joints.
What will a patient with Parkinson’s gait look like
Short shuffling gait
Micrographia
PD/OFS handwriting, writing is shrunken head tilted compared to normal handwriting
How to diagnose Parkinson’s
No specific diagnostic test, based on history and clinical features. Usually 2 to 3 signs of classic triad present. Ultimate confirmation would include a positive response to anti-parkinsonian drugs
Levodopa
Most effective drug for symptomatic Parkinson’s, most effective for Bradykinesia’s, lots of side effects, on and off phenomenon eventually occurs
Main drug therapy for Parkinson’s
Levodopa, dopamine agonist, anti-cholinergic. Anti-cholinergic would be used as a mono therapy, dopamine would be used as a mono therapy or combo medication.
What is the on off phenomenon?
Consequence of long-term levodopa. On equals mobile, off equals immobile. Eventually becomes more unpredictable
What to do if your patient is experiencing the on off phenomenon
Reduce enter does intervals, controlled release medication, avoid high protein meals
Deep brain stimulation
Most common surgical treatment for advance Parkinson’s, adjust to control symptoms, is reversible, electrodes surgically placed in brain and connected to neurostimulator that is a pacemaker device in the chest
General care for a patient with Parkinson’s
A lot extra time for verbal responses, plenty of time for ADL and collaborate with OT, listen, administer meds properly and monitor for side effects, implement interventions to prevent complications of a mobility such as constipation contractures or skin breakdown, encourage physical exercise, collaborate with PT
Climb rate with speech pathologist due to concerns of dysphasia or hypophonia, collaborate with dietitian, assess for depression and anxiety, assessed for insomnia or sleepiness
Dietary considerations
When working with a dietitian ensure that the patient has a balanced diet, high calorie, high-fiber, increase fluid intake, bite-size pieces, small frequent meals
What to teach a patient when they are freezing while walking
Consciously think about stepping over imaginary a real lines on the floor Colonel drop items for them to stop over, Rockside decide, lift toes when stepping, one step backward two steps forward. Remove any rugs or tripping hazards in the home
