parkinsons

Question 1

how to prevent retropulsion when transferring from sit to stand (wc)

Answer 1

shift upper body forward with the shoulder girdle over the quadriceps

Question 2

retropulsion

Answer 2

loss of balance backwards

Question 3

AE for tremors

Answer 3

weighted handle utensils

Question 4

Parkinson’s disease

Answer 4

Progressive nervous system disorder- dopamine depleted in brain
- voluntary & involuntary movements
- tremor, rigidity
- slightly flexed hips/knees, flexed elbows/wrists, forward tilt of trunk
- writing smaller/shaky
- soft voice, slurred/quick speech, monotone voice
- unable to blink, smile, swing arms while walking
- freezing gait
TRAP: tremor, rigidity, akinesia, postural instability
SMART: shuffling gait, mask like face, akinesia, rigidity, tremor

Question 5

PD tremors

Answer 5

• resting tremor
• pill rolling tremor
• intention tremor

Question 6

akinesia

Answer 6

none/slowed movements

Question 7

causes of PD

Answer 7

genetic (sometimes), environmental risk factors, some toxins

Question 8

pill rolling tremor

Answer 8

thumb & index rub back & forth against each other

Question 9

resting tremor

Answer 9

shaking limbs while at rest (especially hands and arms)

Question 10

intention tremor

Answer 10

increase in tremor severity before person moves limb

Question 11

bradykinesia

Answer 11

slow movment, short steps while walking, dragging feet while walking, difficulty changing positions

Question 12

muscle rigidity

Answer 12

stiff muscles, making it impossible to move

Question 13

stooped posture

Answer 13

flexed posture, affects balance

Question 14

types of gait in PD

Answer 14

shuffling, freezing gait

Question 15

PD assessments

Answer 15

• ROM, MMT, grip/pinch strength
• FM (9 hole peg)
• cognitive eval: ACL, mini mental state exam
• visual perception: MFVPT
• ADL & IADL questionnaire
• observation of ADL/IADL skills

Question 16

environmental modifications

Answer 16

• ramps, widen entrance/interior doors
• remove area/throw rugs
• raised toilet or removable raised toilet seat, bath bech & hand held shower, wall mounted grab bars near toilet, bathtub, shower
• frequently used items on lower shelves of upper cabinets, upper shelves of lower cupboards in kitchen
• board or firm support under sagging chair cushions of chairs/couches
• raise low chairs/couches on risers to assist with sit to stand
• power lift chair
• power stair lift

Question 17

caregiver education for PD

Answer 17

rhythmic cues, AE, environmental modifications

Question 18

patient education for PD

Answer 18

energy conservation, work simplification, AE

Question 19

FM coordination activities for PD

Answer 19

grade from assisted to independent, avoid timed tasks to reduce stress/intention tremor

Question 20

focused attention activities for PD

Answer 20

visualize FM activity before completing, focus on single aspect of task to improve that particular movement

Question 21

ROM/strengthening exercises for PD

Answer 21

grade from assisted to independent, use extra repetitions to minimize intention tremor

Question 22

AE for PD

Answer 22

• built up handles in initial PD stages
• lightweight utensils
• weighted devices for object stabilization
  EX: to prevent spills during plate to mouth excursion, weighted utensils offer stability

Question 23

what occurs as PD progresses?

Answer 23

poor endurance & fatigue impact ADL participation

Question 24

adaptations to reduce tremor

Answer 24

• AAROM exercises (ROM by sliding arms on table top)
• wrist/hand weights during writing & other FM tasks
• weighted eating/grooming utensils
• weighted pen/pencil

Question 25

adaptations for mobility

Answer 25

wheeled walker

Question 26

adaptations for UE mobility/strength

Answer 26

reacher, long handled sponge for bathing, adapted clothing fasteners or pull on clothing, slip on/velcro closure shoes, non skid mats, jar opener, large handled cooking utensils, wheeled cart to transport items, walker basket

Question 27

rhythmic cues

Answer 27

help to pattern activities
- reduce hesitation & intention tremor
- auditory, visual, tactile cues

Question 28

cognitive symptoms of PD

Answer 28

impaired memory, EF, dementia, depression

Question 29

oral motor problems in PD

Answer 29

swallowing problems, drooling

Question 30

dressing for PD

Answer 30

1. magnetic or hook & loop closures (for tremors to dress independently)
2. quick-release waistbands (to minimize time to doff pants due to urinary urgency)
3. shirts that open fully in the front, wide armholes (for stiff joints)
4. thread belt through belt loops before donning pants
5. buttonhooks, dressing sticks, shoe horns, sock donners
6. replace standard shoe laces with elastic laces
7. flat seam garments to minimize skin irritation, remove all garment tags (tingling/painful skin)
8. metal ring with opening or easy grip ribbon to zipper pull to make them easier to grasp

Question 31

Lee Silverman Voice Treatment (LSVT BIG)

Answer 31

exercise & self cueing treatment derived from LSVT LOUD - improves mobility & treatment in everyday function
- evidence based tx protocol to address motor, sensory, non motor symptoms due to PD
- loudness in speech, bigger movements
- sensory recalibration to recognize movements with increased amplitude are within normal limits
- training self cueing, attention to action for long term maintenance
- neuroplasticity & motor learning
- high intensity, multiple reps, progressive complexity

Question 32

complementary treatment for PD

Answer 32

lysergic acid diethylamide (LSD)- ergoline drugs which enhance biosynthesis of dopamine

Question 33

most effective drugs for PD

Answer 33

levodopa (long term use results in dyskinesias, dystonias, possible toxicity, loss of effectiveness, cognitive impairment, psychosis)

Question 34

dyskinesia

Answer 34

involuntary, erratic, writhing movements of the face, arms, legs or trunk

Question 35

dystonia

Answer 35

involuntary muscle contractions causing slow/repetitive movements or abnormal postures that can sometimes be painful