parkinsons Flashcards
how to prevent retropulsion when transferring from sit to stand (wc)
shift upper body forward with the shoulder girdle over the quadriceps
retropulsion
loss of balance backwards
AE for tremors
weighted handle utensils
Parkinson’s disease
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
PD tremors
- resting tremor
- pill rolling tremor
- intention tremor
akinesia
none/slowed movements
causes of PD
genetic (sometimes), environmental risk factors, some toxins
pill rolling tremor
thumb & index rub back & forth against each other
resting tremor
shaking limbs while at rest (especially hands and arms)
intention tremor
increase in tremor severity before person moves limb
bradykinesia
slow movment, short steps while walking, dragging feet while walking, difficulty changing positions
muscle rigidity
stiff muscles, making it impossible to move
stooped posture
flexed posture, affects balance
types of gait in PD
shuffling, freezing gait
PD assessments
- 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
environmental modifications
- 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
caregiver education for PD
rhythmic cues, AE, environmental modifications
patient education for PD
energy conservation, work simplification, AE
FM coordination activities for PD
grade from assisted to independent, avoid timed tasks to reduce stress/intention tremor
focused attention activities for PD
visualize FM activity before completing, focus on single aspect of task to improve that particular movement
ROM/strengthening exercises for PD
grade from assisted to independent, use extra repetitions to minimize intention tremor
AE for PD
- 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
what occurs as PD progresses?
poor endurance & fatigue impact ADL participation
adaptations to reduce tremor
- AAROM exercises (ROM by sliding arms on table top)
- wrist/hand weights during writing & other FM tasks
- weighted eating/grooming utensils
- weighted pen/pencil
adaptations for mobility
wheeled walker
adaptations for UE mobility/strength
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
rhythmic cues
help to pattern activities
- reduce hesitation & intention tremor
- auditory, visual, tactile cues
cognitive symptoms of PD
impaired memory, EF, dementia, depression
oral motor problems in PD
swallowing problems, drooling
dressing for PD
- magnetic or hook & loop closures (for tremors to dress independently)
- quick-release waistbands (to minimize time to doff pants due to urinary urgency)
- shirts that open fully in the front, wide armholes (for stiff joints)
- thread belt through belt loops before donning pants
- buttonhooks, dressing sticks, shoe horns, sock donners
- replace standard shoe laces with elastic laces
- flat seam garments to minimize skin irritation, remove all garment tags (tingling/painful skin)
- metal ring with opening or easy grip ribbon to zipper pull to make them easier to grasp
Lee Silverman Voice Treatment (LSVT BIG)
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
complementary treatment for PD
lysergic acid diethylamide (LSD)- ergoline drugs which enhance biosynthesis of dopamine
most effective drugs for PD
levodopa (long term use results in dyskinesias, dystonias, possible toxicity, loss of effectiveness, cognitive impairment, psychosis)
dyskinesia
involuntary, erratic, writhing movements of the face, arms, legs or trunk
dystonia
involuntary muscle contractions causing slow/repetitive movements or abnormal postures that can sometimes be painful
