parkinsons Flashcards
how common is parkinsons
the secound most common neurodegenerative disorder of the CNS
is age an important factor in parkinsons
yes
the vaerage age of on set is 50-60
rare in those < 40
is park more prevalent in men or women
men
what is the cause of park
Mostly idiopathic/unknown (78%)
Some may be linked to genetic mutation (10%)
what is Secondary Parkinsonism
a group of disorders that have features similar to those of Parkinson disease but have a different etiology.
what are some examples of Secondary Parkinsonism
Infection
Drugs - Toxins
Tumors
Vascular
Metabolic disorders
what does the basal ganglia consist of
caudate
putamen
globus pallidus
sub thalamic nucleus
substania nigra
(CPGss)
what are the functions of the basal ganglia
goal directed behavior
self regulation
regulate emotions
regulate eye movements
Regulates skeletal muscle contraction
how specifically does the BG regulates skeletal muscle contraction
Regulates muscle force,
multi-joint movements,
sequencing of movements,
involved in motor planning
the motor coretex feeds into what two parts of the BG
putamen and sub thalamic nucleus
the excite these pathway s
all paths in the BG lead to the
motor part of the thalamus
Pathophysiology of Park
loss of the neuros in the substaia nigra that produce dopamine
how much cell loss do we need to show the signs of park
up to 80%
what does the loss of dope (ext/ihb) do to the BG pathway
causes less disinhibition of “Go” pathway and excess inhibition of “No-Go” pathway
this leads to brady and hypokinesia
clinical manifestation of park - motor
tremor
ridgity
impaired postural control
bradykinesia
(cardinal signs of Park)
what kind of tremors do we see with park
resting, pill rolling tremor
rhythmic
where do we normally see tremors in park
hands and feet
when do park tremors increase
with stress, fatigue, strain
does the tremor seen with park changes
yes it can chnage as the disease progresses
parkinsons and rigidity - type
Velocity independent resistance to stretch
cogwheel or lead-pipe rigidity
where is parkinsons and rigidity felt
a and a
may feel ‘stiffness’ or ‘heaviness
parkinsons and rigidity and gait
may have less arm swing
what is Bradykinesia
Slowness of movement
what causes brady
insufficient muscle force during initiation of movement
Weakness, tremor, and rigidity can be contributing factors
what is Bradyphrenia
slowness of thought
what is Akinesia
poverty of movement
inability to voluntarily move one’s muscles and limbs
“freezing” FOG
what is the cause of akinesia
Influenced by rigidity, stage of disease, attention, depression
Difficulty or inability to initiate movement
what is Hypomimia
masked facial expressions
what is Hypokinesia
the underscaling of movements
decrease in the range or amplitude of movements
Micrographia
small handwriting
what is Postural Instability
Abnormal postural responses
due to Reduced limits of stability
what does decreased postural control lead to difficulties with
reactive and anticipatory postural control
Responses are often too slow or too small
motor learning and park
Reduced ability to retain and transfer motor skills
best to use block practice
what gait disturbances do we see with park
Freezing of gait
Slowness of pace and rhythm
decreased arm swing
decreased postural control
Retropulsion or anteropulsion - Stooped posture
do those with park have sensory dysfunctions
Parasthesias/pain
Difficulty with integration of proprioceptive inputs
Olfactory dysfunction
Visual perceptual dysfunction
what is cog wheel rigidity
jerky resistance to the passive movement , this is because the muscle are relaxed and contracting
what is lead pipe
is a sustained resistance throughout the attempted movement
what is Hypokinetic dysarthria
present in some with park
decreased volume, monotone, decreased articulation, uncontrolled rate
early MCI is a predictor for what
associated with increased risk of dementia in later stages
how do we diagnoses park
there is not one single test
may be made on history and examination
Continued observation of motor & non-motor symptoms
Parkinson-plus syndromes must be ruled out
do we use imagine to help diagnoses park
some what
used to rule out other central disorders
Hoehn and Yahr Classification - stage 1
unilateral involvement only
min to no functional impairments
Hoehn and Yahr Classification - stage 2
bilat or midline involvement
no impairment to balance
Hoehn and Yahr Classification - stage 3
impaired right reflexes
unsteadiness
pt can live independently - disability is mild to mod
Hoehn and Yahr Classification - stage 4
sym are severe
standing and walking are only possible with assistance
Hoehn and Yahr Classification - stage 5
confined to bed or WC
what is a righting reflex
corrects the orientation of the body when it is taken out of its normal upright position
how long is the preclinical period
5 - 25 years
how long to park pt last
10-20 years
slower progression signs
younger age
tremor as the predominant feature
rapid progression signs
postural instability
gait disturbances
when do pt response to dope meds
beginning stages of disease
they will need an increase as the disease progresses
increased dose of meds leads to what after effect
Dyskinesias
what is the gold standard drug for PD
Carbidopa/Levodopa
what does Carbidopa/Levodopa help to control
bradykinesia and rigidity
what is the function of Carbidopa/Levodopa
compensate for dopamine deficiency
Deep brain stimulation (DBS)
treatment
Involves surgically implanted, battery-operated device that delivers electrical stimulation to areas of the brain to block abnormal signals in the BG circuitry to decrease PD symptoms
what does Deep brain stimulation (DBS) treatment help with
tremor and other motor symptoms
High protein diet can do what
block effectiveness of levodopa
what kind of diet should the pt adhere to
high calorie, low protein diet
what is Bradyphrenia
slow thinking - be patient with these pt
what to do with CN
screen
vision and eye movements
olf
swallowing
speech
would we screen sensory or include it in our neuro pt exam
screen
Ask about paresthesia and/or pain
Light touch screen
Proprioceptive information
screen motor
no fully assess
screen coordination
yes
screen balance
no
outcome measure for balance
Berg Balance Scale
FGA
ABC
screen function
no
what do we prioritize
motor
balance
functional
Restorative PT approach
Improving upon functional impairment/activity limitations
Preventative & Maintenance PT approach
moderate to high intensity exercise in earlystages can slow the progression of the disease
Minimize secondary impairments/complications
Compensatory PT approach
Focus on modification of the task/environment and getting patient the necessary equipment needed
Flexibility exercises
for park
evidence is weak
Aerobic exercise
Resistance training
Balance training
for park
all are reccomended
nonprogressive exercise intervention vs progressive resistance training program
A progressive resistance training program was shown to be more effective than a nonprogressive exercise intervention
common balance activities
Common interventions emphasize multidirectional stepping,motor agility,anticipatory postural control,and reactive balance
what type of training should PTs use for improve postural control, balance outcomes, and spatiotemporal gait impairments
balance over resistance training
is gait training good
yes
external cueing good or bad
good
community-based exercise good or bad
good
tai chi, ai chi, power yoga, hatha yoga, Pilates,group training,dance, noncontact boxing,Nordic walking,qigong, and meditation
what is LSVT (Lee Silverman Voice Treatment) BIG Treatment
Focus on intensive exercise of large movement amplitudes
what is Parkinson Wellness Recovery (PWR!)
Free core set of exercises to target a skill known to deteriorate in people with PD
Later Disease Stagesand PT
therapy shifts from restorative interventions to preventative and compensatory interventions
