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Neuro Rehab 2 > Parkinsons - 2a PT management > Flashcards

Parkinsons - 2a PT management Flashcards

1
Q

the majority of standardized tests recommended by the PD EDGE are in what domain

A

activity

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2
Q

which standardized tests recommended by the PD EDGE are in the participation domain (2)

A

PDQ-8 or 39
Parkinsons’ Fatigue Scale
- also activity measure

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3
Q

which standardized tests recommended by the PD EDGE are in the impairment domain (2)

A

MoCA
MDS-UPDRS
- also activity measure

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4
Q

what is the PD EDGE

A

group APTA formed to eval best standardized tests and measures for parkinsons’

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5
Q

what test is the gold standard for evaluating parkinsons

A

UPDRS
- unified parkinson’s disease rating scale

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6
Q

what does the UPDRS measure and what are its 6 sections

A

measures dz severity, progression, and effect of meds

6 sections of BSF & activity:
1. cognition
2. ADLs
3. motor exam
4. complications of therapy (SE of meds)
5. modified Hoehn and Yahr Scale
6. schwab and england ADL scale

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7
Q

what makes the UPDRS so comprehensive

A

sections and 5 and 6 are stand alone tools incorporated into test

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8
Q

what is the MDS-UPDRS and what are its 4 sections

A

movement disorders society UPDRS
- revised, condensed version of UPDRS

  1. non-motor aspects of experiences of daily living (nM-EDL)
  2. motor aspects of experiences of daily living (M-EDL)
  3. motor exam
  4. motor complications
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9
Q

what is the gold standard test specific to disease severity

A

hoehn & yahr scale

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10
Q

what are the 6 hoehn and yahr stages

A

0: no visible sx
1. PD sx unilateral
2: PD sx (B), no difficulty amb
3: PD sx (B), min difficulty amb
4: PD sx (B), mod diff amb
5: PD sx (B), unable to walk

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11
Q

what is a pull test

A

give someone forceful posterior perturbation & measure amt of steps to recover

(+) = >2 steps
(-) = recovers, only 1-2 steps

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12
Q

what is a concern w pts w a 3.0 on the modified Hoehn and Yahr scale

A

high risk for falls
- may need adaptive equipment

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13
Q

what is the modified hoehn and yahr scale

A

1.0: unilateral only
1.5: unilateral & axial
2.0: bilateral, balance is good
2.5: mild bilateral, (-) pull test
3.0: mild to mod bilateral, some postural instability, (I)
4.0: severe disability, able to walk/stand w ADs
5.0: wc bound or bedridden unless aided

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14
Q

what are 3 standardized tests to assess bradykinesia

A

10m walk test
9-hole peg test
5 xSTS test

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15
Q

what does the 10m walk test look at, what does it look like in parkinsons and what is the prompt you give pts w/o PD

A

looking at gait speed
walks at slower velocity
walk at preferred speed vs fastest

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16
Q

what is a predictor of falls in the 5xSTS test

A

16sec score predictor of falls in PD population

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17
Q

what standardized test is used to measure rigidity and how is this measured

A

UPDRS item 22

0 - absent
1 - slight
2 - mild to mod
3 - marked, full ROM easily
4 - severe, ROM difficult

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18
Q

what standardized test is used to measure resting tremor and how is this measured

A

UPDRS item 20

0 - absent
1 - slight/infrequent
2 - mild in amp, or mod but intermittently present
3 - mod amp and present most of time
4 - marked in amp, interferes w feeding/ADLs

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19
Q

what standardized test is used to measure dyskinesia and how is this measured

A

section IV of UPDRS

0 - non-existent
1 - mild
2 - present at rest, doesn’t interfere w activity
3 - mod, causes interference w activity
4 - severe

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20
Q

what is the most common reason we get a referral for someone w PD and what do we want to do ab this

A

falls

advocate for early referrals to dec risk of falls and progression of dz

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21
Q

at what point does postural instability usually present

A

middle stages of health condition

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22
Q

what type of balance test will be most challenging for people w PD and why

A

external perturbations
- d/t slow motor response

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23
Q

what are 5 standardized tests used to measure postural instability and what aspects do they each assess

A
  1. mini BESTest
    - looks at subsystems of balance, very comprehensive
  2. 5x STS
    - internal perturbations
  3. Pull Test
    - external perturbations
  4. FGA
    - stability w amb
    - focus on improving gait and balance
  5. ABC Scale
    - self report of confidence
    - help pinpoint activities they feel most unstable to incorporate
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24
Q

what ABC Scale score is predictive of falls and what is the MDC in PD

A

69
MDC = 13

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25
Q

what are 3 ambulation standardized tests used and what do they each specifically assess

A

10m walk test
- gait speed, fall risk
6MWT - amb endurance
FGA

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26
Q

what is FGA score is a predictor of fall risk in PD? and what score is the MDC for PD?

A

</=18
MDC = 4

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27
Q

what are 6 additional domains to assess w standardized tests and what domain is a specifically emerging area for us

A

cog (OT, SLP)
sleep ***
depression (psych)
akinesia
fatigue
fear of falling

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28
Q

what is a standardized test for cog

A

MoCA

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29
Q

what is a standardized test for sleep

A

parkinson’s disease sleep scale (PDSS)

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30
Q

what are 2 standardized tests for depression

A

geriatric depression scale
beck depression inventory

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31
Q

what is a standardized test for akinesia

A

freezing of gait questionnaire

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32
Q

what is a standardized test for fatigue

A

parkinson’s fatigue scale

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33
Q

what is a standardized test for fear of falling

A

ABC scale

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34
Q

what is a standardized test to assess participation level

A

PDQ39

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35
Q

what is the PDQ39 and its 8 subscales

A

disease specific measure of quality of life
self-report questionnaire

8 subscales:
- mobility
- ADLs
- emotional well-being
- stigma
- social support
- cog
- communication
- bodily discomfort

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36
Q

how can stigma impact someone w PD’s participation level

A

stigma ab a sx (ex: drooling) can be embarrassing and lead to pt self-limiting activities

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37
Q

what are 10 BSF impairments to look at/for in clinical exam

A

strength
ROM
sensation
ms tone
tremor
dyskinesia
vestib function
pain
respiratory function
cardiac function

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38
Q

why is it important to assess if there is a strength impairment

A

won’t see impaired isolated ACOM or abnormal synergies bc corticospinal tracts are intact

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39
Q

what ROM impairments do you commonly see in PD

A

joint play
ms length
trunk rotation

40
Q

what does impaired ROM often result from and lead to in PD

A

from rigidity

lead to developing flex posture w forward head, kyphotic posture, sedentary and sitting a lot
-> won’t see typical rotation and wt shift at trunk

41
Q

at what point in the dz process do you see impaired sensation and why

A

common to be impaired later in dz process
- not primary impairment
- not direct result of PD
- often older adults from typical aging changes in sensation and neuropathy

42
Q

what are 3 common sensation impairments

A

proprioception
light touch
kinesthesia

43
Q

why can you see impaired vestibular function, how does it present, and how is this integrated into our PT interventions

A

w trunk rigidity, lack of mvmt overall, dec rotation of head and trunk -> lead to slower firing of CNVIII vestibular firing d/t lack of activation and moving of head that would trigger signals of vestibulocochlear nerve

see hypofunction where minimal mvmts of head will result in exaggerated responses
- important to encourage more head motion and turns

44
Q

what are 2 common reasons for a pain impairment

A

dec ms length
rigidity

45
Q

what are 2 ways that respiratory function is impaired and why

A

trunk rigidity and poor posture
-> dec chest expansion & vital capacity

46
Q

what are 2 common cardiac function impairments and why? why are these especially relevant to PT interventions?

A

orthostasis
hemodynamic response

bc of deconditioning often

want to optimize CV health as much as possible bc common source of mortality in PD

47
Q

what are 3 areas to assess in the activity level of the clinical exam

A
  1. balance, trunk control, endurance
  2. functional mobility
    - rolling, scooting, sup to sit, STS, bed to chair, amb, dual task, stairs
  3. ADLs
48
Q

what is a mainstay of PT treatment for PD and why

A

external cueing (ie auditory, visual cues)
- can be very effective in initiation and keeping mvmts fluid

49
Q

what was the traditional treatment paradigm for PT and how has this shifted today

A

compensate for paucity of mvmt by teaching behavioral and cog strategies to bypass BG circuits

shifted to encourage exercise in managing PD

50
Q

when is environmental modifications introduced in PD

A

pushed off for awhile

51
Q

why is exercise so heavily supported in managing parkinsons now

A

inc dopamine and other neurotrophins (BDNF) which support functioning of BG circuits and mvmts

52
Q

what is the contemporary framework for PT in PD

A

start PT EARLY in dz process
- PT referral at time of dx

focus on primary impairments, and prevent secondary impairments
- “dental model”

53
Q

what type of exercise does evidence support in PD

A

regular aerobic strongly supported

evidence for resistive strength training, stretching, and balance exercises also

54
Q

what is the most common trigger for referral to PT

A

a fall

55
Q

why might a group exercise class be a good option in PD

A

less isolating
dec stigma if PD exercise group

56
Q

what are 9 PT interventions that there is strong evidence for

A

aerobic exercise
resistance training
balance training
external cueing
community based exercise
gait training
task specific training
behavior change approach
integrated care

57
Q

recommendation for aerobic exercise and 3 reasons why

A

mod to high intensity

inc VO2
dec motor dz severity
improve functional outcomes

58
Q

4 benefits to implementing resistance training

A

dec motor dz severity
improve strength & power
improve non-motor sx
improve function and QOL

59
Q

5 benefits to implementing balance training

A

improve postural control
improve balance/gait
improve mobility
improve balance confidence
improve QOL

60
Q

what PT intervention is there low quality of evidence for its implementation

A

flexibility exercises

61
Q

3 benefits to implementing external cueing

A

dec motor dz severity
dec freezing of gait
improve gait outcomes

62
Q

3 benefits to implementing community based exercise

A

dec motor dz severity
improve non-motor sx
improve function & QOL

63
Q

5 benefits to implementing gait training

A

dec motor dz severity
improve stride length
improve gait speed
improve mobility
improve balance

64
Q

benefit to implementing task specific training

A

improve task specific impairment levels and functional outcomes

65
Q

benefit to implementing a behavior change approach

A

improve physical activity and QOL

66
Q

benefit to implementing an integrated care approach

A

dec motor dz severity and improve QOL

67
Q

what intervention was there moderate quality of evidence for and what was the recommendation

A

telerehabilitation

to improve balance

68
Q

what was the statistically significant outcome of the SPARX Trial

A

significant difference b/w high intensity exercises (80%MHR) and controls
- only applicable to early stages

69
Q

parameters for aerobic exercise in PD

A

3-5x/wk
duration: inc 20min -> 60min
(progress duration/freq before intensity)

mod intensity: 13 on RPE scale
- 60-80% MHR
mode: walking, cycling
- early stages overground

*during “on” cycle w meds

70
Q

parameters for resistive exercise in PD

A

2-3x/wk w min of 1 rest day between training sessions
- can be same day as aerobic exercise training

1 to 3sets of 8-12reps
- rest each ms group 2-4min between sets

resistance of 40-80% of 1RM

modes: machines, free wts, elastic bands

71
Q

what are 6 current trends in neurorehab

A

tai chi
kayak
boxing
agility course
pilates
boot camp

72
Q

what does tai chi help to improve in PD (2)

A

anticipatory postural control
-> improves balance

improve bradykinesia thru emphasis on timing & fluidity and continuing mvmt pattern once initiated

73
Q

what does kayaking help to improve in PD (3)

A

promote axial rotation
improve rigidity
address brady & hypokinesia
- inc speed and encourage faster/larger amp mvmts

74
Q

what does boxing help to improve in PD (4)

A

internal/external perturbations
-> improve balance

improve akinesia of gait
axial rotation
counters brady and hypokinesia in UE

75
Q

what does an agility course help with in PD (3)

A

direction changes, turns
improve sequential coordination
dec akinesia or freezing

76
Q

what does pilates help with in PD (2)

A

strengthening
spinal ext and rotation

77
Q

what does a boot camp for PD entail (4)

A

10min of each activity
- progress w dual/cog
- progress w wt/resistance
- progress by inc speed/amp

78
Q

how to manage tremors: PT, equipment, meds

A

use mvmt to diminish tremor
- gesture, pass object from hand to hand

travel mugs w lids
half fill to avoid spills
adaptive spoons, pens

meds: MAOIs, DBS, ablation

79
Q

what are PT interventions for rigidity and flexibility

A

focus on trunk and spine ms

PNF B UE D2 w DBE
hook lying LTR, counter rot
frequent position changes
rocking chair (parasym)
yoga & tai chi
kayaking
boxing

daily stretching
- low evidence but include

80
Q

how do you structure PT management for bradykinesia and what is a primary example of an intervention

A

goal directed
high amp mvmts
multiple reps

LSVT-BIG
- 1hr 4x/wk for 4wks

81
Q

what PD population does LSVT-BIG have the best outcomes

A

earlier stages of PD

82
Q

what are 3 characteristics in PD does LSVT-BIG help improve

A

improve gait velocity
improve stride length
improve reaching velocity

83
Q

what are 3 major factors associated w recurrent falls in PD

A

progressing PD
postural instability
cog impairment

84
Q

what are characteristics that distinguish fallers from non-fallers

A

hx of falls
presence of FOG
preferred gait speed <1.1m/s

85
Q

PT interventions to improve balance (strengthening, ROM, anticipatory/reactive, sensory input, gait) led to what significant outcomes

A

37% decline in fall rates in active phase

significant dec in fear of falling and improved balance (mini BESTest)

86
Q

what evidence is available on Tai Chi and Qigong

A

low level evidence studies, don’t have a large scale RCT

definitely worth doing for anecdotal evidence if someone is interested

87
Q

what are PT interventions for postural instability (7)

A

internal perturbations (proactive or anticipatory)
- wt shifts
- alt stances
- reaching
- axial rotation + reaching
- throwing/boxing

external perturbations (reactive)
- SR, RS to upper and lower trunk
- nudges
- catching balls

alter tasks, positions, environment
falls diary
environment changes
ADs
tai chi

88
Q

what are 3 interventions to help w someone who has difficulty w direction changes

A

TUG
obstacle course
figure 8 pattern

89
Q

what are 5 compensations in later stages of PD if the pt has difficulty w direction changes

A

avoid sharp turns
turn in large arc
attention/cog strategies
clock turn strategy
concentrate on high stepping

90
Q

what are PT interventions and cueing to work on a STS (5)

A

part -> whole task training
mental rehearsal
proprioceptive cues
auditory cues
environmental modifications

91
Q

what are PT interventions and strategies for improving rolling and bed mobility in PD (4)

A

part task, log-roll
wake up 30min early
- take meds
- HEP for AROM/stretching
mental rehearsal, imagery
environmental modifications
- bed rail, silk sheets or pjs

92
Q

what are strategies for negotiating doorways (2)

A

vertical strip of colored tape thru doorway

visual spotting of object past the doorway

93
Q

what are 2 types of cues and 4 examples of each to manage hypokinesia in gait

A

visual cues
- laser line walkers/canes
- theraband on walkder
- tape lines on floor
- pennies

behavioral cues
- postural alignment
- inc UE swing
- trunk rotation
- cadence

94
Q

what are 3 PT interventions for akinesia or FOG and why does each work

A

rhythmic auditory stim (RAS)
- music, metronome, counting
cycling program
- external pacing cue of pedals
BWSTT, treadmill training
- inc gait speed

95
Q

what are 5 benefits to group classes for someone w PD

A

educational component
social interaction/support
address impairment & activity
add music, make it fun
improved adherence rates

Neuro Rehab 2 (48 decks)

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