Parkinsons Flashcards
What is parkinsons?
Neurodegeneration
Chronic and progressive movement disorder that makes the patient unable to control movement normally
What happens in parkinsons
Malfunction and death of cells in substantia nigra (dopamine producing cells)
What’s the causes parinsons?
Unknown in most cases
gene mutations
environment
genes
What’s the prevalence of parkinsons?
Primary- 78% (don’t know how it happened)
Secondary- 8% (drugs, trauma, infection, toxins)
What’s the typical parkinsons pt
Adult - 65-75 y/o
Male > Female
Tremor
Dyskinesia (bradykinesia / hypokinesia), Small involuntary
Rigidity
Dystonia- (Difficulty initiating movement) involuntary muscle cramps
Postural instability
What is an essential tremor?
Tremor with no other signs of PD
What are some assessment tools for PD?
Hoehn & Yahr Scale
What are the Hoehn and Yahr’s stages of PD
Stage 0 - no signs
Stage 1 - unilateral disease
Stage 1.5 - Unilateral plus axial movement
Stage 2 - Bilateral disease, w/o balance impairment
Stage 3 - Mild to moderate bilateral disease, postural instability; capacity of living indep. still
Stage 4 - Still able to walk or stand unassisted but unstable
Stage 5 - Wheelchair bound or bedridden w/o assist
What are some treatment approaches for PD?
Surgical - Deel Brain stim, Ablation, Transplantation
Pharmacological - Symptomatic, Neuroprotective
Nonpharmacologic - Education, Nutrition, Exercise
What is the goal of meds in treating PD?
Restore lost dopamine function -adds synthetic dopamine Stimulate dopamine receptors stimulate release of remaining dopamine inhibit enzyme that breaks dopamine down
What is L-dopa?
Synthetic version of dopamine
What does deep brain stimulation do?
Electrically stimulates the area around the electrode thus activating or inhibiting brain tissue depending on parameters
What does DBS help with?
Tremors Stiffness Freezing Speech (can also hurt) Balance (can also hurt)
What are complications to DBS?
Doesn’t cure PD
Inter-operative (hemorrhage, infection)
Perioperative (weakness, fatigue, confustion, mood changes)
Hardware-related (Erosion, lead fracture)
What are some key areas of intervention with PD?
Therapeutic exercise -aerobic conditioning -Strengthening -Posture -ROM -Balance Functional Training -Fall prevention, self-care, community included
What are some outcomes for therapy in pt c PD?
Minimize/ delay functional limitations leading to disability
Secondary prevention
pt understanding of disease
pt caregiver integration of appropriate intervention strategies
Where do you want to stretch and strengthen the pt
Stretch the front (neck flexors, pecs, biceps, flexors
Strengthen the back (axial retractors, extensors,
What are some exercises not recommended?
Biceps
ABD
Pecs
SLR
What are some areas of functional impairment?
Turning in bed
sit to stand
falling
gait (festination (shuffling gait), akinesia, freezing)
What is festinating gait?
Short step length
Lack of DF on heelstrike
absent counter rotation of trunk
loss of reciprocal arm swing
What are some things you can do to help with gait training?
Treadmill training
Auditory cues
Visual cues
Verbal Cues
What are some un-freezing strategies?
Try stepping over cracks on sidewalk Try mimic others walking Carry walking stick and place in front of you as target Relax, rock back on heels and try again Tap the leg you want to move forward
