Parkinsons

Question 1

What is parkinsons?

Answer 1

Neurodegeneration

Chronic and progressive movement disorder that makes the patient unable to control movement normally

Question 2

What happens in parkinsons

Answer 2

Malfunction and death of cells in substantia nigra (dopamine producing cells)

Question 3

What’s the causes parinsons?

Answer 3

Unknown in most cases
gene mutations
environment
genes

Question 4

What’s the prevalence of parkinsons?

Answer 4

Primary- 78% (don’t know how it happened)

Secondary- 8% (drugs, trauma, infection, toxins)

Question 5

What’s the typical parkinsons pt

Answer 5

Adult - 65-75 y/o
Male > Female
Tremor
Dyskinesia (bradykinesia / hypokinesia), Small involuntary
Rigidity
Dystonia- (Difficulty initiating movement) involuntary muscle cramps
Postural instability

Question 6

What is an essential tremor?

Answer 6

Tremor with no other signs of PD

Question 7

What are some assessment tools for PD?

Answer 7

Hoehn & Yahr Scale

Question 8

What are the Hoehn and Yahr’s stages of PD

Answer 8

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

Question 9

What are some treatment approaches for PD?

Answer 9

Surgical - Deel Brain stim, Ablation, Transplantation
Pharmacological - Symptomatic, Neuroprotective
Nonpharmacologic - Education, Nutrition, Exercise

Question 10

What is the goal of meds in treating PD?

Answer 10

Restore lost dopamine function
-adds synthetic dopamine
Stimulate dopamine receptors
stimulate release of remaining dopamine
inhibit enzyme that breaks dopamine down

Question 11

What is L-dopa?

Answer 11

Synthetic version of dopamine

Question 12

What does deep brain stimulation do?

Answer 12

Electrically stimulates the area around the electrode thus activating or inhibiting brain tissue depending on parameters

Question 13

What does DBS help with?

Answer 13

Tremors
Stiffness
Freezing
Speech (can also hurt)
Balance (can also hurt)

Question 14

What are complications to DBS?

Answer 14

Doesn’t cure PD
Inter-operative (hemorrhage, infection)
Perioperative (weakness, fatigue, confustion, mood changes)
Hardware-related (Erosion, lead fracture)

Question 15

What are some key areas of intervention with PD?

Answer 15

Therapeutic exercise
-aerobic conditioning
-Strengthening
-Posture
-ROM
-Balance
Functional Training
-Fall prevention, self-care, community included

Question 16

What are some outcomes for therapy in pt c PD?

Answer 16

Minimize/ delay functional limitations leading to disability
Secondary prevention
pt understanding of disease
pt caregiver integration of appropriate intervention strategies

Question 17

Where do you want to stretch and strengthen the pt

Answer 17

Stretch the front (neck flexors, pecs, biceps, flexors

Strengthen the back (axial retractors, extensors,

Question 18

What are some exercises not recommended?

Answer 18

Biceps
ABD
Pecs
SLR

Question 19

What are some areas of functional impairment?

Answer 19

Turning in bed
sit to stand
falling
gait (festination (shuffling gait), akinesia, freezing)

Question 20

What is festinating gait?

Answer 20

Short step length
Lack of DF on heelstrike
absent counter rotation of trunk
loss of reciprocal arm swing

Question 21

What are some things you can do to help with gait training?

Answer 21

Treadmill training
Auditory cues
Visual cues
Verbal Cues

Question 22

What are some un-freezing strategies?

Answer 22

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