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Neurology Final > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Parkinson’s is a _ _ _ disease involving the _ _.

A

Parkinson’s is a SLOWLY PROGRESSIVE CNS disease involving the BASAL GANGLIA

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2
Q

The cardinal symptoms of Parkinson’s disease is _, _, _ instability and _.

A

Cardinal symptoms of RIGIDITY, TREMOR, POSTURAL instability, and BRADYKINESIA.

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3
Q

What are the 2 clinical subtypes of Parkinson’s?

A

Postural Instability dominance

Tremor dominance

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4
Q

There is a genetic influence in _ than _% of cases. Age of onset is - years, and it affects _ more than _. Ratio?

A

Genetic influence in less than 10% of cases.

Age of onset is 50-60 years, and it affects MEN MORE THAN WOMEN

Ratio of 1.2-1.5

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5
Q

3 types of Parkinson’s disease?

A

Primary Parkinson’s
Secondary Parkinson’s
Parkinson-Plus Syndromes

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6
Q

What is the most common type of Parkinson’s? Associated percentage?

A

Primary Parkinson’s at 78% of cases

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7
Q

Which type of Parkinson’s disease includes post-infectious, toxic and metabolic Parkinson’s?

A

Secondary Parkinson’s

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8
Q

Parkinson- Plus syndromes includes? (6)

A

WilliaM CHAP

Wison’s disease, Multiple system atrophy (MSA)

Cruetzfeld-Jakob Disease (CJD), Huntington’s disease, Alzheimer’s disease, Progressive Superanuclear palsy (PSP)

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9
Q

Which two types of Parkinson’s disease respond to levidopa?

A

Primary and secondary Parkinson’s

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10
Q

There is _ _ _ test available for Parkinson’s disease.

A

NO SINGLE DEFINITIVE TEST

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11
Q

Diagnostic criteria: Objective evidence of _ _ _of the _ Cardinal signs, exclusion of - _, and ruling out of _ _.

A

Objective evidence of 2 or more of the 4 Cardinal signs, exclusion of PARKINSON-PLUS SYNDROME, and ruling out of OTHER PATHOLOGIES

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12
Q

What is the classification scale used to classify Parkinson’s? General scale trend?

A

Modified Hoehn and Yahr Classification of Disability

1-5, from least to most disabling

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13
Q

Modified Hoehn and Yahr classification of Disability: 1- _ or _, _ if present; 1.5- _ disease with _ involvement; 2- minimal _ or _ involvement. _ not impaired. 2.5- Early signs of _ _.

A

1-MINIMAL or ABSENT, UNILATERAL if present
1.5- UNILATERAL disease with AXIAL involvement
2- minimal BILATERAL OR MIDLINE involvement; BALANCE not impaired
2.5- Early signs of POSTURAL INSTABILITY

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14
Q

Modified Hoehn and Yahr Classification of Disability: 3- impaired _ _. _ when rising from a _. Some activities are _, but patient can live _ and continue some forms of _.

A

3- impaired RIGHTING REFLEXES. UNSTEADINESS when rising from a CHAIR. Some activities are RESTRICTED, but patient can live INDEPENDENTLY and continue some forms of EMPLOYMENT.

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15
Q

Modified Hoehn and Yahr Classification of Disability: 4-_ _ to still able to _ or _ unassisted. 5- _ to _ or _.

A

4- SEVERE DISABILITY to still able to STAND OR WALK unassisted.

5- CONFINED TO BED OR WHEELCHAIR

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16
Q

_ is a _ _, and is considered to be the gold standard medication for Parkinson’s since 1961.

A

SINEMET (levodopa/ carbidopa) is a DOPAMINE REPLACEMENT . . .

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17
Q

Deprenyl helps control the “_ _” phenomenon

A

Helps control the ‘WEARING OFF’ phenomenon

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18
Q

Requires and Mirapex are _ _.

A

DOPAMINE AGONISTS

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19
Q

Anticholinergics such as Artane help moderate _ and _

A

Moderate TREMOR AND DYSTONIA

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20
Q

The On-OFF phenomenon are random _ in _ and _ performance

A

RANDOM FLUCTUATIONS in MOTOR and FUNCTIONAL performance

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21
Q

The honeymoon period, is the period?

A

Is the initial phase in which the medication works immediately and is able to control symptoms

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22
Q

--_ _ is where symptoms begin to change or worsen as the medication ‘wears off’ with each dose over time.

A

END-OF-DOSE DETERIORATION

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23
Q

What are 2 surgical procedures that are less commonly used today to treat Parkinson’s? Most common surgical procedure?

A

Less commonly used: (TP)
- Thalamotomy and Pallidotomy

Most common:
Deep Brain Stimulation

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24
Q

Sensory changes, hypo kinetic dysarthria, dyphonia/ mutism, Dysphagia, sialorrhea (drooling), dementia, Bradyphrenia, seborrhea (crusty greasy skin), akathisia (restlessness), bladder/ bowel issues, micrographia (small writing), masked face/ flat affect, fatigue, orthostatic hypotension and sleep disturbances are all?

A

Common impairments seen with Parkinson’s

25
Q

4 more common impairments seen with Parkinson’s?

A

RB PT

Rigidity (cogwheel or lead pipe)
Bradykinesia (hesitation, freezing)
Postural Instability
Tremor (resting and postural)

26
Q

_, _, and _ are impairments of the body structure and function that are directly related to Parkinson’s disease.

A

BRT

Bradykinesia, rigidity, and tremor

27
Q

Impaired _ and _ are impairments of body functions and structures indirectly related to Parkinson’s disease.

A

Impaired FLEXIBILITY AND ENDURANCE

28
Q

Key Questions to ask regarding Medical History: _ symptoms, _ over time , _ _, patient _, _, _ history, _ _ history, and current _ _/ _ level.

A 
INITIAL symptoms
PROGRESSION over time
CHEIF COMPLAINTS
Patient GOALS
MEDICATIONS
FALL history
PAST MEDICAL history
Current HEALTH STATUS/ ACTIVITY level
29
Q

Gait (arm swing, step length), gait initiation, reactive postural responses, sit to stand, saccades (being able to visually jump from one object to the next), facial expressions, swallowing, blood pressure adjustments to postural changes are all?

A

Highly practiced (automatic) daily behaviors that are modulated by the Basal Ganglia

30
Q

What are 2 common postural stability tests that are used? How are they performed? (3) What is a positive result? (3)

A

Pull Test and Push and Release test

Can be done forwards, backwards and to each side

Positive result includes festinating gait, quick steps or inability to maintain balance

31
Q

A PT evaluation should be performed in the _ state or at both the _ and the _ state. Reassessment should be performed at the _ _ in the _ _.

A

Evaluation should be performed in the ON state or at BOTH THE ON AND OFF state.

Reassessment should be performed at the SAME TIME in the MEDICATION CYCLE (on/ off state)

32
Q

_ and _ is best performed in the on state, as well as _ _to allow for the best _. Strategies learned in the _ _ can help in the _ _, these include _ and _ _.

A

TRAINING AND EXERCISE best performed in the on state, as well as STRATEGY TEACHING to allow for the best CARRYOVER.

Strategies learned in the ON STATE can help in the OFF STATE, these include incorporating VISUAL AND AUDITORY CUES.

33
Q

_/ _ is usually associated with the ON state. Finding a balance with _ is important to keep from _ _ _ versus _ _ able to _.

A

DYSKINESIA/ WRITHING is usually associated with on state.

Finding a balance with MEDICATION is important to keep from MOVING TOO MUCH versus NOT BEING able to MOVE

34
Q

Disability specific instruments such as the _ _ _ _ , the _ _ _ (-_), and the _ _ can be useful tools during the examination.

A

UNIFIED PARKINSON’S DISEASE RATING SCALE (UPDRS), the PARKINSON’S DISEASE QUESTIONNAIRE (PDQ-39), and the PD EDGE can be . . . .

35
Q

Which disability specific instrument provides an overview of how PD is affecting a patient life?

A

Unified Parkinsons’ disease rating scale (UPDRS)

36
Q

Sensation/ Vision, flexibility, rigidity, strength, tremor, postural instability, balance, gait, and functional mobility are all examples of?

A

Things that should be looked at during the physical examination

37
Q

Tremor should be examined _ _ and _ _. During gait examination you should look at ability to _, _ as well as _ and _.

A

Tremors should be examined AT REST and WITH ACTIVITY

During gait examination you should look at ability to INITIATE, SUSTAIN as well as SPEED AND ENDURANCE

38
Q

Functional examination should include _ mobility, _, _ recovery and ability to _ _ _ the _.

A

BED mobility, TRANSFERS, FALL recovery, and the ability to GET UP OFF OF THE FLOOR

39
Q

5X sit to stand, MiniBEST test, 10 M gait speed, functional gait assessment (FGA), TUG-COG/ dual task TUG, 6MWT, and the 9-hole peg test are all?

A

APTA PD EDGE recommended tests for PD

40
Q

What is considered the gold standard by the APTA EDGE for PD? Where is performed? What is it?

A

MDS- UPDRS

Performed in an MD’s office

Large scale quality of life assessment

41
Q

What does the EDGE document recommend for cognitive assessment? What is the name of the more simplified version of the PDQ-39?

A

Montreal Cognitive Assessment (MOCA)

The simplified version of the PDQ-39 is the PDQ-8

42
Q

What APTA practice pattern for determining impairments is recommended for PD? Also recommended for? (2)

A

Pattern 5E

Also recommended for MS and ALS

43
Q

Practice pattern 5E is used for impaired motor function and sensory integrity associated with _ _ of the _ _ _.

A

Associated with PROGRESSIVE DISORDERS of the CENTRAL NERVOUS SYSTEM

44
Q

Motor learning strategies for PD include using external _, _, or () cues to help with _ and _ _. Practice strategies include _ _/ _ _.

A

Include using external VISUAL, VERBAL, or TIMING (METRONOME) cues to help with STEPS and STRIDE LENGTH.

45
Q

Relaxation training for both _ and _, _/ _ training, _ training, _ training, balance/ gait/ _ management training, and _ / _ education are all PT interventions that can helpful with Parkinson’s patients.

A

Relaxation training for both PATIENT AND CAREGIVERS
STRENGTH/ CARDIOPULMONARY training
FLEXIBILITY training
FUNCTIONAL training
Balance/ gait/ FREEZING MANAGEMENT training
HEP/ FAMILY education

46
Q

What is the name of PD intervention which helps by resetting the internal system to increase and maintain large amounts of movement? How often is it performed? Includes _ daily tasks and - functional tasks that include _ and _.

A

LSVT BIG

Performed 4X/ week for 4 weeks

Includes 7 daily tasks, and 3-5 functional tasks that include REPETITION AND VARIABILITY

47
Q

_, , and _ are effective when implemented during the neuroprotection phase ( _ _% of dopamine loss)

A

EXERCISE, DIET, and MEDICATION are effective when implemented during the neuroprotection phase (LESS THAN 20% of dopamine loss)

48
Q

_ as much _ as possible is important during the neurorestoration phase (%-% dopamine loss)

A

RESTORING as much FUNCTION AS POSSIBLE is important during the neurorestoration phase (21%-60% dopamine loss)

49
Q

The _ _ occurs with greater than 60% of dopamine loss

A

COMPENSATION

50
Q

- _(aka _ _ _) may protect or rejuvenate viable dopamine agonist neurons during pre-clinical or early stages of PD. Even in moderate or advanced stages of PD _ _ _ improve specific functions (mobility, balance, gait, endurance) even in the absence of evidence for neuroprotection.

A

FORCED-USE PARADIGMS (aka INTENSIVE EXERCISE PROTOCOLS) may protect or rejuvenate viable DA neurons during pre-clinical or early stages of PD.

Even in moderate or advances stages INTENSIVE EXERCISE PROTOCOLS improve specific function . . .

51
Q

Stopping _ or _ _ cancels the brain and behavioral benefits gained by _.

A

Stopping EXERCISE OR ADDING STRESS cancels the brain and behavioral benefits gained by EXERCISE.

52
Q

Exercise is a _ - _ option in PD. Shown to stimulate _ of new _, alter _ and _ responses, increase _ _, and protect against natural _.

A

Exercise is a LEGITIMATE DISEASE-MODIFYING THERAPEUTIC option in PD

Shown to stimulate PROLIFERATION of NEW NEURONS
Alter METABOLIC and IMMUNE responses
Increase BLOOD SUPPLY
Protect against natural NEURODEGENERATION

53
Q

_ _, _ protein diet works best with medication and activities to help _ _.

A

HIGH CALORIE, LOW protein diet works best with medication and activities to help MINIMIZE FLUCUATIONS

54
Q

Current PD paradigm for physical therapy is _ _ of care, ideally APTA is pushing for a move toward _ _, in which rehab is provided at _ _ over the _ _ with _ _ _ at each visit.

A

Current PD paradigm for PT is DISCRETE EPISODES of care, ideally APTA is pushing for a move toward SECONDARY PREVENTION, in which rehab is provided at REGULAR INTERVALS over the DISEASE CONTINUUM with STANDARDIZED OUTCOME MEASURES at each visit.

55
Q

_ riding/ _ _ riding, _ _, _ _, _ dancing have all been shown to be helpful in PD patients. It is important to find?

A

BIKE RIDING/ TANDEM BIKE RIDING, TAI CHI, KICK BOXING, TANGO dancing have all been shown to be helpful in PD patients

It is important to find and activity that is meaningful to the patient

56
Q

Dopamine has little control over _, and it usually made worse with _ _ on the the _. Patients need a _ or _ to allow the system to reset.

A

Dopamine has little control over FREEZING, and it is usually made worse with FOCUSING HARDER on the GOAL.

Patients need a DISTRACTION OR STIMULUS to allow system to reset.

57
Q

3 strategies for freezing?

A

ADO

Alternate motor program
Distraction
Outside stimulus (sound, visual cue)

58
Q

An alternate motor program is taught when patient is _ _, and the _ is _ so the body has an _ _ to fall back on.

A

Is taught when patient is NOT FREEZING, and the PATTERN is PRACTICED so the body has an AUTOMATIC SCHEMA to fall back on.

59
Q

Freezing occurs in the _ phase (no _ or _ phase) and is most commonly seen with _ movements, changes in _ _ or when walking over a _ or through a _.

A

Freezing occurs in the OFF phase (no MEDS OR WEANING phase) and is most commonly seen with TURNING movements, changes in FLOOR SURFACE, or when walking over a THRESHOLD or through a DOORWAY

Neurology Final (3 decks)

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