PARKINSONS DISEASE

Question 1

What is it?

Answer 1

Condition affecting the brain causing movement issues.

Dopamine producing neurons in the substantia nigra (midbrain) die, causing a reduction in dopamine production. This disrupts the normal function of th basal ganglia which is responsible for initiation of movement, coordination and smooth movement.

Question 2

Early Symptoms of PD

Answer 2

bradykinesia
rigidity
tremor
pain
fatigue

Question 3

progressed symptoms of PD (~10yrs)

Answer 3

urinary symptoms
orthostatic hypotension
falls
freezing of gait
dysphagia
dyskinesia (involuntary movement)

Question 4

Advanced to late symptoms of PD

Answer 4

Psychosis
Plus all the others.

Question 5

Primary motor impairments of PD

Answer 5

Bradykinesia: slowness of movement
Hypokinesia: reduced movements
Akinesia: absence of movement
Freezing: sudden, temporary inability to move (subtype of akinesia)
Tremor: rhythmic, involuntary movements of a body part.
Rigidity: increased passive stiffness through range.

Question 6

Secondary motor impairments

Answer 6

Dyskinesia: involuntary movements
Dystonia: involuntary muscle contractions in the PF or wrist extensors.

Question 7

Difference between tremor and dyskinesia

Answer 7

Tremor is a primary impairment of PD whereas dyskinesia is caused from. long term use of levodopa.

Dyskinesia is irregular in direction and amplitude of movement. Whereas, tremor is regular in direction and amplitude

Tremor resting frequency: 4-6Hz
Dyskinesia frequency: 1-4Hz

Question 8

Physiotherapy focused impairments

Answer 8

Reduced bed mobility, transfers, sitting, standing, walking, stair climbing, reaching and manipulation.

Question 9

OT focused impairments

Answer 9

tolieting, dressing, showering, groceries, meal preparation, cleaning/chores.

Question 10

What is the goal of physio in PD?

How does physio achieve this?

Answer 10

Reduce the severity of the condition and slow the progression of symptoms.

1. cueing and attentional/cognitive strategies
2. task-specific training
3. falls prevention
4. general exercise

Question 11

How do we determine risk of falls?

Answer 11

1. Previous falls in the past 12/12?
2. Previous freezing of gait in the past 1/12?
3. > 3.6 s to walk 4 m?

Question 12

What are some cueing and attentional strategies used in the management of PD?

Answer 12

Visual cues: tape on the ground, lasers, walking over obstacles.
Attentional: lift your knees, big steps.
Self-prompting cues: counting, kicking walking stick.
External auditory cue: metronome.

Question 13

what are some falls prevention programs for PD management?

Answer 13

Balance training
Prescription of aids
LL strengthening exercises
Cueing strategies to reduce freezing

Question 14

Evidence for falls prevention:

Answer 14

Canning et al 2015: Mild-mod PD
- 6 month follow up: ~450 falls in Rx group and ~800 falls in the control group.
- insignificant

Morris et al 2015: mod-severe PD
-Falls rate was higher in the control group

Question 15

What is LSVT BIG?

Answer 15

Focuses on amplitude of movement. Aims to restore normal movement by recalibrating a patients sensory perception of movement.

Question 16

Briefly discuss management strategies (and their rationale) for tremor, dyskinesia and dystonia

Answer 16

Purposeful movements and simple steps (e.g. using hands to push up during standing up)
Constraining movements (e.g. clasping hands behind back, putting hands in pocket)
Relaxation strategies (e.g. breathing exercises, hydrotherapy)
Medical interventions: medications, deep brain stimulation

Visual/auditory/somatosensory/cognitive cues.