Parkinsons Disease

Question 1

Parkinsons Overview

Answer 1

• Genetic and hereditary condition that involves degeneration of neurons in basal ganglia (which produces dopamine)
• Male, 50-60 years of age

Question 2

Basal Ganglia Functions

Answer 2

• Memory
• Initiate involuntary movement
• Regulate trunk and limb musculature
• Cognition
• Storing and initiating well learned and repetitive movements (habits)

Question 3

Parkinsons Signs / Symptoms

Answer 3

• Bradykinesia / freezing of gait
• Diminished motor recruitment and force (LSVT BIG)
• Tremor (resting or action)
• Rigidity (not velocity dependent)
• Lead-Pipe Rigidity (sustained resistance to movement with no fluctuations)
• Cogwheel Rigidity (jerky, ratchet-like resistance as muscles alternatively relax and tense)

Question 4

Parkinsons Prognosis

Answer 4

• Pt normally has it for 5 years before seeking treatment
• Duration of progression is about 13 years
• Most common cause of death is CVD and pneumonia
• Postural Drainage is important

Question 5

Parkinsons Early Stage

Answer 5

• Functional and independent with minimal impairments

Question 6

Parkinsons Middle Stage

Answer 6

• Symptoms are readily apparent and activity limitations emerge
• May be still independent and functional with ADLs but slow
• Preventative, restorative, and compensatory based treatment

Question 7

Parkinsons Late Stage

Answer 7

• More severe impairments and limitations
• Dependent for most ADLs
• Typically w/c bound or bed-ridden

Question 8

Parkinsons Impairments

Answer 8

• Gait Disturbances (diminished torque/force production and COM shifted anteriorly)
• Rigidity (trunk is most impacted)
• Postural instability
• Balance
• Orthostatic hypotension

Question 9

Parkinsons Pharmacology

Answer 9

• Levodopa (Sinemet)
• Exercise should be done during optimal drug effectiveness (45 minutes)
• Can cause hallucinations, paranoia, depression, dyskinesia, cardiovascular changes, or orthostatic hypotension
• Severe return of symptoms during wearing off phase
• If pt seems to have the wrong dosage where there is a functional status change due to the medication then CONTACT the physician

Question 10

Parkinsons Freezing of Gait Treatment

Answer 10

• Stationary floor markings
• Laser lights on AD
• Rhythmic auditory stimulation (set 25% faster than the patients selected speed)

Question 11

Parkinsons Festinating/Shuffling Gait Treatment

Answer 11

• Shoe orthotics (toe wedge to shift COM anteriorly)

Question 12

Hoehn-Yahr Stage 1 (parkinsons)

Answer 12

• Sub-clinical
• Not getting PT yet
• Minimal or absent symptoms
• Unilateral if present

Question 13

Hoehn-Yahr Stage 2 (parkinsons)

Answer 13

• Minimal bilateral or midline involvement
• Balance not impaired

Question 14

Hoehn-Yahr Stage 3 (parkinsons)

Answer 14

• Impaired righting reflexes
• Some activities limited but can live independently

Question 15

Hoehn-Yahr Stage 4 (parkinsons)

Answer 15

• All symptoms present and severe
• Standing and walking possible only with assist

Question 16

Hoehn-Yahr Stage 5 (parkinsons)

Answer 16

• Confined to bed or w/c