Parkinsons Disease Flashcards
what does the basal ganglia role in movement and posture?
movement scale movement initiation movement preparation identifying one's own body position relative to the environment longer loop postural reflexes perceptual and cognitive
what are 4 common BG disorders?
Parkinson’s disease
Huntington’s disease
Wilson’s disease
Dystonia
what are the typical signs and symptoms of PD?
changes in muscle tone decreased movement coordination decreased motor control decreased postural stability presence of extraneous movement
True or False
Parkinson’s Disease is the 3rd most common BG disorder?
False
it is the most common
PD usually affects people _____
over 50 yrs
True or False
PD is more prevalent in women
False
MEN=WOMEN
1 in _____ who are 85 years old have PD
1 in 3
S/S of PD are?
rigidity ( leadpipe; cogwheel) bradkinesia micrography masked face postural abnormalities lack of equilibrium reactions resting tremor decreased trunk rotation
what kind of postural abnormality is seen in PD?
flexed posture
_______ of patients with PD fall with a ____% chance of 1 fall per week
2/3
10%
PD non-motor symptoms (cognitive) include:
anxiety and depression bradyphrenia and mild cognitive impairment (MCI) decreased attention easily distracted decreased executive functioning decrease ability of dual tasking decreased organizational ability
PD non-motor symptoms (other) include:
sleep disturbances bladder urgency and frequency orthostatic hypotension hyposmia pain/paraesthesia
what is hyposmia?
low energy, hypoglycemia due to not eating, “I can’t taste anything.”
secondary problems and complications of PD include?
muscle atrophy respiration compromise nutritional changes osteoporosis contracture and deformity decubiti
examples of respiratory compromise that affect PD include?
Decreased vital capacity
Decreased Chest expansion
Posture
Rigidity
UE posturing
Increased energy consumptionwhat kind of nutritional changes will a person with PD have?
Problems with eating, chewing, swallowing
keeping a good appetite
Modified Hoehn and Yahr Scale: stage 0 means?
no signs of disease
Modified Hoehn and Yahr Scale: stage 1 means?
unilateral disease
Modified Hoehn and Yahr Scale: stage 1.5 means?
unilateral disease w/ axial involvement
Modified Hoehn and Yahr Scale: stage 2 means?
bilateral disease w/o postural instability
Modified Hoehn and Yahr Scale: stage 2.5 means?
early signs of postural instability
Modified Hoehn and Yahr Scale: stage 3 means?
bilateral disease with postural instability, physically independent
Modified Hoehn and Yahr Scale: stage 4 means?
severe disability but still able to strand or walk unassisted
Modified Hoehn and Yahr Scale: stage 5 means?
confinement to WC or bed
how do you test for early signs of postural instability ( 2.5 )
see if patient has recovery on ‘pull test’
what are the PD treatments?
Pharmacological/Medical Management Surgery Nutrition Exercise! Physical Management of Symptoms
deep brain stimulation involves a stimulator impacted into the _______ ______
subthalamic nucleus
True or False
Deep brain stimulation is a slower movements and gait deviations respond well
False
faster movements
what is the disadvantage of deep brain stimulation?
low morbidity but significant psychiatric complication concerns (depression/mania)
Deep brain stimulation works on PD symptom relief in _______ after the implantation
minutes
Deep brain stimulation works on dystonia symptom relief in _______ after the implantation
days to weeks
_____ _____ ______ can black the effectiveness of dopamine replacement and it recommended that no more than _____% come from this?
high protein diet
15
how can you manage your protein so it doesn’t affect your motor fluctuations during the day?
intake in the evening
True or False
Longevity and physical activity are related for individuals with PD
True
True or false
There is no link identified between lack of exercise and development of PD
False, there is a link
______ exercise is found to reduce PD dysfunction
aerobic exercise
what are additional benefits of aerobic exercise for PD pts?
Additional important pulmonary benefits
Improved QOL with decreased depression, improved mood and initiative
what does UPDRS stand for?
Unified Parkinson’s Disease Rating Scale (UPDRS)
what is the Unified Parkinson’s Disease Rating Scale (UPDRS)
Comprehensive adult neuro examination
PT Evaluation of Medication Effectiveness includes?
“all day evaluation”
Choose 3-5 impairments or functional limitations that are issues for the patient
5-7 minute examinations on the hour and perhaps on the half-hour as well
Consult with MD to discuss “best” and “worst” times
Recommendations made for medication titration
describe typical gait for a person with PD
decreased velocity decreased stride length decreased foot clearance flat footed progression decreased arm swing
what is festination?
Festination: attempt to catch up BOS with COG
what is retropulsion?
disorder of locomotion associated especially with Parkinson’s disease that is marked by a tendency to walk backwards
what triggers Freezing in Gait?
sudden direction changes, turning, or pivoting doorways or thresholds approaching furniture/obstacles turning around to sit change in floor pattern confined spaces crowds stress, anxiety, hurrying
what triggers retropulsion?
backing up to sit down
reaching overhead
stepping away from sink, counter
opening door
carrying items close to the body in both hands
being approached closely/ suddenly jostled
PD rehabilitation includes?
Aerobic (forced) Flexibility (to maintain ROM) Strengthening Rhythmic exercise Mambo Tai chi Functional activity Pushing complexity Gait and balance Decrease fall risk Changing task & environmental contexts
what is the leading cause of death in person with PD?
Pneumonia
how can respiratory management be addressed with pts with PD?
early aggressive aerobic exercise
maintain regular moderate exercise as disease progresses
an example of an exercise that is Forced, Not Voluntary, and Improves Motor Function in PD Patients is?
Tandem Cycling
goals for early phase PD ( 1-2.5)
Prevent inactivity
Prevent fear of falling
Improve physical capacity
goals of mid phase PD ( 2-4)
same as early phase plus maintain or improve: Transfers Body posture Reaching and grasping Balance Gait
goals for late phase ( 5 ) include?
same mid phase plus:
Maintain vital functions
Prevent pressure sores
Prevent contractures
what are two examples of Parkinson Plus Syndromes:
Progressive supranuclear palsy (PSP)
Multiple system atrophy (MSA)
what is Progressive supranuclear palsy (PSP)
Similar to PD
More cognitive impairment
Progression more rapid
Does not respond to L-dopa
what is Multiple system atrophy (MSA)?
Cortical, BG and cerebellar
Frontal lobe and autonomic dysfunction
Does not respond to L-dopa
what is a classic order resulting in hyperactivity of the basal ganglia?
Huntington’s Disease
True or False
Huntington is an autosomal recessive trait
False
autosomal dominant trait
S/S of Huntington Disease include?
Abnormalities in postural reactions Decreased trunk rotation Abnormal tone Extraneous movements They exhibit too much movement
Wilson’s disease AKA?
hepatolenticular degeneration
what causes wilson’s disease?
caused by abnormal copper metabolism that lead to toxic copper levels and degeneration of liver and BG
True or False
if wilson’s disease is recognized and properly treated, then the pt functions w/o restrictions
true
what is Tardive Dyskinesia?
Drug-induced disorder
Dyskinesia = inability to perform voluntary movement
Series of rhythmical extraneous movements
Associated with extension of spine/trunk
what is dystonia?
Movement disorder characterized by sustained muscle contraction in the extreme end range of a movement, frequently with a rotational component.
dystonia can be _____ or ______
generalized or focal
generalized dystonia is usually ________ and it most prevalent in those with ____ ____ _____
inherited
European Jewish Descent
focal dystonia is usually related to _________ movement produce under high cognitive ______ and ______
repetitive
constraints and attention
what is the most common focal dystonia?
spasmodic torticollis
other example of focal dystonia include:
vocal folds, tongue, facial muscles, hand, toes
how is dystonia managed?
Botox
Rehab
True or False?
In all cases, excessive co-activation of agonists and antagonists occurs that interferes with timing, execution, and loss of independent joint movements
true
true or false
With dystonia, there is generally abnormal tone or abnormal reflexes
There is generally NO abnormal tone or abnormal reflexes
