Parkinsons - Motor Symptoms - 2 Flashcards
cardinal signs
TRAP
TRAP
tremor
rigidity
akinesia
posture
tremor –> TRAP
resting
stereotypical “pill rolling” tremor
rigidity –> TRAP
lead pipe or cog wheel
akinesia –> TRAP
bradykinesia
inability to initiate movement or slowed movement
postural instability –> TRAP
late stage finding
decreased balance and coordination
what does dx require
2 of the 3 early motor signs
what is the most common clinical manifestation
tremor
75%
what are tremors generally
unilateral UE
can be bilateral
how are tremors first seen
in fingers
pill rolling
tremors are present
at rest
w/ exertion or tension
disappear w/ sleep or action
what side do symptoms start on
right side
61%
role of the BG
imbalance b/w Cb and BG inhibition
cholinergic activity
what will occur overtime –> tremor
will spread to other body parts
tremor will spread to
LEs
face (blepharospasm)
shoulder and neck/trunk (titubation)
may become bilateral
non-velocity dependent hypertonicity
uniform resistance to PROM throughout ROM
different from spasticity
types of rigidity
lead pipe
cog wheel
lead pipe
slow
sustained resistance to ROM
cog wheel
jerky
ratchety
catch & release to ROM
where can rigidity appear
agonist and antagonist muscle groups
how could rigidity appear
unilaterally before bilaterally
what does rigidity typically affect
proximal muscles
then extremities and face
early sign of rigidity
loss of arm swing in gait
prolonged rigidity
contractures and postural deformity
fatigue secondary
resting energy expenditure
akinesia
difficulty w/ the initiation of movement
akinesia is different from
bradykinesia
both are motor planning deficits
how is movement initiated
co-contraction of agonist and antagonist
drugs that limit bradykinesia
do not affect akinesia
results from problems in the preparation for movement
what is akinesia associated w/
fixed postures
“freezing”
“glue foot”
where does akinesia frequently occur
tight/enclosed spaces
approaching a change in floor surface
what is freezing exacerbated by
stress
what can akinesia be overcome w/
external cues or attentional strategies
bradykinesia
slow or decreased movement
bradykinesia includes
a decrease in arm swing
slow shuffling gait
lack of facial expression
what does bradykinesia have difficulty w/
initiating or changing direction of movement
stopping movement once is has started
posture
typically flexor-bound
often considered diagnostic
posture –> often diagnostic
neck/trunk flexion
hip/knee flexion
ankle PF
there is a loss of –> posture
natural heel to toe progression
becomes to to heel instead
rotation
what are posture and gait changes d/t
combination of rigidity and bradykinesia
what is common –> postural instability
festination and retropulsion
COG is too far forward
what does postural instability lead to
difficulty in bed mobility
what does postural instability cause
decrease heel strike
decrease step length
decrease stride length
what does gait turn into
“en bloc”
in early stages
there is shuffling
in later stages there is
festination
motor SXS (1)
TRAP
stooped posture
shuffling gait or festination
freezing
decrease arm swing
motor SXS (2)
difficulty arising from a chair
difficulty turning in bed
imbalance & falls
dystonia (esp leg/foot)
hypophonic speech
motor SXS (3)
dysphagia
dysarthria
micrographia
masked face
slowing of ADLs
sialorrhea
dystonia
twisting, sometimes bizarre, movements
what is dystonia caused by
involuntary contractions of the axial and proximal muscles of the extremities
hypophonic speech
soft speech
what does hypophonic speech result from
lack of coordination of the vocal musculature
dysphagia
difficulty swallowing
what does dysphagia result from
lack of coordination of the vocal musculature
individuals w/ PD –> dysphagia
often unaware that they are experiencing it
dysarthria
motor speech disorder resulting in poor articulation
what is dysarthria often termed
hypokinetic dysarthria in PD
micrographia
abnormally small handwriting
progressively smaller handwriting
masked face
bradykinesia of the facial muscles
reduction of facial expression of emotion
slowing of ADLs
combo of TRAP
causing increased challenge w/ ADLs
sialorrhea
hypersecretion of saliva
impaired or frequent swallowing
% of PD pts that experience falls
66%
13% fall more than once a week
why do PD pts fall
delayed equilibrium rxns
lack of anticipatory postural control
inability to adequately respond to perturbations
other factors of fall risk
mm weakness
meds S/E
postural hypotension
fatigue
depression
dementia
what are common in PD
procedural learning
but declarative learning is usually intact
why is dual tasking difficult for PD pts
involves shifting of attention and motor programs
what type of practice do we use
block practice
