PD Flashcards
The basal ganglia are involved in
a. volitional control
b. automatic control
d. both
e. neither
both volitional and automatic
The cortical basal ganglia loop is responsible for
a. automatic control
b. volitional control
c. planning strategies
d. motor strategies
volitional control
Which process is the strongest volitional control?
paremetal system
What are the main structures of the basal ganglia?
caudate
putamen
globus palidus
The BG is part of the _ _ system
extra paramydal system
(afferent/efferent) input to caudate and putamen from areas of cerebral cortex and thalamus
afferent
the output from the substantia nigra is governed by
dopamine
The globus pallidus sends info to the _ then to the _
thalamus
motor cortex
What are the functions of the BG?
skeletal motor circuit
oculomotor circuit
prefrontal circuit
limbic circuit
The circuits are in the regulation of
movement and cognitive behavior
What are functions of the BG?
adapt behavior as task requirements change
organize sensory input
motivation to move
This circuit prepares for and executes movement, selective activation, initiation of complex movements organized here
a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit
skeletal motor circuit
This circuit is responsible for saccadic eye movement, and quick movements from one point to another
a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit
oculomotor circuit
This circuit is respobile for organizing behaviors, governing and executive function, dampens on certain behaviors
a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit
prefrontal circuit
This circuit is responsible for motivated behavior, procedural learning, verbal cognitive stage of learning
a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit
limbic circuit
what disorders involve the action system
involuntary movements, difficulty initiating movements, akinesia, bradykinesia, postural instability
movements are (internally/externally) generated
internally
What is the average age of onset in PD?
50-60 years
Incidence (increases/decreases) with age
increases
what is the youngest onset of PD?
<21 years
2/3 of patients with PD present initially with
a. tremor
b. postural instability
c. rigidity
d. bradykinesia
tremor
1/3 of patients with PD present initially with
a. tremor
b. postural instability
c. rigidity
d. bradykinesia
postural instability
Postinfectious toxic and drugs tumors normal pressure hydrocephalus vascular metabolic these re
secondary parkinsonism
The direct loop represents _ movement
volutitional
Which loop is related to hypokinesia?
a. indirect loop
b. direct loop
direct loop
The indirect loop role is _
inhibition
The indirect loop has a role in _ movement
automatic
What is the most affected with the indirect loop?
regulation of trunk and limb muscles for posture and balance
The _ _ communicates with striatum
substania nigra
What is the role of the substania nigra?
produce dopamine inhibitory to neurons in indirect pathway
Dopamine has an (inhibitory/excitatory) effect on the indirect pathway
inhibitory
Dopamine has an (inhibitory/excitatory) effect on the direct pathway
excitatory
Production of dopamine is the largest problem due to
lost of receptors
(underactive/overactive) indirect pathway gives rise to akinesia and rigidity
overactive
an overactive indirect pathway leads to
a. akinesia and spasticity
b. rigidity and bradykinesia
c. akinesia and hypokinesia
d. akinesia and rigidity
akinesia
rigidity
an underactive direct pathway leads to
a. akinesia
b. rigidity
c. spasticity
d. bradykinesia
bradykinesia
an overactive direct pathway leads to
dyskinesia
dystonia
athetosis
What is caused by a release of inhibition in basal ganglia?
tremor
What are the cardinal motor symptoms?
TRAP tremor rigidity akinesia postural instability
This symptom is shown initially in about 70% of PD patients
a. rigidity
b. akinesia
c. postural instability
d. tremor
tremor
Tremor is
a. resting
b. intentional
c. during movement
d. constant
resting
A resting tremor (increases/decreases) with movement
decreases
Tremor (appears/disappears) during sleep
disappears
Tremors can be aggravated by
stress and fatigue
The later the stage the (better/worse) the tremor is
worse
What is the cause of tremor
overactive indirect pathway
Rigidity is felt
a. at fast velocity
b. at the end of the range
c. slow and fast velocity and most of the range
d. at slow velocity at mid range
slow and fast velocity and most of the range
This is defined as difficult to move, feels completely stiff
a. cog wheel
b. rigidity
c. lead pipe
d. low tone
lead pipe
This is when there is jerking throughout the range
a. cog wheel
b. rigidity
c. lead pipe
d. low tone
cog wheel
Rigidity makes it difficult to
motor plan
Movement preperation deficits are
start hesitation
freezing
this difficulty with motor planning is a difficulty with initiating or changing direction
a. akinesia
b. hesitation
c. freezing
d. rigidity
freezing
difficulty perfoming ,,_ movements
complex
stimultaneous
sequential
This is defined as a slowness of movement
a. hypokinesia
b. akinesia
c. hypomimia
d. bradykinesia
bradykinesia
This is defined as reduced amplitude and slowness
a. hypokinesia
b. akinesia
c. hypomimia
d. bradykinesia
hypokinesia
This is defined as a poverty of movement
a. hypokinesia
b. akinesia
c. hypomimia
d. bradykinesia
akinesia
What is hypomimia?
masked face
this is defined as masked face where there is a loss of expression, lifeless in the face
a. hypokinesia
b. akinesia
c. hypomimia
d. bradykinesia
hypomimia
What type of posture do patients with PD show?
kyphosis
What types of contracture can patients have?
hip and knee flexion
What is the biggest problem with patients who have PD?
a. tremor
b. rigidity
c. falls
d. small movement
falls
(increased/decreased) body sway
increased
Base of support is
a. wide
b. narrow
c. normal
narrow
Patients show difficulty in dynamic _ initiated movements
self
How do they react to a perturbation?
decreased reaction
patients show difficulty in _ postural control
feedforward anticipatory
What cardinal sign is the last to develop?
postural instability
Clinical diagnosis is based on the presence of
2 of first 3 cardinal signs
What are the torque production deficits seen?
decreased at all speeds
disuse weakness as disease progresses
extensors weakness more noticeable
increased weakness in off periods
What is the main byproduct of rigidity?
fatigue
What type of gait is seen?
festinating gait
This type of gait is an increased step frequency with shortening of stride
festinating gait
Common deviations seen with gait
reduced stride length increased variability decreased speed shuffling initial contact with foot flat or toes first decreased trunk rotation and arm swing freezing difficulty turning, dual-task, attentional demands of complex environments
(increased/reduced) stride length and (increased/decreased) variability (decreased/increased) speed shuffling initial contact with _ (increased/decreased) trunk rotation and arm swing difficulty _ difficulty in _ _ difficulty in _ _
reduced increased decreased foot flat or toes first decreased turning dual task attentional demands of complex environments
Patients have problems with (procedural/declarative) learning deficits
declarative
Which type of practice is best for motor learning?
a. random practice
b. blocked practice
c. massed practice
d. constant practice
blocked practice
Patients experience _ type of sensation
paresthesia and pain
This is described as a sense of need to move, restlessness
akathisia
Proprioception is impaired (true/false)
true
The sensation is impaired in all patients with PD (true/false)
false
What autonomic NS dysfunction occurs?
excess sweating
slow pupillary responses
GI problems
Dementia is a (direct/indirect) effect
direct
visual disturbances with some drugs orthostatic hypotension arrhythmias decreased circulation and edema deconditioning decreased chest expansion these are (primary/secondary) features
secondary
What walking category are most patients?
least limited
fMRI is used to
rule out secondary and parkinson-plus syndromes
stages 0-1:
a. severe stage
b. bilateral signs and balance problems
c. no signs or unilateral
no signs or unilateral
stages 2-3:
a. severe stage
b. bilateral signs and balance problems
c. no signs or unilateral
bilateral signs and balance problems
stages 4-5:
a. severe stage
b. bilateral signs and balance problems
c. no signs or unilateral
severe stage
What neuroprotective medication is taken?
MAO inhibitor
MAO inhibitor purpose is to
improve metabolism of dopamine
What symptomatic medications are taken?
levodopa
dopamine agonists
anticholinergic drugs
The purpose of this medication is to control symptoms related to a limited about of dopamine
a. dopamine agonist
b. MAO inhibitor
c. levodopa
d. anticholinergic drugs
levodopa
The purpose of this medication is to act on post synaptic receptors to decrease amount of l-dopa needed
a. dopamine agonist
b. MAO inhibitor
c. levodopa
d. anticholinergic drugs
dopamine agonists
This medication is taken to help decrease l-dopa dosage needed
a. dopamine agonist
b. MAO inhibitor
c. levodopa
d. anticholinergic drugs
dopamine agonists
This medication is used to control tremor and rigidity
a. dopamine agonist
b. MAO inhibitor
c. levodopa
d. anticholinergic drugs
anticholingergic drugs
How should their nutrition be managed?
high calorie, low protein
This surgery is a permanent fix to help tremor and akinesia
ablative surgery
During this stage, the goal is a preventive exercise program
a. early middle
b. late
c. late middle
d. early
early
During this stage, the physical goal is a corrective exercise program
a. early middle
b. late
c. late middle
d. early
early middle
During this stage, the physical treatment is compensatory and corrective exercise
a. early middle
b. late
c. late middle
d. early
late middle
During this stage, the physical treatment is compensatory exercise, dietary concerns, skin care, hygiene, pulmonary function
a. early middle
b. late
c. late middle
d. early
late
This test has 4 parts and measures mentation, behavior, mood, sleep, speech, tremor, walking, motor exam, freezing, dyskinesia, and more
a. MOCA
b. unified parkinsons disease rating scale
c. Parkinsons Disease questionnaire
unified parkinsons disease rating scale
This scale measures cognitive function
a. MOCA
b. unified parkinsons disease rating scale
c. Parkinsons Disease questionnaire
Montreal Cognitive Assessment (MOCA)
What visual changes are seen?
saccadic eye movement
What motor function is expected to be seen?
rigidity bradykinesia tremor dyskinesia postural instability
Which test is better for postural instability in early stages?
miniBEST
TUG with cognitive should not increase more than _ seconds with cognitive task
5
What are you assessing for with 10MWT?
speed stride length cadence stability variability safety
This test looks at quality of life and how they perceive their abilities?
a. MOCA
b. unified parkinsons disease rating scale
c. Parkinsons Disease questionnaire
parkinsons disease questionnaire
ability to turn, gait speed, and stride length are most highly correlated with
severity of disease
QoL
confidence
Which is the most common neuromuscular movement system diagnoses?
hypokinesia
Dual task should be practiced in _ stages
earlier
What cues should be used for initiation, freezing, and gait problems?
external cues
What are external cues for PD?
auditory
visual
combined
PNF rhythmic initiation, rotation, rocking, distal to proximal relaxation and yoga used as what treatment
a. strength training
b. functional training
c. rigidity and bradykinesia
d. ROM and flexibility
rigidity and bradykinesia
PNF, Traditional stretching, Positioning – prolonged stretch, Trunk/joint mobs, Music – facilitates movement used for what treatment type
a. strength training
b. functional training
c. rigidity and bradykinesia
d. ROM and flexibility
ROM and flexilbity
For strength training focus on _
extensors
What stages is it better to do strength training
mild to moderate
Avoid _ with strength training
isometrics
PNF, NDT assisted to cueing, mobility and transitional movements, adaptive equipment used as what type of treatment
a. strength training
b. functional training
c. rigidity and bradykinesia
d. ROM and flexibility
functional training
Dynamic balance training is
most engaging
high level of physical and cognitive
What is key with gait training?
bigger and faster
This type of intervention addresses flexibility, balance, gait, kinesthetic awarenss, dual tasking, agility, aerobic and function
Big and PWR
Big and PWR address
a. tremor
b. rigidity
c. bradykinesia
d. hypokinesia
hypokinesia
This treatment if 4 foundational movements, the building blocks of function, 5 body positions in variety of ways, used across all levels of disease severity, framework not protocol, patient centered-dosing
a. PWR
b. LSVT Big
PWR
This treatment is 7 movement exercises, 2 body positions, protocol is not adaptable, requires 4x/week for 4 weeks, followed by HEP
a. PWR
b. LSVT Big
LSVT Big
What stage is balance disturbed?
a. 2
b. 3
c. 4
d. 5
3
At what stage do gait impairments begin?
a. early
b. early middle
c. late middle
d. late
early middle
What stage are they severely disabled, dependent with ADL’s?
a. early
b. early middle
c. late middle
d. late
late
Fatigue is caused by
rigidity
Postural response:
co-activation
Which tool is best to use to measure muscle performance?
5 x sit to stand
Which outcome measures are best for postural instability?
miniBEST
Berg
Which outcome measures should be used to measure gait?
TUG
FGA
10MWT
Cause of tremor is
a. overactive direct pathway
b. underactive direct pathway
c. overactive indirect pathway
d. underactive indirect pathway
overactive indirect pathway
Visual processing is completed in the
a. thalamus
b. cerebellum
c. brainstem
d. basal ganglia
brainstem
This structure receives ascending information from the SC
a. cerebellum
b. thalamus
c. brainstem
d. motor cortex
thalamus
freezing is a difficulty _ or _ direction
initiation
changing
