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NI2 > PD > Flashcards

PD Flashcards

2
Q

What is Parkinson’s Disease (PD)?

A

Degenerative disorder of the CNS resulting from decreased stimulation to the motor cortex by the basal ganglia (loss of dopamine)

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3
Q

What are the functions of the Basal Ganglia? (4)

A

Functions

  • Execution of complex motor tasks
  • Runs well learned and predictable movement sequences (with the Supplementary Motor Area)
  • Provides internal cues
  • Involved with memory and cognitive function
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4
Q

What 4 nuclei make up the basal ganglia and which one loses cells in PD?

A
  1. Striatum
  2. Globus pallidus
  3. Subthalamic nuclei
  4. Substantia nigra (loss of cells)
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5
Q

Describe the basic pathology of PD

A
  1. Loss of dopaminergic neurons in the substantia nigra (less than 20% left)
  2. Lewy bodies
  3. ???
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6
Q

What is the main problem that physios deal with in PD patients?

A

Inability to perform simultaneous or sequential motor tasks

  • Bilateral tasks
  • Walking and talking
  • Standing ? i.e. activating muscles in a certain order and at the same time
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7
Q

What are the primary impairments of PD? (6)

A

Primary impairments

  • Bradykinesia
  • Hypokinesia
  • – most pronounced in complex tasks
  • – reduced stride length
  • – occurs at all joints in walking (so do whole task training)
  • Akinesia
  • – Festination often occurs prior to freezing
  • – often relevant to environment, e.g. narrow doorways, busy environment
  • Tremors
  • Rigidity
  • Loss of balance = falls risk
  • – MUST ask about falling, assess balance and external perturbations
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8
Q

Define:

  • Bradykinesia

- Hypokinesia

A

Bradykinesia = decreased speed of movement

Hypokinesia = decreased amplitude of movement (most common impairment in PD)

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9
Q

Define:

  • Akinesia

- Rigidity

A

Akinesia = no initiation of movement (freezing)

Rigidity (increased stiffness to passive stretch, not like spasticity)

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10
Q

Measurement of PD (measures - 5; field tests - 6)

A

Measures

  • Unified PD rating scale (UPDRS)
  • Hoen and Yahr scale (0-5)
  • FOGQ
  • FES-I
  • Berg Balance

Field tests

  • 10m walk
  • 6min walk
  • TUG
  • STS
  • Timed activities
  • Handwriting/Spiral test
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11
Q

Assessment of PD (6)

A

Assess:

  • ROM
  • Strength
  • Respiratory
  • Fitness
  • Falls diary
  • Dyskinesia
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12
Q

What pharmacological management is generally used in PD?

A

Levadopa (precursor to Dopamine that can cross the blood-brain barrier)

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13
Q

What are 3 significant side-effects with Levadopa?

A

Side-effects

  • Hypertension
  • Dyskinesia
  • On/off phenomenon (“turn off” and can’t move when Levadopa decreases)
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14
Q

Name 2 surgical options for PD

A
  1. Globus pallidus removal

2. Deep brain stimulation (shown improvements in QOL in advanced PD)

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15
Q

Why are attentional and cueing strategies often effective in PD?

A

External stimuli instead of internal cues allows alternative circuitries in the brain to be engaged to accomplish tasks, avoiding the defective basal ganglia circuitry (remove automaticity)

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16
Q

How can a falls diary help prevent falls in PD?

A

Falls diary

  • Discover black area times
  • Common links (environment, fatigue etc)
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17
Q

What are 4 impairments that contribute to falls in PD?

A

Freezing, poor balance, loss of muscle strength and flexed posture

18
Q

Management of falling in PD (3)

A

Management

  • Educate (use info from falls diary)
  • Modify environment
  • Train impairments
19
Q

What are 2 ways to treat a flexed posture in PD?

A

Exercise

Positioning in bed for thoracic extension

20
Q

Research on training dual tasks in PD

A

Brauer and Morris 2010
- 20 mins walking step length training with dual task
= longer step (5/6)
= walking speed (3/6)

21
Q

Research on cueing for hypokinesia in PD

A
  1. Spaulding et al 2013
    - Visual and auditory both improve stride length
    - Auditory also speed and cadence
  2. Canning 2005
    - Concentrate on tray = worse than normal
    - Concentrate on big steps = normalised speed + stride
22
Q

Research on akinesia

A

RESCUE trial
- auditory, somatosensory or visual cues
- 30 mins, 3x week for 3 weeks
= less freezing but no carry-over at 6 wks

Brichetto et al 2006
- gait in varied environments + auditory then cognitive strategies
- 45 mins, 3x week for 6 wks
= Better FOGQ and QoL (1m after)

23
Q

Research on falls in PD

A

Stolze et al 2004
- 62% fell within last 12m (more than MND and MS)

Allen et al 2010
- RCT of 48 PD pts
- Monthly group exercise class + home program 3x/week for 6m
= better STS, decreased freezing
= decreased falls risk, fear of falling
24
Q

Treadmill training in PD?

A

Merholtz et al 2010 (systematic review)

  • gait speed
  • stride length
  • walking distance
25
Q

Strength training in PD

A 
Dibble et al 2006
- high-force eccentric resistance training
- 3 days/week for 12wks 
= volume
= force
= mobility

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