PD

Question 1

T/F PD is a chronic, non-progressive neuromuscular disease?

Answer 1

False: PD is a chronic, progressive neurologic disease.

Question 2

What are some of the movement changes seen in PD?

Answer 2

1. Slowness
2. Tremor
3. Rigidity
4. Balance problems

Question 3

What is the average onset of PD? and what age group does it affect the most?

Answer 3

Avg. onset is 58 y/o.

1/100 in people over 75

Question 4

What is the etiology of PD?

Answer 4

unknown

Question 5

Describe the pathophysiology of PD?

Answer 5

Decrease dopamine production by substantia nigra and degeneration of nigrostriatal fibers.

Question 6

How many nuclei are in the basal ganglia? Name them.

Answer 6

5 Nuclei:

1. Caudate
2. Putamen
3. Globus pallidus
4. Substantia nigra
5. Subthalamus
   * putamen+ caudate=striatum

Question 7

What is the name of the fibers that directly run TO or FROM the BG to the spinal cord?

Answer 7

There is no direct input to or from the BG to the spinal cord.

Question 8

When information is received in the BG, where does it primarily come from?

Answer 8

Primarily from the entire cortex

Question 9

After the information is sent out of the cortex what nuclei in the BG does it send it to?

Answer 9

Mostly into the putamen

Question 10

Where is the output primarily sent?

Answer 10

Portions of the cortex involved in motor function

Question 11

Name the portions of the cortex involved in motor function.

Answer 11

Prefrontal, premotor/supplemental, motor corticies

Question 12

What is “set activity” ? and what part of the cortex is involved in set activity?

Answer 12

Set activity is an increase in neural activity before the movement sequence is activated.

The SMA is involved in set activity.

Question 13

T/F: the SMA can also terminate a movement sequence?

Answer 13

True

Question 14

There are 5 functions attributable to the BG, name them.

Answer 14

1. Initiation and regulation of gross intentional movements.
2. Planning and execution of complex learned movements with SMA.
3. Facilitating desired motor responses and inhibiting unwanted responses.
4. Helps maintain normal background muscle tone.
5. involved in motor learning.

Question 15

How does the BG help maintain normal background muscle tone?

Answer 15

It inhibits motor cortex and brainstem motor areas.

Question 16

What are the movement dysfunctions of the BG? And which one is attributable to PD?

Answer 16

1. Increased movement
2. decreased movement

Decreased movement is attributable to PD.

Question 17

Read the Motor Loop section on your own.

Answer 17

pg.45

Question 18

What are the stages of PD according to Hoehn and Yahr?

*there is more info and pg.46

Answer 18

Stage 0 No visible symptoms of PD
Stage 1 Symptoms confined to one side of the body(unilateral)
Stage 1.5 Unilateral plus axial involvement
Stage 2 Bilateral-NO difficulty walking
Stage 2.5 Mild bilateral disease, with recovery on pull test
Stage 3 Symptoms are bilateral ; minimal difficulty walking
Stage 4 Symptoms are BILAT-moderate difficulty walking
Stage 5 Symptoms are BILAT- unable to walk(End-stage PD)

Question 19

What are the cardinal signs of PD?

Answer 19

1. Bradykinesia/akinesia
2. Tremor
3. Rigidity
4. Postural insstability

Question 20

What are the early signs of PD? and what are the causes?

Answer 20

1. bradykinesia-cause unknown
2. mild gait hypokinesia-decrease in set activity buildup in the SMA
3. resting tremor-cause unknown
4. micrographia-decrease in set activity
5. decreased speech volume-decrease in set activity

Question 21

What are the later stages of PD?

Answer 21

1. festination-small step gait.
2. dyskinesias-movements you don’t want to make.
3. akinesia-cause unknown
4. increased hypokinesia-decreased set activity
5. postural instability and falls

Question 22

Which clinical sign is caused by taking medications?

Answer 22

dyskinesia

Question 23

What is often the first symptom reported?

Answer 23

resting tremor

Question 24

What increases and decreases resting tremors?

Answer 24

It increases with emotional stress or fatigue

Decreases with active movements, sleep or complete relaxation

Question 25

T/F you will occasionally see intention tremor with PD?

Answer 25

True but it is rare

Question 26

What is rigidity?

Answer 26

too much supraspinal drive. Too much information is being sent to the LMN to fire.

Question 27

What are the types of rigidity?

Answer 27

leadpipe-same level of resistance throughout the range

cogwheel-tremor superimposed on rigidity

Question 28

T/F the neural component of rigidity does appear to effect volitional movement and therefore there is a point in addressing it throughout treatment

Answer 28

False it does not appear to effect volitional movement and therefore many feel there is no point in addressing it throughout treatment.

Question 29

What causes an increase in rigidity?

Answer 29

1. stress
2. anxiety
3. postural stress(standing)
4. muscular changes (stiffness)
   * some fell it may be an adaptive behavior

Question 30

What are the deficits of akinesia?

Answer 30

1. bradykinesia
2. hypokinesia
3. delayed initiation of movements
4. freezing
5. loss of spontaneous movements

Question 31

What percentage of Parkinson’s patients have bradykinesia?

Answer 31

80%

Question 32

What deficit is characterized by extreme bradykinesia/ “poverty of movement”

Answer 32

hypokinesia

Question 33

What is the term for “lack of emotion shown on PD patients face”?

Answer 33

Parkinsonian facies