PD and HD Flashcards
1
Q
basal ganglia role
A
- plans willed movements
- regulates muscle tone
- regulates force production
- motor learning
*execution of automatic and repetitive movement
2
Q
the direct motor loop of the basal ganglia is ______ while the indirect look is _______
A
excitatory - initiates movement
inhibitory - suppresses movement
3
Q
what neurotransmitter has a major impact on the two pathways of the basal ganglia
A
dopamine
4
Q
a decrease in dopamine creates an overactive _____ pathway leading to…
A
indirect
akinesia and rigidity
5
Q
a decrease in dopamine creates an underactive ___ pathway leading it
A
direct
bradykinesia
6
Q
motor circuit of basal ganglia is for….
A
motor control
7
Q
oculomotor circuit of basal ganglia is for..
A
eye sccades
8
Q
prefrontal circuit of basal ganglia is for…
A
behavior, problem solving, cognition
9
Q
limbic circuit of basal ganglia is for…
A
motivation, learning, memory, sleep/wake
10
Q
huntingtons disease involves deterioration of the…
A
striatum (caudate/putamen) *will eventually affect entire brain
11
Q
HD is autosomal-____. what does this mean?
A
dominant
*if you inherit the gene, you will 100% get HD
12
Q
genetically, HD is caused by 37 repeates of ______
A
CAG (cytosine - adenine - guanine)
13
Q
T or F: HD is progressive
A
T but is rare disease
14
Q
age for adult onset of HD? juvenile? late?
A
adult = 30-50
juvenile = <20
late = >59
15
Q
2 HD specific outcome measures
A
1 - unified HD rating scale
2 - total functional capacity scale
16
Q
which HD outcomes measure is used for staging? how many stages of HD?
A
total functional capacity scale
5
17
Q
HD is a ______kinetic disease
A
HYPERkinetic
*issues with inhibiting movement
18
Q
common cognitive impairments with HD
A
loss of focus, slow thinking, lack of impulse control, inability to multitask
19
Q
most common psychiatric impairment with HD
A
depression
20
Q
two movement disorders associated with HD
A
chorea and dystonia
21
Q
chorea
A
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
22
Q
dystonia
A
movement disorder in which a person’s muscles contract uncontrollably
23
Q
T or F: there is strong evidence to support PT interventions to improve fitness, motor function, and gait in people with HD
A
T
24
Q
parkinson’s is the ___ most common progressive neurological disorder
A
2nd
Alzheimers is the 1st
25
cause of PD
not sure, but thought to be a combination of genetics and environmental exposures
26
is PD more common in men or women
men
27
PD is usually diagnosed at age _____ or older
65
28
PD is a _____kinetic disorder
HYPOkinetic
29
PD is due to a loss of dopamine caused by degeneration of the _____
substantia nigra
30
______-______% of dopaminergic neurons are depleted before seeing motor symptoms in PD
60-80
31
characteristic features of PD
T = tremor (usually starts unilaterally)
R = rigidity
A = akinesia/bradykinesia
P = posture/balance
32
tremor
involuntary shaking or oscillating movement
33
tremors are seen in about ___% of people with PD
80
34
what kind of tremor in PD
resting
*some pts also c/o internal tremors
35
T or F: stress increases tremor
Tr
36
Rigidity
increased resistance to passive movement
37
T or F: rigidity is velocity dependent
F, spasticity is
38
does rigidity affect proximal or distal muscles first
proximal
39
cogwheel rigidity
jerky, ratchet-like resistance to passive movement (on/off resistance)
40
lead pipe
sustained resistance to passive movement
41
what is the difference between akinesia and bradykinesia?
akinesia is the absence of movement while bradykinesia is the decreased speed of movement
*akinesia is a progression of bradykinesia
42
hypokinesia
decreased AMPLITUDE of movement
43
what is an early clinical sign involving gait in PD
decreased amplitude of arm swing on one side
44
what is an early sign of PD in the eyes? what about in the face?
eyes = saccadic hypometria
face = reduced frequency of blinking, diminished facial animation
45
Pts w/ PD typically have increased LE ___ activation causing _____
flexor
retropulsion
*extensors are weak
46
what is the #1 cause of death in PD
aspiration pneumonia due to swallowing issues
47
what do you often see in PD when it comes to handwriting
micrographia = small handwriting
48
T or F: dysarthria and dysphagia is common in PD
T: affects 95% of pts
49
sialorrhea
excessive drooling
50
What do PD patient often have involving their voice
hypophonia = decreased volume
51
how is PD diagnosed
presence of 2/4 cardinal motor feature and responsive to meds = PD diagnosis
52
T or F: there is a single test/group of tests to diagnose PD
F: based on history and clinical exam
53
T or F: Parkinsonism's respond to PD meds
F
54
is procedural learning affected in PD? what about declarative
procedural = yes
declarative = no
55
since declarative learning is unaffected, what kind of cues are important in PD
verbal
visual
external
56
2 outcome measures for staging PD
1 - Hoehn and Yahr
2 - unified PD rating scale
57
H and Y stage 0
no signs of disease
58
H and Y stage 1
unilateral disease
59
H and Y stage 1.5
unilateral plus axial involvement
60
H and Y stage 2
bilateral disease w/o impairment of balance
61
H and Y stage 2.5
mild bilateral disease, recovery on pull test
62
H and Y stage 3
mild to mod bilateral disease; some postural instability but still able to live independent
63
H and Y stage 4
severe disability, still able to walk or stand unassisted
64
H and Y stage 5
wheelchair bound or bedridden unless aided
65
what is the gold standard scale to stage PD? is a higher or lower score greater disability?
unified PD rating scale
higher
66
Your pt with PD has a tremor in one hand, and rigidity and clumsiness in one leg. He has decreased blinking and some speech abnormalities. Is he in the early, middle, or advanced stages of PD?
early
67
Your pt with PD has compromised balance and cannot make rapid adjustments. He has tremors and rigidity bilaterally. Is he in the early, middle, or advanced stages of PD?
middle
68
Your pt w/ PD has freezing of gait and struggles to walk/stand unassisted. He has tremors and rigidity, as well as cognitive impairments and PD dementia. He is unable to live alone. Is he in the early, middle, or advanced stages of PD
advanced
69
T or F: freezing of gait only happens in the late stages of PD
F: it can happen at any stage
70
young onset PD starts before age _______
55
71
T or F: genetics play a larger role in young-onset PD
T
72
T or F: young-onset PD progress faster
F: slower
*but freezing usually comes earlier
73
dystonias
abnormal muscle contractions... almost like a cramp
*more common in young-onset PD
74
what is the most common form of parkinsonism
progressive supranuclear palsy
75
what is the specific diagnostic feature of supranuclear palsy
supranuclear gaze palsy
** you don't lose this with parkinsons
76
supranuclear gaze palsy
loss of vertical eye movements with inability to look down
77
T or F: tremors are rare in progressive supranuclear palsy
T
78
progressive supranuclear palsy symptoms
FIGS
F = frequent sudden falls
I = ineffective meds
G = gaze palsy
S = speech/swallowing difficulties
79
this is the 2nd most common form of parkinsonism
multiple system atrophy
80
multiple system atrophy
autonomic system starts to fail
*progresses rapidly
81
lewy body dementia
- parkinsonism with early dementia
- visual hallucinations, impaired executive function, agitation
82
what is vascular parkinsonism caused by? is it progressive?
- small CVAs to basal ganglia
- not progressive
83
does vascular parkinsonism cause more symptoms in UE or LE
lower
84
what is the purpose of a DaTscan
developed to distinguish between PD and essential tremor
85
T or F: SaTscans diagnose PD
F: it will appear abnormal in ANY disease with a loss of dopamine
86
T or F: MRI appears normal in PD
T
87
2 possible locations for deep brain stimulation for PD. which is most common?
1 - subthalamic (most common)
2- globus pallidus interna
88
T or F: deep brain stimulation cures PD
F: it decreases the need for medications in some but it will not make the symptoms any better than their best on time with meds
89
T or F: those with parkinsonism syndromes will benefit from deep brain stimulation
F
90
T or F: there is an increased risk for falls after deep brain stimulation. Why or Why not
T: because they are able to move faster but are not able to catch their balance yet
91
what are the two gold standard meds for PD and how do they work
- carbidopa and levodopa
- dopamine agonist
*they have a lot of crazy side effects
92
T or F: food can play a role in the effectiveness of meds
T
93
T or F: you should only asses patients on their on times with meds
F: you want to assess and treat during the off times if possible because you need to see them at their worst
94
T or F: domapinergic therapy improves cognitive function and motor learning
F
* gait and balance impairments also persist
*aka: you still need exercise
95
with PF, it is important to look at _____ of movement
quality
96
most common areas of pain and cause of pain in PD
back and shoulder caused by rigidity
97
why do pts with PD tend to do better with stairs
it is a continuous external cue
98
freezing of gait
unwanted stop in forward progression of gait, feels like their feet are stuck to the floor
*stress, distractions, and turning are triggers
99
festination
tendency to move forward with increasingly rapid small steps
100
what is the goal when treating freezing of gait? how can you do this?
- reduce frequency of freezing
- progress from closed to open environments
- identify freezing triggers and include them
- gradually add distractors
101
you are gait training with you pt who has PD and they experience a freezing of gait. what do you do?
1 - stop
2 - stand tall
3 - shift weight
4 - step big
*never fight a freeze b/c they will fall
102
what is the biggest predictor of future falls in PD? what about of the first fall?
- fall history
- decreased gait speed and SLS time
103
T or F: when exercise is introduced early in PD, progression can be slowed
T: dopaminergic neurons are highly responsive to exercise and activities that are rewarding increase dopamine levels
104
T or F: amplitude matters at all stages and ages of PD
T
*people with PD feel like normal movements are too large. have them move big!
105
why do external cues work so well in PD?
they bypass the damaged basal ganglia to use cortical areas for movement initiation and control
106
what PRE do you want patients with PD to stay between
13-16 (moderately hard-hard)
*intensity matters!
