PD Exam & Intervention

Question 1

Unified PD Rating Scale (UPDRS)

Answer 1

Developed by an international group of
neurologists; Revision launched in 2009
 Total score
 Subscales
  Mentation, behavior, mood
  ADL
  Motor
  Complications of (drug) therapy
  Other issues

Question 2

Schwab & England

Answer 2

Rates overall function on a ten point scale
 100 = completely independent
  0 = totally dependent, vegetative
    functions are not working (e.g.,
    bowel, bladder, swallowing)

Question 3

PROFILE PD

Answer 3

24 item scale; 96 points total
11 items: Body systems (e.g., rigidity, tremor, postural instability)
10 items: Activities (e.g., turn in bed, adjust bed
sheets, transfer, gait)
3 items: memory, depression, involvement

0-4 for each item
0= no difficulty to 4 = marked/severe difficulty
Data obtained by interview & examination

Question 4

Psychometrics of PROFILE PD

Answer 4

Inter-rater reliability ICC = .97
Factor Analysis – single scale
Validity
Regression with CS-PFP and covariates:R-sq = .78
Correlation with UDPRS: .86
Strong correlation even after adjusting for
other factors

Question 5

Continuous Scale Physical Functional

Performance – CS-PFP

Answer 5

Performance based test
15 real life task (e.g., carry pot, make
bed, laundry, vacuuming)
Performed continuously
High reliability, sensitivity to change
Realiable and valid for people with PD

Question 6

Continuous Scale Physical Functional

Performance – CS-PFP Cutoff Scores

Answer 6

Transition from
independence, about 57

H&Y 3 - 30

Question 7

Functional Reach Cutoff Score

Answer 7

Cut off, falls risk: 12.5 inches

Question 8

Timed Up & Go Cutoff Score

Answer 8

Cut off, falls risk: 7.95 sec

Question 9

Six Minute Walk Scores

Answer 9

Expected range 60-69 yrs. 460-609 m.

Increased mortality 350 m.

Question 10

Two Minute Walk Scores

Answer 10

Expected mean: 185.3

Question 11

Impairments of Typical Importance - PD

Answer 11

Posture
Range of motion and flexibility
 E.g., hamstring muscles, gastrocnemius /
soleus, shoulder flexion, axial
Strength
 Quads, dorsiflexors, hip extensors, axial
Pain
Cardiovascular condition

Question 12

Clinician’s Bottom Line - T&M

Answer 12

Functional decline begins very early – most
measures aren’t sensitive
Two measures detected deficits early
 CS-PFP
 Functional reach
Choose measures, based on stage of PD
 and expected progression
For all patients – overall summary (e.g.,
 PROFILE PD or UPDRS)

Question 13

Early Stage T&M

Answer 13

Balance
 Postural pull test
 Functional reach
 iTUG – Horak et al
Gait
 Six Minute Walk test (SMW)
 10 meter walk
Impairments
 FAR
 Muscle length: Hamstrings, gastroc/soleus

Question 14

Middle Stage - Balance T&M

Answer 14

Postural pull test
Activities Balance Confidence Scale (ABC)
Estimate of likelihood of falling
 Berg Balance
 Dynamic Gait Index
 Timed Up and Go
 Functional reach
Late Middle Stage
 Falls diary

Question 15

Middle Stage - Gait T&M

Answer 15

Six Minute Walk
 10 meter walk (gait speed)
 Clinical issues:
 Level walking, inclines, stairs
 Turns – difference according to side of turn
 Cluttered areas
Late Middle Stage
 Freezing of gait
 Two Minute versus Six Minute walk test

Question 16

Middle Stage – Combined balance and gait T&M

Answer 16

Timed Up & Go (TUG)
360 degree turn
Steps / time
Four Square Step Test?

Question 17

Middle Stage Add’l T&M

Answer 17

FAR
Supine to stand
Impairments
 Muscle length: hamstring, gastroc/soleus,
 shoulder flexors, axial
 Muscle strength: quads, axial

Question 18

Late Stage – H&Y 4 T&M

Answer 18

Two minute walk
Timed UP & Go
Falls diary
Freezing of gait

Question 19

Emphasis of Physical Intervention

Answer 19

Strategy training
 Pathophysiology (direct effects)
 Compensate for problems in neuromotor
 processing
Sequelae
 Secondary impairments (sequelae)
 Correct/improve underlying impairments to
 enhance functional ability despite the disorder
Falls
 Combination of a variety of strategies

Question 20

Strategy Training for Direct Effects of the Pathophysiology for PD

Answer 20

Compensate for the impairments
associated with movement organization
 Strategies Training - Motor learning strategies to        improve performance through practice, compensatory strategies
 Avoid dual task performance
Visualization
Rhythmic Auditory Stimulation (RAS)

Question 21

Compensatory strategies to bypass the basal

ganglia

Answer 21

Use of rhythmic stimulation, mental rehearsal

Breaking down task into components)

Question 22

Strategies learned through repeated practice

Answer 22

Bed mobility, transfers

Avoid performing dual task

Question 23

Treatment Goals - Concepts

Answer 23

Optimize independence & participation (home,
work, leisure)
Optimize safety & independence with functional
tasks (bed mobility, transfers, balance, gait,
specific ADLs)
Preserve / improve physical capacity
(cardiovascular endurance, strength, flexibility)
Prevent falls
Optimize long term independence with home
exercise program & activity

Question 24

Four key elements of PD Treatment

Answer 24

Promote physical activity
Strategy training
Management of secondary sequelae
Fall prevention / reduction

Question 25

Cueing Strategies

Answer 25

```
Consciously think
Visualize
Mentally rehearse
Break down complex movements
Avoid dual task performance
Use feedback (cues) ``` 3x/wk for 6-8 wks or until acquired Thereafter - bouts of therapy 2-3X / yr

Question 26

Exercise Dosing

Answer 26

Aerobic -
3x/wk for at least 30 min for 4 mo. at 65% to 80% HRmax to establish change Strength -
2-3X/wk; 1-3 sets exercise
Use resistance loads equivalent to 8-12 reps for at least 6 wks
Use body weight for load Stretching - 3X/wk for 6-12 weeks,
then ongoing practice

Question 27

Intervention strategy for early-stage PD

Answer 27

Promote active lifestyle with continued involvement at home, work and leisure Strategy training while capacity to learn motor skills is still present Begin a general exercise program  Aerobic  Flexibility  Strength Think prevention from the beginning: Prevent falls through prevention of secondary sequelae

Question 28

Intervention strategy for mid-stage PD

Answer 28

``` Promote active lifestyle Make changes to task / environment as needed
Encourage participation in activities and exercise when ‘on’ Strategy training with compensatory techniques (e.g., task specific practice) Prevent/ reduce falls Reduce multi-tasking Exercise to reduce sequelae ```

Question 29

Intervention strategy for late-stage PD

Answer 29

``` Teach caregiver  How to assist with function  Compensatory cues Active assisted exercise to prevent worsening of secondary sequelae (e.g., contractures)
Change positions regularly to prevent skin breakdown, contractures, postural deformity. ```