PD - Motor Symptoms

Question 1

What are some motor S/S of PD

Answer 1

TRAP (cardinal signs)
Stooped posture
Shuffling gait or Festination
Freezing
↓ Arm Swing*
Difficulty arising from a chair
Difficulty turning in bed
Imbalance & Falls
Dystonia, esp leg/foot
Hypophonic speech 
Dysphagia* 
Dysarthria
Micrographia*
Masked face*
Slowing of ADLs
Sialorrhea

Question 2

What are the cardinal Signs of PD

Answer 2

TRAP
Tremor (resting)
Rigidity
Akinesia or Bradykinesia
Postural instability 
-late stage->dec. balance and coordination

Question 3

What does Diagnosis of PD require?

Answer 3

2/3 early motor signs
Tremor (resting)
Rigidity
Akinesia or Bradykinesia

Question 4

What are the 2 types of rigidity and what are they

Answer 4

lead pipe
-low, sustained resistance t/o ROM

cog wheel
-Jerky, ratchety, catch & release t/o ROM

Question 5

Tremor and PD

Answer 5

The most common initial clinical manifestation (75%)
Usually appears unilaterally, and in a single UE
First seen in fingers: “pill rolling”
In 61%, symptoms started on right side
Is present at rest
↑ with exertion or tension
PD “Stress Test”
↓ or disappear with sleep or action
Can be unilateral or bilateral

Question 6

What is Sialorrhea

Answer 6

Drooling or excessive salivation

Question 7

What is responsible for a tremor

Answer 7

Occurs as a result of an imbalance between cerebellar actions and BG inhibition

Question 8

How does the tremor progress over time

Answer 8

Over time, the tremor will spread to other body parts including the legs, the face (blepharospasm), shoulders and neck/trunk (titubation), and may become bilateral
Blepharospasm: abnormal contraction of the eyelid

Question 9

What is a blepharospasm

Answer 9

Abnormal contraction of the eyelid muscles

Question 10

What is titubation

Answer 10

nodding movement of the head or body

Question 11

What is rigidity

Answer 11

Non-velocity-dependent hypertonicity
Uniform resistance to PROM throughout the ROM
Different from spasticity

Question 12

How does rigidity present

Answer 12

Can appear in both the agonist and antagonist muscle groups
Appears unilaterally before bilaterally
Typically affects proximal muscles, then extremities & face
An early sign is loss of arm swing in gait

Question 13

What are the effects or prolonged rigidity

Answer 13

Prolonged rigidity–> contractures & postural deformity, fatigue 2o ↑ resting energy expenditure

Question 14

Movement quality of people with PD

Answer 14

Poverty of Movement:

• Bradykinesia – reduced speed of movement
• Hypokinesia – reduced amplitude of movement
• Akinesia – No movement

Characterized by an inability to perform purposeful (functional) movements

Difficulty producing movement forces accurately, quickly or smoothly, which leads to undershooting of movements or production of too much force

Question 15

What is hypokinesia and how would you work on this

Answer 15

reduced amplitude of movement

ex: they cant lift arm all the way up
* usually have to use external cueing b/c ppl with PD respond better with external cues

Question 16

What is bradykinesia

Answer 16

Sequential or simultaneous movements appear to be affected

It is not due to rigidity, but an inability to run motor programs correctly

Seen in facial movements as well

Question 17

What is akinesia and what would ppl with PD have difficulty doing?

Answer 17

Difficulty with the initiation of movement

Different from bradykinesia
But…both are motor planning deficits

Initiation of movement occurs with co-contraction of agonist and antagonist

Drugs that limit bradykinesia do not affect akinesia - results from problems in the preparation for movement

Question 18

What do bradykinesia and akinesia have in common

Answer 18

Both are motor planning deficits

Question 19

Postural Instability andPD

Answer 19

Posture and gait changes are due to a combination of rigidity and bradykinesia

Question 20

Gait Impairment and PD (name 2 types)

Answer 20

Festination & retropulsion are common

COG is too far forward so they have to speed up to catch fall

Question 21

Would someone with PD have trouble getting out of bed?

Answer 21

yes, from the loss of rotation (& thus arm swing)

Also leads to difficulty in bed mobility

Question 22

Do ppl with PD typically fall forward or backwards

Answer 22

backwards

Question 23

When you see them standing what type of tone do they have

Answer 23

Typically flexor-bound
Often considered highly diagnostic
↑ Neck/trunk flexion
↑ Hip/knee flexion
↑ Ankle PF

Question 24

What is the foot strike of someone with PD

Answer 24

Loss of natural heel-to-toe progression–> becomes toe-to-heel instead

Question 25

What does the toe to heel step pattern do to gait

Answer 25

↓ heel strike

↓ step length

↓ stride length

Turns “en bloc”

Shuffling in early stages
–>festination in later stages

Question 26

PD and falls

Answer 26

D pts experience falls, 13% fall more than once a week
Delayed equilibrium reactions
Lack of anticipatory postural control
Inability to adequately respond to perturbations
↓ Sensorimotor adaptation
Other factors: muscle weakness (esp. in extensors), meds S/E, postural hypotension, fatigue, depression, dementia, etc.

Question 27

What is micrographia

Answer 27

Small, cramped handwriting characterized by reduction in width and height of letters
Becomes almost illegible towards the end
Related to bradykinesia – 2° to inappropriate rate and scale of movements
Test pts w/ unlined paper and start at top of page

Question 28

what is hypomimia

Answer 28

masked-like face

Question 29

What happens to someone with PD face?

Answer 29

Hypomimia – masked-like face

“Reptilian Stare” – lack of spontaneous facial expression with little blinking

Reduction of facial expressions, often misinterpreted as apathy or anger by others

Can lead to social isolation

Question 30

What can happen to someones speech with PD

Answer 30

Speech is impaired in >75% of PD pts
Hypophonia
↓ volume & breath control, hoarse speech

Hypokinetic Dysarthria
low volume, monotone/ monopitch speech, imprecise or distorted articulation, uncontrolled speech rate
Speech impairments cause social isolation!!!
Speech therapy & voice therapy are a critical component of rehab for PD pts

Question 31

What is Hypophonia

Answer 31

↓ volume & breath control, hoarse speech

Question 32

What is Hypokinetic Dysarthria

Answer 32

low volume, monotone/ monopitch speech, imprecise or distorted articulation, uncontrolled speech rate (PD)

Question 33

what is Dysphagia

Answer 33

Abnormal tongue control, impairments in chewing, bolus formation, swallowing response, and peristalsis
Leads to aspiration, ↓ nutrition, & weight loss

affects 95% of PD pts

Question 34

What is Sialorrhea

Answer 34

Excessive salivation & drooling 20 spontaneous swallowing
Can lead to risk of aspiration too (PD)

Question 35

What is Dystonia, what can it affect and what can help treat it

Answer 35

Sustained, uncontrolled, muscle contractions cause twisting and repetitive movements or abnormal postures
Can be part of the PD or medication-induced
Worsens with activity & causes a lot of pain
Cervical dystonia, foot IV/PF, hand dystonia, facial spasm
“Off” Dystonia – Early morning foot dystonia/pain
Can be treated with BOTOX

Question 36

PD and Motor Learning Deficits

Answer 36

Procedural learning deficits are common in PD while declarative learning is usually intact
The processing requirements of the procedural task are critical in determining the degree of learning capable – complex & sequential tasks are difficult for PD pts
Dual tasking is difficult as it involves shifting of attention & motor programs
Use block practice instead of random practice

Question 37

What is procedural learning

Answer 37

Difficultly learning new tasks