PT Managemnet Of People With PD (part 1) Flashcards
What is the pathophysiology of IPD
Loss ode dopanergic cells in the substantial intra leads to a deficiency in dopamine for use by the communication pathways in the BG , frontal lob and sympathetic decision of the ANS
What is teh basal ganglia critical to producing
Normal movements and postural control
What ist he normal circuits to the frontal lob critical for
Mental processing , motor planning and personality
What is the sympathetic division of the ANS responsible for
Temperature regulation , blood pressure control
Symptoms may not be seen until what
60-80% of dopanergic cells have been lost
What are prodromal symptoms
Symptoms that show up prior to the classic motor symptoms that define PD
What symptoms does prodromal symptoms include
- loss of smell
*chronic constipation - BP fluctuatation
- sleep disorders
What are the classic clinical features of IDIOPATHIC PARKINSON’S
DISEASE (IPD)
TRAP
•Tremor, resting
•Rigidity, cogwheel
•Akinesia, bradykinesia
•Postural Instability`
What are the 4 cardinal signs for IPD
- resting tremor
- mm ridgity
- akinesia/bradykinesia
- impaired postural reflexes
What 2 problems often lead to social isolation for PD
Micrographia (small handwriting)
Speech difficulties
What motor symptoms is usually seen first for PD
Micrographia (small handwriting)
Loss of smell, feelings of hot or cold, excessive
sweating, oily skin, increased dandruff, orthostatic hypotension, sleep disturbances, depression and/or anxiety, decreased “executive function”, dementia, characterized particularly by decreased memory for recent events
What kind of symptoms are these
Non motor ones
Are the motor or non motor problems more distressing for patients with PD
Non motor
What are the stages of PD using the modified Hohen and Yahr staging
Stage 0:
Stage 1:
Stage 1.5:
Stage 2:
Stage 2.5:
Stage 3:
Stage 4:
Stage 5:
Stage 0: no signs
Stage 1: unilateral disease
Stage 1.5: unilateral plus axial invovlement
Stage 2: bilateral disease without impairment of balance
Stage 2.5: mild bilateral disease with recovery on pull test
Stage 3: mild to moderate bilateral disease , some postural instability . Independent still
Stage 4: moderate to severe bilateral disease , loss of balance
Stage 5:non ambulatory
Differential Dx includes, but is not
limited to, the following syndromes:
Essential Tremor*
⚫ Idiopathic Parkinson’s disease (IPD)
⚫ Progressive Supranuclear Palsy (PSP)
⚫ Multi-system atrophy (MSA)
⚫ Vascular Parkinsonism
⚫ Corticobasal ganglionic degeneration
(CGD)
Vertical gaze restriction is really seen in what kind of Parkinsonism disorder
Progressive supranuclear palsy
What are the 4 common things to CLINICAL DIFFERENTIATION OF PARKINSONIAN DISORDERS
- symmetry of deficits
- vertical gaze restriction
- L dopa response early
- L dopa response late
IDIOPATHIC PARKINSON’S DISEASE
(IPD)- Features supporting diagnosis (5)
• Unilateral symptom onset
• Characteristic resting tremor
• Narrow-based gait with flexed/
stooped posture
• Reduced arm swing with tremor
• Sustained and significant levodopa
effect (helps retain dopamine) ** important
Clinical features distinguishing other parkinsonian syndromes from IPD
• Symmetry at onset
• Rapid progression (to H&Y stage 3 in 3 years)
• Lack of tremor
• Falls at presentation and early in the
disease course
• Early dysautonomia (BP, GI, GU)
• Poor response to levodopa
What is one way to differentiate PSP from IPD
F – Frequent, early falls backwards
I – Ineffective meds
G – Gaze stability
S – Speech and swallowing changes
What is a way to differentiate cortical basically ganglia disorder vs IPD
C- Cognitive change
I - ineffective meds
A- asymmetry present
O- odd movement/freezing
