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PTA - Neuro > PTA Neuro - Parkinsonism > Flashcards

PTA Neuro - Parkinsonism Flashcards

1
Q

what is bradykinesia?

A

slowness

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2
Q

what is akinesia?

A

absence of spontaneous movement
freezing
difficulty initiating movement

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3
Q

what is hypokinesia?

A

reduced amplitude

  • no arm movement
  • no expresson on face - mask-like
  • no trunk movement
  • tiny little steps
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4
Q

what is dyskinesia?

A

usually caused by the medications
writhing
wriggling

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5
Q

what is festinating gait?

A 
trying to catch up with yourself
more rapid
more uncontrolled
usually can't stop without help
starts with shuffling
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6
Q

what is the on/off phenomenon?

A

symptoms abate while on medicine

symptoms return as medicine wears off

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7
Q

what is micrographia?

A

very very small writing

no amplitude

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8
Q

what are paresthesias?

A

numbness
tinglings
pins and needles

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9
Q

what is the big thing the clinches the diagnosis of Parkinson’s Disease?

A

symptoms are improved with L-dopa

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10
Q

what is levadopa?

A

synthetic replacement for dopamine

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11
Q

what is the Modified Hoehn & Yahr Staging Scale?

what are the stages?

A

how the severity of PD is classified
Stage 1 - Mid/Early
- Unilateral symptoms
Stage 1.5 - Mid/Early
- Unilateral symptoms with some axial (trunk) involvement
Stage 2 - Mid/Early
- Bilateral symptoms without impaired balance
Stage 2.5 - Mod/Middle
- Mild bilateral symptoms; recovery on pull test
Stage 3 - Mod/Middle
- Mild/moderate bilateral symptoms; some postural instability; can live independently
Stage 4 - Mod/Middle
- Severe disability; can walk independently
Stage 5 - Severe/Late
- Wheelchair dependent; bedridden unless assisted

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12
Q

what ablative procedures may be done when meds becomes less effective?

A

pallidotomy

thalamotomy

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13
Q

When is Deep Brain Stimulation applied?

A

When the meds just anren’t helping anymore

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14
Q

What is Deep Brain Stimulation?

A

procedure to help with symptoms

will not affect progression of disease

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15
Q

What are the four cardinal features of Parkinson’s Disease?

A

rigidity
tremor (often the first sign)
bradykinesia
postural instability

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16
Q

What is dopamine?

A

a neurotransmitter

  • controls movement
  • emotional response
  • ability to experience pleasure and pain
  • located in substantia nigra
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17
Q

by what other names is Parkinson’s Disease known?

A
  • primary Parkinsonism

- idiopathic Parkinson disease (IPD)

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18
Q

how is Parkinson’s Disease diagnosed?

A
  • at least two of the four major symptoms are present
  • onset of symptoms started on one side of the body
  • symptoms are not due to secondary causes such as medication or stroke
  • symptoms are significantly improved with levodopa
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19
Q

syndromes that present as PD (but really aren’t) are know as:

A
  • atypical Parkinsonism syndromes

- Parkinson-Plus syndromes

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20
Q

name some Parkinson-Plus syndromes:

A
  • multi-infarct vascular disease
  • diffuse Lewy body disease (because early dementia)
  • multi-system atrophy:
    • shy-drager syndrome
    • striatonigral degeneration
    • progressvie supranuclear palsy
    • olivopontocerebellar atrophy
21
Q

what causes PD?

A
  • deficiency of the neurotransmitter dopamine due to certain neurons in the substantia nigra
22
Q

what causes Secondary Parkinsonism?

name 2 types.

A
  • drugs, medicine
  • associated with encephalitis, alcoholism, exposure to certain toxins, TBI, vascular insults, use of psychotropic medication
  • Drug-Induced Parkinsonism (gradually reduced when meds stop)
  • Toxic Parkinsonism (due to Agent Orange, pesticides, manganese)
23
Q

what is the Incidence of Parkinson’s Disease?

A
  • 1 million cases living in USA
  • 60,000 diagnosed per year
  • Mean age of onset is 60 years
  • ~ 4% cases before age 50
  • Incidence increases with age and rising with aging population
  • Males slightly more at risk than females
24
Q

describe Resting Tremor as it pertains to PD

A

Resting tremor

  • most common is “pill rolling” (often the first symptom)
  • tremor usually disappears with voluntary effort
  • occurs in hand/wrist, forearm, jaw, tongue, head
25
describe Rigidity as it pertains to PD
Rigidity—increased resistance to passive motion; typically affects shoulders and neck first; as disease progresses, it becomes more severe, decreasing ability to move easily Cogwheel—jerky, ratchetlike Leadpipe—more sustained resistance w/ no fluctuations
26
describe Postural Instability as it pertains to PD
Postural instability—abnormal and inflexible postural responses and increased body sway → impaired balance reactions → lots of falls Loss of automatic movements (blinking, smiling, arm swing) Stooped posture—extensor muscles of trunk experience greater weakness than flexors—changes center of gravity → easier to get off balance
27
describe a typical Gait pattern exhibited by PD
- slow, shuffling gait - may develop into a festinating gait - no arm swing - head and trunk forward - freezing of gait (person is stuck in a posture) - difficulty turning, increased steps per turn - difficulty backing up, turning, starting, stopping
28
describe the On/Off Phenomenon that occurs in PD
- fluctuations in motor performance often related to meds | - In an "off" state, the person becomes very stiff, slow and may even be unable to move for a few minutes.
29
what is an early sign of Rigidity relating to PD?
when the individual has reduced arm swing
30
how do you recognize the PD related tremor?
it will be a resting tremor, that dissipates upon movement
31
why are speech and swallowing affected by PD?
rigidity | - as oral structures lose their ability to move and become rigid, swallowing becomes more and more difficult
32
name other typical characteristics of PD
- Depression - Dementia (in approximately 1/3 affected) - Fatigue that increases as day progresses - Difficulty with movement transitions * (not just gait, also sit<>supine, sit<>stand, just any change in position) - Micrographia - Parasthesias - Anxiety
33
what are three contributing causes to Postural Instability?
- festinating gait - postural dysfunction - freezing
34
what are the two types of PD? | which is worse?
- tremor- predominant | - postural instability-predominant ** worse
35
what are the two approaches in pharmacological management/treatment of PD?
- neuroprotective | - symptomatic
36
why is Monoamine Oxidase Inhibitor prescribed?
- as a neuroprotective agent - to delay the need for levodopa - used in early stages of PD; blocks the breaking down of dopamine; side effects—dry mouth, orthostatic hypotension, mild nausea, confusion
37
what meds are used to treat the symptoms of PD?
- Levodopa—mainstay of treatment; given w/ carbidopa; Sinemet most common med; alleviates bradykinesia and rigidity; side effects—GI, cognitive, cardiovascular, urinary, neuromuscular, sleep; therapeutic effectiveness wears off with time; dyskinesias become worse towards end of dosage - Dopamine agonist—used along w/ L-dopa; reduces rigidity and bradykinesia; side effects—orthostatic hypotension; nausea, hallucinations - Anticholinergic agent—used in early PD or along with L-dopa; moderate tremor and dystonia; also multiple side effects
38
what Physical Therapy assessments are pertinent to PD?
- Timed tests for rapid alternating movement (RAM)- bradykinesia? (disdiadochokinesia) - Balance * Functional Reach Test * Berg Balance Scale (open eyes/close eye, change surface) - Timed Up and Go Test (TUG) - 6 or 2 Minute Walk Test - BESTest - (Balance Evaluation Systems) balance, postural responses, stability in gait - Functional Gait Assessment - 10 item test that assesses postural stability during various walking tasks
39
things the PTA must consider when treating the PD patient:
- PD patients will rely on cortical control mechanisms to initiate movement, on attentional mechanisms to sustain it - Training in position changes is best broken down into component parts with lots of repetitions - PD patients will be at risk for developing decreased ROM, poor posture, weakness, decreased endurance, restrictive pulmonary disease *In early stages, encourage regular physical & aerobic activities
40
What kinds of cues will help make movement easier with PD patients?
External (visual, auditory) cues to use intact pre-motor cortex. - Visual cues for increase step length * laser, cones, discs - Auditory cues to initiate movement * "big step" * "1-2-3 go" * "pull toes up" (frozen gait) - Rhythmic cues to initiate movements, prevent freezing * use of metronomes
41
what is blocked practice?
a practice sequence organized around one task or one section of the task performed repeatedly, uninterrupted by practice of any other task
42
what PT strategies are used in the Mid/Early Stage of PD?
Rehabilitative Strategies - Vigorous exercise. - Big, free movement - Maintenance of flexibility, strength, and cardiovascular function. - Maintenance or relearning of motor skills.
43
what PT strategies are used in the Mod/Middle Stage of PD?
Compensatory Strategies - Strategies similar to those used in early stage, but with progressively less emphasis on impairments. - Use compensatory cueing strategies.
44
what PT strategies are used in the Severe/Late Stage of PD?
Safety Strategies - Focus is on compensatory strategies and safety. - Caregiver instruction. - AA exercise - to keep flexible
45
What therapy interventions will be needed for PD patients?
- Flexibility /Stretching exercises—of tightened flexors and rigid musculature - Strengthening exercises – of postural musculature with focus on elongated extensors (upright posture) - Relaxation exercises - Rhythmic Initiation - Big movements - LSVT Big - Balance training - Transitional training – rolling, sit< > sup, sit < >stand - Gait Training - Instruction in energy conservation - Instruction in Fall prevention and home safety - Educate about Equipment assessment - Educate about Cardiopulmonary exercise
46
what are some PD-specific strategies for Gait Training?
- Increase stride length, BOS, armswing, trunk counterrotation - External cues for getting out of a freeze (lift toes) - High stepping, sidestepping, braiding, crossing thresholds - Use of PWBTT - Practice starting, stopping, turning
47
what is LSVT-Big?
LSVT Big * 50-60 min sessions 4x/wk x 4 wks + home prog qd or BID * Repetitive exaggerated movements * Found faster walking w/ bigger steps increases balance & trunk rotation
48
what are some fancy new Assistive Devices that are great for PD patients?
- virutal walker - u-step walker - laser cane

PTA - Neuro (6 decks)

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