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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
Q

describe Rigidity as it pertains to PD

A

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
Q

describe Postural Instability as it pertains to PD

A

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
Q

describe a typical Gait pattern exhibited by PD

A
  • 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
Q

describe the On/Off Phenomenon that occurs in PD

A
  • 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
Q

what is an early sign of Rigidity relating to PD?

A

when the individual has reduced arm swing

30
Q

how do you recognize the PD related tremor?

A

it will be a resting tremor, that dissipates upon movement

31
Q

why are speech and swallowing affected by PD?

A

rigidity

- as oral structures lose their ability to move and become rigid, swallowing becomes more and more difficult

32
Q

name other typical characteristics of PD

A
  • 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
Q

what are three contributing causes to Postural Instability?

A
  • festinating gait
  • postural dysfunction
  • freezing
34
Q

what are the two types of PD?

which is worse?

A
  • tremor- predominant

- postural instability-predominant ** worse

35
Q

what are the two approaches in pharmacological management/treatment of PD?

A
  • neuroprotective

- symptomatic

36
Q

why is Monoamine Oxidase Inhibitor prescribed?

A
  • 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
Q

what meds are used to treat the symptoms of PD?

A
  • 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
Q

what Physical Therapy assessments are pertinent to PD?

A
  • 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
Q

things the PTA must consider when treating the PD patient:

A
  • 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
Q

What kinds of cues will help make movement easier with PD patients?

A

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
Q

what is blocked practice?

A

a practice sequence organized around one task or one section of the task performed repeatedly, uninterrupted by practice of any other task

42
Q

what PT strategies are used in the Mid/Early Stage of PD?

A

Rehabilitative Strategies

  • Vigorous exercise.
  • Big, free movement
  • Maintenance of flexibility, strength, and cardiovascular function.
  • Maintenance or relearning of motor skills.
43
Q

what PT strategies are used in the Mod/Middle Stage of PD?

A

Compensatory Strategies

  • Strategies similar to those used in early stage, but with progressively less emphasis on impairments.
  • Use compensatory cueing strategies.
44
Q

what PT strategies are used in the Severe/Late Stage of PD?

A

Safety Strategies

  • Focus is on compensatory strategies and safety.
  • Caregiver instruction.
  • AA exercise - to keep flexible
45
Q

What therapy interventions will be needed for PD patients?

A
  • 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
Q

what are some PD-specific strategies for Gait Training?

A
  • 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
Q

what is LSVT-Big?

A

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
Q

what are some fancy new Assistive Devices that are great for PD patients?

A
  • virutal walker
  • u-step walker
  • laser cane

PTA - Neuro (6 decks)

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