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Year 2: Neuromuscular II > Test 2: PD management > Flashcards

Test 2: PD management Flashcards

1
Q

describe pharm management of PD/how it works

A

dopaminergic meds to manage symptoms

response to meds change over time; PT may see these changes over course of disease

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2
Q

gold standard med for PD and details (schedule, SEs, etc)

A

Levodopa-carbidopa (Sinemet) is gold standard

take on empty stomach

SEs: nausea, OH, dyskinesia, motor fluctuations, and hallucinations

on/off times

therapeutic window narrows over time

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3
Q

when does dyskinesia occur most often in relation to medication use

A

occurs at peak dose

*getting too much dopamine at peak

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4
Q

medications considerations for PTs and questions you may ask a pt

A

How long do the meds take to kick in?

how long does the dose last?

do you have off times?

how severe are you off times? are they predictable or random?

on/off time eval can be helpful

complete re-test at same time of med cycle

PT can occur during on times to teach strategies during off times

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5
Q

symptoms of PD that are not responsive to meds

A

postural instability
freezing of gait
mental changes
ANS dysfunction

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6
Q

sx management for PD

A

deep brain stimulation

unclear mechanism

goals:
- minimize off times and dyskinesias
- reduce dose of medication
- does not eliminate meds all together

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7
Q

characteristics that make a pt a candidate for deep brain stim

A

idiopathic PD
intact cognition
good dopamine response
lack of sx co-morbidities
realistic expectations
normal MRI
younger candidates
ability to tolerate wake sx
degree of disability
ability for follow up program

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8
Q

risks of DBS

A

symptoms reduction variability

no impact on postural instability

infection risks associated with brain sx

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9
Q

PD considerations that are not motor related

A

depression
cognitive dysfunction
dysautonomia
Orthostatic hypotension

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10
Q

ways to help/manage orthostatic hypotension

A

increase fluid intake

increased dietary sodium

consider use of oral water bolus

raise head of bed

use compression garments

instruct use of physical counter maneuvers

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11
Q

benefits of exercise for PD pts

A

improvements in:
- CV health
- motor performance
- psychological health
- sleep
- bone health

decrease fatigue

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12
Q

goals of PT in relation to PD

A

slow disease progression

optimize ADL participation with home/community

optimize independence and safety during functional tasks

preserve/improve physical function

decrease fall risk

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13
Q

importance of aerobic exercise in PD and FITT principle

A

PD pts have reduced CV function and reach max aerobic capacity at much reduced ex levels

RX = mod to high intensity aerobic training

salience is key!

F: 3x/wk
I: 60-85% HRmax
T: 30-40 min
T: stationary cycling and treadmill training

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14
Q

key things you want to improve with PD pts and to keep in mind while writing goals

A

speed of movement

power

initiation

endurance

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15
Q

benefits of treadmill training with PD pts

A

safe/feasible

gait improvements: speed, stride length, symmetry, etc

improved balance and motor performance

improved QOL

reduced fatigue

**considerations for higher level H&Y stages

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16
Q

balance training for PD

A

most appropriate for ambulatory pts; H&Y stages 1-4

F: 2-3x/wk
I: mod to high
T: 20-120 min
T: multimodal balance training, dynamic gait, balance with tech such as biofeedback

17
Q

contributors to balance

A

biomechanical constraints

stability limits vertically

anticipatory postural adjustments

postural adjustments

sensory orientation

stability in gait

18
Q

resistance training for PD

A

need to adapt for advanced H&Y stages

F: 2 nonconsecutive days/wk

I: progress as tolerated
- Beginner = 40-60% 1RM for strength and 20-30% for power
- Experienced = 80% 1RM for strength and 40% for power

T: 30-60 min/session

T: all major mm groups (target extensors!)

improves power, strength, non-motor S&S

19
Q

gait training FITT principle

A

F: 3-5 days/wk

I: no specific parameters

T: 20-60 min

T: treadmill training, robotic assisted training, overground training, nordic walk

20
Q

community based exercise for PD

A

consider appropriateness for those with advanced balance/cognitive impairments

F: 2x/wk

I: max intensity while optimizing safety

T: 45-60 min for 12+ wks

T: consider a salient task based on eval findings

Examples: aerobic ex, balance ex, boxing, dance, pilates, resistance, tai chi, and yoga

21
Q

types of exernal cueing

A

visual
auditory
amplitude
somatosensory

22
Q

other interventions specific to PD

A

dual task

LSVT big

PWR! moves

23
Q

examples of dual task training

A

carrying a laundry basket

counting bwds by 3

categorical naming

naming items that begin with one letter

24
Q

describe LSVT big

A

key features
- target: amplitude
- mode: high intensity and effort
- calibration

4 days/wk for 4 weeks, 60 min sessions

7 maximal daily exercises + additional functional component tasks and hierarchy task

daily hw expectations

25
Q

what are PWR! moves

A

PD specific functional exercises

performed in 5 positions

cognitive and physical parameter adjustments are available for modification and progression

to improve: flexibility, strength, and balance

26
Q

positions for PWR! moves

A

quadruped
sitting
standing
supine
prone

27
Q

how to practice PWR! moves

A

prepare: performed slowly, increase attention
- rigidity

activation: high effort and repetition of big and fast movement
- bradykinesia
flow: linking of PWR! moves into a sequence

28
Q

task specific training with PD pts

A

indicated for those who have idopathuc PD and H&Y stage 1-3 w/o cognitive impairments

F: 2-5 days/wk
I: high intensity
T: 15-45 min
T: one on one manner

Ex: UE, turning, dual task, fall prevention, and bladder training

29
Q

describe the behavior change approach

A

goal setting

client centered care

action planning

problem solving for long term behavior change

builds rapport and understanding

needs to be adapted with those with cognitive impairments

often used in OP or via telehealth services

30
Q

flexibility exercise for PD

A

weak evidence/support

can be used as warm up or cool down

may help reduce rigidity

F: daily
T: warm up, cool down, am/pm
T: major mm groups

could use supplemental equipment

ex: tragus to wall, occiput to wall

31
Q

why utilizing certain learning strategies can be useful with PD pts

A

replace internal cuing mechanisms with external (bypass basal ganglia)

equivalent to compensatory techniques

shifts learning to explicit continuum

used to facilitate motor learning

32
Q

goals of using certain strategies with PD pts

A

cognitive = involves more of cortex by facilitating conscious thinking

external driven = i.e. using metronome

33
Q

considerations for PD therapy with early/mid vs late stages

A

early/mid = facilitate motor learning

late = provide compensation

34
Q

motor learning/neuroplasticity principles

A

high reps
use of blocked practice
utilize external cues
close environment as needed

35
Q
A

Year 2: Neuromuscular II (18 decks)

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