Week 4 - PD and outcome measures Flashcards
what is parkinsons disease?
- when the cells that produce dopamine die, the symptoms of parkinsons appear
- progressive complex neurodegenerative disease
- everyone’s experience is different
- no cure
- movement is controlled by dopamine
-dopamine is a chemical that carries signals between nerves in brain
Stages of PD 1-5
Stage 1
mild
- unilateral movement
symptoms:
- tremor of one hand
- rigidity
- clumsy leg
- one side of face may be affected
Stage 2
mild
- bilateral involvement
or
- midline
symptoms
- loss of facial expression on both side
- decreased blinking
-speech abnormalities
-rigidity of muscles in trunk
Stage 3
moderate
- loss of balance and slowness of movement
symptoms
- balance is compromised
- inability to make rapid and automatic and involuntary adjustments
- other symptoms of pd are present
Stage 4
moderate
- severely disabling
symptoms
- pt can walk and stand unassisted but noticeably incapacitated
- pt can’t live an independent life and needs assistance
Stage 5
severe
- symptoms are severe
- inability to rise
symptoms
- falls when standing or turning
- freeze or stumble when walking
- hallucinations or delusions
what are clinical signs of pd?
- RIGIDITY
- BRADYKINESIA
- TREMORS
cogwheel vs leadpipe in PD
cogwheel:
jerky response to passive movement as muscles alternately contract and relax
leadpipe:
smooth uniform resistance with no fluctuations to passive movements
what are the clinical manifestations of pd?
1.postural changes:
2. fatigue
3. festinating gait
4. autonomic nervous system dysfunction:
5. cognitive- behavioural changes
what are some PT management for PD? - goals
goals
- delay effects of symptoms
- prevent development of secondary complications
-maintain / maximize function
what are the principles of LSVT BIG approach?
LSVT - Lee silverman voice treatment big
- thinking big to make big improvements
- big size amplitude whole body pt movements of improving flexibility, flow and movement pattern
- emphasis on rotation movements
- encourages sensory input to brain
- count out late as voice therapy same time as exs
- reduces pd symptoms and slow down progression of the disease
what are some walking patterns in pd?
- freeze in narrow spaces
- needs to practice walking in order to improve walking
- pt needs to practice turning to sit down in a chair and turning in tight spaces
- pt needs to practice taking longer step lengths, increasing trunk rotation, swinging their arms and looking forward
what are the 4 S’s to break a freeze?
S - Stop
S - Stand tall and breath
S - Shift weight side to side
S - Step out BIG and think BIG movements
how to assist in turning patterns in pd?
strategies
- walk around large arc
- clock face method
- high marching
- clapping
stage 4 assist
- they can walk without assistance but most likely need a cane or walker for safety
- assistance with adls and unable to live alone
stage 5 assist
- may be bedridden or confined to a wheelchair
what is neurogenic orthostatic hypotension?
- 20-30 mmhg drop in bp when moving from dependent position to a position of higher gravity
example: supine to sit or sitting to standing
how is NOH happening in patients with pd?
- damage in brain cause by pd results in nervous system not being able to make norepinephrine. this causes dizziness or lightheadedness
- can occur in any position but most obvious when moving to a position of gravity
what is norepinephrine?
chemical that constricts blood vessels and raises bp
how can NOH present?
common symptom in mid and late stages of pd
presents as
- lighthead
-dizzy
- weakness
how to manage NOH?
- reducing or eliminating medications like anti hypertensives
- drink more fluids
- sleep with head elevated between 10 and 30 degrees
hallucinations and delusions in people with pd
hallucination : false perception
- visual hallucinations are common in people with pd like vivid colour and happens at night
delusion : fixed conviction that something is real when it is not
- some delusions may be dominated by suspiciousness, fear and concern about safety
slight, mild, mod, and severe halluc/delu
slight:
- illusions with no form like a movement in the shadows
- person recognizes it is not real
mild:
- formed hallucinations, sees child or animal, looks real, but person knows its not real
mod:
- formed hallu, like person
- loss of insight, and person thinks hallu is real
severe:
- negative
- or positive
what is catatonia?
complex neuropsychiatric syndrome characterized by range of motor, speech, and behavioural abnormalities
can be subtle, or acture, come and go or change during episodes
includes:
- stupor
- catalepsy
- staring
-mutism
-negativism
- agitation
these are not affected by external stimuli, withdrawal from human contact and refusal to eat, stereotypy (repeating meaningless phrases
what can you use for a neuro patient as a outcome measure?
- 2 min walk test
- 6 min walk test
-10 metre walk distance
the 4 stage balance test…
- stand with your feet side by side
- place the instep of one foot so it is touching the big toe of the other foot
- tandem stand: place on foot infront of the other, heel touching toe
- stand on one foot
what are the repetitive sit to stand tests?
- 5 times sit to stand
- 30 second chair test
what is the single leg stance test?
- pt is required to stand on one leg motionless as long as possible for 30 seconds
- test is performed with or without vision
- shoes or no shoes
what are the normative values for a single leg stance test?
young adults: approx 30 seconds
age 65-74: 10 seconds
age 75 and plus:5 seconds
fall risk:
high risk: less than 5 seconds
mod: 5-20
low risk : greater than 20 sec
what is the functional reach test?
assess balance and risk of falls
Scores are determined by assessing
the difference between the start and end position which is the reach distance.
Three trials are done and the average
of the last two is noted
Low risk of falls: 10”/25 cm or greater
risk of falling is 2x more than normal: 6”/15cm to 10”/25cm
risk of falling is 4x than normal: 6”/15cm or less
berg balance scale
- for adults
- static and dynamic activities
- scale 0-4
- max = 56
chedoke - mcmaster stroke assessment
determine the presence and severity of common physical impairments
the 6 dimensions are:
1. arm
2. hand
3. Leg
4. Foot
5. Postural control
6. Shoulder pain
tinetti falls efficacy scale
- self reported outcome measure
- 10 item questionnaire
- indicator of how one’s fear of falling impacts physical performance
scale of 1-10
1 - confident
10 - not confident
how confident are you to do the following activities without falling?
- Take a bath or shower
- Reach into cabinets or closets
- Walk around house
- Prepare meals not requiring carrying heavy or hot objects
- Get in and out of bed
- Answer the door or telephone
- Get in and out of a chair
- Getting dressed and undressed
- Personal grooming (i.e. washing your face)
- Getting on and off the toilet
activities specific balance confidence scale (ABC)
0-100
0 - no confidence
100- confidence
what is FIM and its function?
functional independence measure
- measures patient’s functional ability during inpatient rehab
- track pt progress and indicate their functional level at start and end of stay
- assess variety of conditions like neuro, msk, and other disorders
What are the two main types of outcome measures used for neurological patients?
Self-reported measures
Performance-based measures
What are common performance-based outcome measures?
- 2-Minute Walk Test (2MWT)
- 6-Minute Walk Test (6MWT)
- 10-Meter Walk Test (10MWT)
- Timed Up and Go (TUG) Test
- Four-Stage Balance Test
- Functional Reach Test (FRT)
- Berg Balance Scale (BBS)
