10/2- Physical Exam and Intervention for PD part 2

Question 1

What is the difference between using outcome measures for examination and using clinical decisions?

Answer 1

Outcome measure- has psychometric properties and allows for a reliable/valid assessment of progress

Clinical decision - relies on task analysis to evaluate impairments, does not have psychometric properties but is functional for the patient

Question 2

What are the 5 most important big picture items to focus on in the history for someone with PD?

Answer 2

1. Patients goals- focus on the person not the disorder
2. Chief complaints of activity and participation- roles and responsibilities
3. Typical level of activity and exercise
4. Fall history- how often, when, where why
5. Social History

Question 3

What Parkinson’s disease specific information should you obtain in the history?

Answer 3

Characteristics of PD
1. initial side of onset
2. profile of symptoms at onset and now
3. Type of PD
Relationship of symptoms to medications
Co-morbidities and treatments

Question 4

What does the UPDRS stand for? What are the 5 subscales on the test?

Answer 4

Unified PD Rating Scale

1. Mentation, behavior, mood
2. ADL
3. Motor
4. Complications of drug therapy
5. other issues

Question 5

What is the purpose of the Schwab and England test?

Answer 5

It rates overall physical function on a 10 point scale
100= completely independent
0 = totally dependent - vegetative

Question 6

What items are examined on the Profile PD test? What is special about the Profile PD?

Answer 6

24 item scale- 96 point total

• Body systems- rigidity, tremor, postural instability
• Activities- turn in bed, adjust bed sheets, transfer, gait
• Memory, depression, involvement

Question 7

What key (7) functional activities should you observe during the examination of someone with PD?

Answer 7

1. Bed mobility and transfers
2. Stability- balance control
3. Gait- on level, uneven surfaces, in cluttered spaces, over obstacles, turning
4. Reaching
5. Dual task performance
6. Fine motor performance
7. Specific ADL’s

Question 8

What is the CS-PFP? What does it evaluate?

Answer 8

Continuous Scale Physical Functional Performance

• performance based test with 15 real life functional tasks
• reliable and valid for people with PD

Healthy adults in their 60’s typical score 64

Transition from independence scores -57

PD scores H & Y stage 3 - 30 - really low in comparison

Question 9

What is the cut off score for individuals with PD in the functional reach test? Timed up and Go?

Answer 9

FRT- >12.5 inches is at an increased risk of falls

TUG- 7.95 sec

Question 10

How does an individuals functional axial rotation change with an increase in the H & Y stages of PD? What are the expected values for men and women ages 40-59?

Answer 10

It quickly declines with an increase in stage

40-59 males - 117 degrees
40-59 females- 127.8

Question 11

What other (8)measures can evaluate balance and gait for individuals with PD

Answer 11

1. Activity balance confidence
2. Berg Balance Scale
3. Dynamic Gait Index
4. Functional Gait Assessment
5. Best test
6. Four Square step test vs 360 turn
7. TUG
8. Freezing of gait

Question 12

What are the most typical impairments seen in individuals with PD?

Answer 12

Posture
ROM and flexibility-  hamstrings, gastroc, soleus, 
Strength
Pain
Cardiovascular condition

Question 13

What two measures used for PD detect deficits early on in the diagnosis ?

Answer 13

CS-PFP

Functional Reach test

Question 14

In the early stage of PD, what tests should be used to evaluate Balance, Gait and Impairments?

Answer 14

Balance

1. postural pull test
2. functional reach

Gait

1. 6 minute walk test
2. 10 meter walk test

Impairments

1. Functional axial rotation
2. muscle length

Question 15

What tests should be used to evaluate balance for people with Middle Stage PD?

Answer 15

postural pull test
ABC scale
Fall risk assessment- BBS, DGI, TUG, FRT
Falls diary

Question 16

What tests should be used to evaluate gait for people with Middle Stage PD?

Answer 16

TUG
6MWT
10 meter walk
walking in various conditions
Turning
Freezing of gait

Question 17

What 3 tests combine balance and gait in the evaluation for the middle stage PD?

Answer 17

1. TUG
2. 360 degree turn
3. Four square step test

Question 18

What H & Y stage is classified as a late stage?

Answer 18

Level 4 and Up

Question 19

What tests are used to evaluate gait/balance for the late stages of PD?

Answer 19

2 minute walk
TUG
Falls Diary
Freezing of gait

Question 20

How does the pharmacology impact physical therapy interventions?

Answer 20

The medications allow for a decrease in the rigidity, bradykinesia, tremor and postural instability to allow for exercise and a decrease in functional limitations

Question 21

What should the emphasis of physical intervention be for individuals with PD?

Answer 21

Strategy training - to compensate for problems in neuromotor processing and pathophysiology

Secondary impairments- correct/ improve the underlying impairments to enhance function

Address falls

Question 22

What are 3 types of strategy training that can have direct effects on the pathophysiology?

Answer 22

1. movement organization - avoid dual task performance
2. visualization
3. rhythmic auditory stimulation/ mental rehearsal

Question 23

T/F individuals with PD have trouble learning new things

Answer 23

True -
Early stages- can still learn motor skills however it is slower and requires more repetition
Late stages - have more difficulty and may need to bypass the defective basal ganglia

Question 24

What are the concepts for treatment goals for individuals with PD?

Answer 24

1. Optimize independence and participation in work, home and leisure
2. Optimize safety and independence with functional tasks- bed mobility, transfers, balance, gait, ADLS
3. Preserve/improve physical capacity- CV endurance, strength, flexibility
4. Prevent falls
5. Optimize long term independence with HEP and activity

Question 25

What are the 4 key elements of an appropriate plan of care and intervention for PD?

Answer 25

1. Promote physical activity- BIGGETS EMPHASIS 2. Strategy training 3. Management of secondary impairments 4. Fall prevention/ reduction

Question 26

What are important aspects to consider when encouraging someone with PD to engage in physical activity?

Answer 26

Think about their barriers and abilities for exercise implement strategies for the barriers Establish realistic goals Think about what they like to do- walking, dancing

Question 27

What are two types of strategies that can be used for strategy training?

Answer 27

Motor learning strategies to improve performance through practice compensatory strategies

Question 28

What are different types of cues? Cueing strategies?

Answer 28

1/ Verbal cues 2. Auditory cues 3. Visual cues ``` consciously think visualize mentally rehearse break down complex movements avoid dual task performance use feedback/ cues ```

Question 29

Cardiovascular fitness is beneficial for individuals with PD, what should the dosing of endurance training be?

Answer 29

3/wk for at least 30 min for 4 months at 65-80% of HR max to establish change need to keep doing it in order to keep the effects of exercise

Question 30

Strength training is also beneficial for PD- what muscle groups should strength training target and what should be the dose?

Answer 30

LE balancing muscles- specifically LE extensors and postural extensors Dose - 2-3 x/wk 1-3 sets of exercise, use resistance loads equivalent to 8-12 reps for atleast 6 weeks use body weight for load

Question 31

How can flexibility training impact someone with PD? What area is the most important to target for flexibility

Answer 31

it leads to improved balance and gait Spinal flexibility 3x wk for 6-12 weeks

Question 32

What is the over all intervention strategy for early stage PD?

Answer 32

Promote active lifestyle with continued involvement at home, work and leisure Strategy training while they can still learn new things Begin a general exercise program - aerobic, flexibility, and strength Think PREVENTION!

Question 33

What is the over all intervention strategy for MID stage PD?

Answer 33

Promote an active lifestyle encourage participation in activities and exercise when meds are ON strategy training with compensation techniques prevent. reduce falls reduce multi tasking exercise

Question 34

What is the over all intervention strategy for LATE stage PD?

Answer 34

Teach the care giver how to assist active assisted exercise to prevent the worsening of sequelae- ex contractures change position regularly to prevent skin break down