Chp 21 PD Flashcards
What is Parkison’s Disease? and what 3 things is it typically characterzied by?
How does it come about?
PD- is an progressive disease of the Nervous system and is characterized by rigidty, bradykinesia, and tremors.
Etiology- Idiopathic PD caused by late onset 40 years or so generally sporadic Juvenille 21 years yound onset greater than 21 years of age
Parkisons due to ID causes:
virus encephalitis lethargica , toxins (CO carbon sulfate cyanide, methanol) usally from work exposure drugs (antihyerptensive, antidepressants, antileptics. neuroleptics ( thorazine)
Parkisonism in othe neurogeneative disorders - Progressive supranuclear palsy Cortical-basal ganglioninc palsy
Pathopyhsiology-
Basal Ganglia area of interconnected gray matter contains caduate and putamen commonly refered to as the striatum. BG plays a big role in planning and coordinating movements. It stimulates motor neruon pathways to be inhibited or to be excited.
What happens is the dopamingergic neurons that produce dopamine. Once the neuron degenerates it releases parts called “lewey bodies”. Then this in turn leads to depleted Dopamine and this can cause an overactive pathway which leads to akinesia or rigidity or a underactive pathway that leads to bradykinesia.
pg. 856 displays a diagram of the inter workings of this issue.
What are some Clinical presentations of parkisons (12)
Rigidty - Leadpipe- resistance throughout the movement and Cogweheel- random bits of resistance throughout the movement
Bradykinesia- Freezing- sound break or block in movement, hypokinesia- reduced amplitude of movment
Tremors- Can be postural, dynamic, usally have a pill rolling tremor in the hands.
postural instability- narrow base of support
Motor planning- Start hesitation to a movement especially in later stages, Micrographia- usally have a very small handwriting that is hard to read
Freezing episodes- especially when they see a narrow space they have to conquer or an obstacle
Poverty of Movement- describes an overall decrease in the total number of amplitude of movements. Patient just cant do bicep curls or leg extensions anymore they don’t have the motor plan in his or her brain anymore. Hypomia- a reduction in the expressiveness with diminished blinking and smiling
Motor Learning- Procedural memory or ability to form new motor patterns like learning to ride a bike fuck it throw it in the shiter.
Gait- Festinating - short quick little steps and can be anterior meaning leaning forward or posterior festinating gait.
Sensation loss- although not always present and may experience akathisa- an inner sense of of restlessness and need to move.
Speech, Voice, Swallowing- Dysphagia, hypokinetic dysarthia
Cognitive Function and Behavior- Bradyphernia- a disorder of intellectual function can be seen in patients with PD.
Auntnomic Nervous System Disorders- Dysautonomia- Thermulregualtory dysfunction constant feelings of hot and then cold agian
Cardiopulmonary function- Orthostatic hypertension is common. Sometimes may even have airway trapping and lung insulfation can lead to death.
Hoehn and Yahr Classification of Disability scale
stage 1 - minmal or absent unilateral if present
stage 2- minimal bilateral or midline involvement balance not impaired
stage 3- impaired righting reflexes unsteadiness when turning or rising form chair
stage 4- All symptoms present cant walk or stand without assistance
Stage 5- Confined to a bed
Pharamolgical management
Neuroprotective Med is?
Symptomatic Med is?
What is the end -of-deterioration
on-off phenomenon
dyskinesias ?
What are some dopamine agnoists
Neuroprotective drugs - Monoamine Oxidase inhibitors
Symptomatic treatment- Drug of choice is L-DOPA
Wearing off occurs and this the “end-of-deterioration and the drug effectiveness is decreased the theruaptic window is essentially 5-7 years and usally results from a destruction of the BG.
On-off phenomenon - random fluctuation in muscle movement
dyskinesias- general term for involuntary movements
Some agnosits - include Parlodel, Requip, and Pramipexole.
Table of all drugs on pg. 864
Nutrional Managment
High calorie low protein diet. Interestingly enough the protein decreases the effectiveness of L-DOPA due the amino acid complex. Only 15 percent of calories should come from protein per day. Pt. also encouraged to take dietary supplements and vitamins to recieve anything that may have been lost previously.
Surgical Management- Only performed if drug treatment is ineffective.
Stereotactic Surrgery what is? (Edeer)
(
Pallidotomy-
Thalaotomy
Deep Brain Stimulation
Neural Transplantation
Stereotactic Surgery - Causing Lesions in the brain. Pallidotomy- Destructive lesion to the GP to reduce inhibitory controls
Thalamotomy- Causing harm to the ventral intermediate nucleus in the thalamus and decreases longstanding tremors
Neural Transplantation- Delievering transplatantion cells to the striatum to produce more healthy dopamine however, this process is still under investigation.
Deep Brain Stimulation- implanting electrodes into the brain that suppress certain nerve signals that cause the problems.
what is included in a physical therapy examination for a patient with PD
pg. 866 shows the progress on how to address the medications for PD properly
Cognitive Function- Examine the memory, attention, processing speed, and concentration abilities of a patient
Psychosocial Function- Check for depression, anxiety, and stress levels and various coping mechanisms.
Sensation- Make sure to test deep and superficial pressures and make use of the VAS.
Flexibility- Check ROM both AROM and PROM
Posture- Use posture grids or plumb lines.
Muscle Performance- MMT and dyanometer
Rigidity- Cogwheel or Leadpipe
Bradykinesia- perdue peg board test (finger dexetrity) writing, buttons and so forth
Tremors/ Postural instability - a through exam of balance is indicated that patients perception. Functional Reach Test. Steps per minute, Talking and walking at the same time. Just some ways to test postural stability
Gait- 10 meter walk test, check for foot clearance, look for shuffling gait, test step length, look for recipcoral arm movement etc..
Swallowing and Speech- Refer
Autonomic function- Excessive droolin or sweating or greasy skin or abnormalities in thermo-regulation. Check these along with Vitals very important.
Cardiopulmonary- Froced vital capacity, maximal expiratory flow, maximal inspiratory flow, total lung capacity are things you can mesure, Breathing patterns, inspection of rib cage, chest wall mobility stuff like that.
Integumentary integrity, - brusing or skin breakdown. Remember pressure relief strategies
Functional Status- FIM
Global Health Measures- SF-36. Unified Parkisons Disease Rating Scale and many others that essentially test the same thing
Didn’t include the Physical Therapy intervention as it very similar to the other chapters.
