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NM PCM > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What kind of disease is Parkinson’s?

A

Chronic, Progressive disease

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2
Q

What is parkinson’s characterized by?

A

Rigidity, Bradykinesia, Tremor, Postural instability.

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3
Q

What is the typical age on onset?

A

40-60, caucasian men most.

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4
Q

Parkinsonism

A

group of disorders that produce abnormalities of basal ganglia

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5
Q

Paralysis agitans

A

Primary parkinson’s disease, “shaking palsy”

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6
Q

How is the diagnosis arrived at?

A

Symptoms/Clinical Signs
Response to L-Dopa
Rate of Onset
Differential Dx: EEG, CAT scan

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7
Q

Types of Parkinson’s

A

Postural instability disturbed gait (PIDG)

Tremor predominant

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8
Q

Secondary Parkinson’s

A

Postinfectious parkinsonism
Toxic parkinsonism
Drug induced (pharmacological) parkinsonism
Metabolic causes

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9
Q

Postinfectious parkinsonism

A

Seen after influenza epidemic (encephalitis lethargica)

Infectious pathogen infects substantia nigra.

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10
Q

Toxic parkinsonism

A

Toxic industrial poisons/chemicals

Manganese (miners), etc.

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11
Q

Drug induced (pharmacological) parkinsonism

A

Drugs that produce extrapyramidal dysfunction . This is REVERSIBLE. (neuroleptic, antidepressant, antihypertensive)

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12
Q

Metabolic causes

A 
Calcium metabolism disorder with basal ganglia calcification
Hypothyroidism
Hyperparathyroidism
Hypoparathyroidism
Wilson's disease
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13
Q

Parkinson-plus

A

Akinetic/rigid symptoms with parkinsonisan features

Typically DO NOT respond to parkinson drugs (L-Dopa)

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14
Q

Clinical Manifestations of PD

A

Rigidity (Cogwheel, leadpipe or both)
Bradykinesia/Akinesia (Difficulty initiating, freezing, hypokinesia, micrographia)
Tremor
Postural Instability (MSK changes)

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15
Q

What rate of tremor on EMG?

A

4 Hz resting tremor. Tremor may go away with movement. –> indicates involvement of basal ganglia.

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16
Q

Turning en block

A

Pelvis, head and shoulders all turn as a unit. Taking small steps to accomplish a turn.

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17
Q

Non-motor symptoms

A 
Depression
Excessive daytime sleepiness
Sleep disturbances
Fainting/Dizziness 
REM sleep behavioral disorder 
Bladder overactivity 
Constipation
Sexual dysfunction (ED)
Soft/lower voice volume 
Lack of smell
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18
Q

Clinical Impairments of PD (indirect impairments/complications)

A 
Motor planning problems
Gait disturbance
Cognitive issues
Autonomic dysfunction
Cardio Pulm dysfunction
Speech/voice/swallowing problems
Sensorimotor/sensation disturbance
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19
Q

Indirect Impairment: Motor planning problems

A

Poverty of movement, fatigue, masked face (hypomimia)/decreased facial expression

20
Q

Indirect Impairment: Gait Disturbances

A

Festinating gait, anteropulsive gait, retropulsive gait

21
Q

Indirect Impairment: Sensorimotor/Sensation Disturbances

A 
Parasthesias, Pain, postural stress syndrome, akathisia (extreme motor restlessness)
Visual Disturbances (blurring, conjugate, saccadic eye movement impaired, decreased blinking), Anosmia
22
Q

Indirect Impairment: Speech/voice/swallowing problems

A

Dysphagia
Sialorrhea
Hypokinetic dysarthria (low volume, monotone, etc)
Mutism – not talking

23
Q

Indirect Impairment: Cognitive Issues

A

Dementia
Bradyphrenia
Visuospatial problems
Depression

24
Q

Bradyphrenia

A

slowed thought process and lack of concentration, attention

25
Q

Indirect Impairment: autonomic dysfunction

A

Thermoregulatory dysfunction, sebborheic dermatitis, slow pupillary reaction, GI discomfort (dec motility), bladder dysfunction

26
Q

Indirect Impairment: CP dysfunction

A 
Orthostatic hypotension (L- dopa can make worse)
Suppressed tachycardia with exercise
Respiratory problems (airway obstruction/restrictive dysfunction)
27
Q

Hoen and Yahr

A

Classification of Disability in pts with PD

28
Q

HY I

A

Minimal or Absent; unilateral if present

29
Q

HY II

A

Minimal bilateral or midline involvement. Balance not impaired

30
Q

HY III

A

Impaired righting reflexes. unsteadiness when turning/rising from a chair. Some activities are restricted but pt can live independently

31
Q

HY IV

A

All symptoms are present and severe. Standing and walking possible only with assistance

32
Q

HY V

A

Confined to bed or wheelchair.

33
Q

Levadopa (L-dopa)

A

Precursor to dopamine that improves symptoms but does not change underlying disease.
Need drug holiday to maintain efficacy. 20-40 min to be effective, duration 2-4 hrs.

34
Q

Carbidopa

A

helps to inhibit l-dopa breakdown in the periphery

35
Q

Medication SE

A

Orthostatic Hypotension
Nausea (can take more carbidopa to offset)
Hallucinations
Somnilence; daytime sleepiness
Anticholinergics: dry mouth, sedation, confusion

36
Q

Surgical Management

A

Pallidotomy, Thalamotomy, neural transplantation, deep brain stimulation

37
Q

Palllidotomy

A

lesion in globus pallidus, reducing GP internus inhibitory activity that results in thalamic hypoactivity

38
Q

Thalamotomy

A

ventral intermediate nucleus lesion to reduce tremor and rigidity

39
Q

Neural transplantation

A

Implanting of embryonic stem cells

There is a lot of promise in this area but they aren’t that efficacious at this time.

40
Q

Unified Parkinson’s Disease Rating Scale III

A

Outcome measure for this population. 5 point or greater improvement makes a clinical difference. Not only PT use.

41
Q

Exercise training

A

Relaxation, flexibility, strength, functional, adaptive/supportive devices. Balance, locomotor, cardiopulm, group/home exercise.

42
Q

Motor learning strategies

A

Structured instructional sets, visual cues (targets), rhythmic auditory stimulation (music/beat), pulsed cues (tactile tapping), multisensory cues

43
Q

LSVT

A

Lee Silverman Voice Treatment. BIG AND LOUD.

44
Q

Antifreeze

A 
Imagine line & step over
Count out loud with rhythm (ONE two THREE four) 
Heel stepping
Look at ceiling
Rock side to side
March
45
Q

BIG and LOUD

A

Pt speaks lous, movements as big as possible. May produce more dopamine.

46
Q

Altering environment

A

Satin sheets/pajamas
Car: satin on seat
Wall handle/grab bars near fridge, to avoid retropulsion.

47
Q

Deep Brain Stimulation

A

Later in the disease course usually. May be effective earlier.

NM PCM (6 decks)

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