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Neuro II > Exam 2 - PD > Flashcards

Exam 2 - PD Flashcards

(70 cards)

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1
Q

what is the average age of onset for parkinsons

A

50-60 years

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2
Q

describe young onset PD vs juvenile onset PD

A

young onset: 21-50 years
juvenile onset: < 21 years

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3
Q

are men or women more likely to have PD

A

men

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4
Q

describe the etiology of PD

A

disturbance in the dopamine in the basal ganglia

typically, less DA in the substantia nigra

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5
Q

what types of PD are there

A

idiopathic - most common
genetic
secondary parkinsonisms
atypical parkinsonsims (parkinson’s plus syndrome)

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6
Q

describe postural instability gait disturbances related to PD

A

worse prognosis
more bradykinesia
higher prevalence of non-motor symptoms
higher likelihood of dementia

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7
Q

describe tremor dominant PD

A

better prognosis
lower incidence of non-motor symptoms
less difficulty with bradykenesia and postural instability
lower risk of developing dementia

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8
Q

list the secondary parkinsonisms

A

postencephalitic
toxic
drug-induced

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9
Q

what is toxic parkinsonism

A

exposed to pesticides or industrial chemicals (often miners)
synthetic heroine with chemical MPTP

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10
Q

what is drug-induced parkinsonisms

A

drugs that interfere with dopaminergic systems
neuroepileptic drugs, antidepressants, some antihypertensives

medications for PD increase DA, so any medication that influences DA systems will result in PD symptoms

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11
Q

list examples of PD plus syndromes

A

progressive supranuclear palsy
multiple systems atrophy
cortical-basla ganglionic degeneration
lewy body dementia
normal pressure hyrdocephalus
cretzfedlt-jakob disease
wilson’s disease

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12
Q

describe the pathophysiology of PD

A

degeneration of dopaminergic neurons resulting in less DA produced

direct loop of signal from basal ganglia to thalamus to cortex is inhibited

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13
Q

describe the direct loop

A

excitation putamen to globus pallidus

globus pallidus to ventral lateral nucleus of thalamus

VL nucleus of thalamus to supplemental motor area of the cortex

Result: voluntary motor movement and positive feedback loop

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14
Q

what is the function of DA in the direct loop

A

DA from substantia nigra helps with activation

how much/little DA determines the amplitude of the excitation/activation

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15
Q

what are the cardinal motor symptoms of PD

A

bradykinesia
resting tremor
postural instability
rigiditiy

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16
Q

how should muscle strength be tested in pts with PD, why

A

functional movements should be examined rather than MMT

MMT is not alway s consistent

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17
Q

how is motor function affected in pts with PD

A

difficulty with speed and accuracy
difficulty with dual tasking
difficulty with starting and stopping motion

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18
Q

how is gait altered in pts with PD

A

up to 25% have this as inital symptom
bradykinesia, flexed posture, decreased arm swing
possible freezing

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19
Q

what are the 4 cluster non-motor symptoms related to PD

A

rapid eye movement sleep behavior disorders
cognition related
mood related
sensory and disautonomia

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20
Q

describe symptoms related to rapid eye movement sleep behavior disorders in pts with PD

A

frequent nightmares
dream enacting behaviors (talking, walking during sleep)
insomnia

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21
Q

what are the cognition related symptoms of PD

A

memory complaints
cognitive fatigue
inattention
excessive day-time sleeping
mild cognitive impairment

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22
Q

list mood related symptoms of PD

A

anehodonia (lack of joy with joyful activities)

apathy (because of decreased apathy or bradykinetic facial muscles)

depression, subclinical depression, suicidal ideation, anxiety

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23
Q

describe sensory and dysautonomia symptoms related to PD

A

loss of taste, smell
visual perception disturbances (hallucinations)
chest pain
unexplained pain
parestesias (60-80% of pts)
hyperhydrosis (excessive sweating)
GI disorders
orthostatic hypotension

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24
Q

what is the MOvement Disorder Society (MDS) Clinical Diagnostic Criteria for PD

A

bradykinesia in combination with at least resting tremor and/or rigidity

absence of absolute exclusion criteria, at least 2 supportive criteria, and no red flags

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25
what nutritional advise is appropriate for a pt with PD
high protein diets and block effectiveness of levodopa high calorie, low protein diet PEG tube could be neccessary
26
how is deep brain stimulation utilized in pts with PD
typically for tremor can impact gait, on/off symptoms electrodes typically in globus pallidus internus or subthalamic nucleus
27
what is the main function of pharmacology treatment of PD
increase or keep DA
28
what outcome measures are utilized for pt with PD
hoehn and yar united parkinson's disease rating scale PD EDGE
29
describe the H&Y grading
1: unilateral involvement only 1.5: unilateral and axial involvement 2: bilateral involvement without impairment of balance 2.5: mild bilateral disease with recovery on pull test 3: mild to moderate bilateral disease; some postural instability; physically independent 4: severe disability; still abilty to walk or stand unassisted 5: WC bound or bed ridden unless aided
30
what does the united parkinson's disease rating scale (UPDRS) measure and how is it scored
mentation, behavior, mood ADLs motor scale other symptoms such as on/off periods, hypotension, etc scored 0-4 with higher numbers being worse
31
what are the pros and cons for the UPDRS
gold standard for determining the severity of a disease often done by neurologist time consuming
32
what is evaluated during the mentation, behavior, and mood portion of the UPDRS section 1
intellectual impairment thought disorder depression motivation/initiative
33
what is evaluated during UPDRS section 2 (ADLs)
speech dressing salvation hygiene walking tremor turning in bed swallowing handwriting falling sensory complaints cutting food, handling utensils freezing
34
what is assessed during UPDRS section 3, motor exam
speech facial expression tremor at rest action or postural tremor of hands rigidity finger taps hand movement rapid alternating movements of hands leg agility arising from chair posture gait postural instability body bradykinesia and hypokinesia
35
what PD outcome measures belong in the body structure and function portion of the ICF model
parkinson's fatigue scale UPDRS
36
what PD outcome measures belong in the participation portion of the ICF model
parkinson's disease questionnaire 8 & 39
37
what PD outcome measures belong in the activity portion of the ICF model
new freezing of gait questionnaire parkinson's fatigue scale
38
what exercises are highly recommended for pt with PD
aerobic fitness resistance training balance external cueing community based exercise gait training task specific training behavior change approach integrated care
39
what is the general POC for PD pts
remediations of function is possible treatment of MSK is possible may consider skilled maintenance between remediation episodes medication timing may matter
40
desscribe dyskinesia
abnormal voluntary movement occurs at peak dose
41
what should you consider regarding medications when treating PD
how long it takes for medication to kick in and how long it lasts when off times occur and severity PT can occur during on times to teach strategies during off times
42
what symptoms of PD are not responsive to medications
postural instability gait freezing mental changes ANS dysfunction
43
what is the goal of deep brain stimulation
minimize "off" times and dyskinesias reduce medication doses does not eliminate use of medication all together
44
what pt characteristics would indicate the pt to be a candidate for deep brain stimulation
idiopathic PD intact cognition good response to DA lack of co-morbidity for brain surgery realistic expectations pt age normal brain MRI ability to tolerate awake surgery degree of disabiltiy ability for follow-up programming
45
what are the risks association with deep brain stimulation
symptom reduction variability no impact on postural instability infection risks associated with brain surgery
46
what interventions could improve orthostatic hypotension in PD pts while at PT
increase fluid intake and dietary sodium use of water bolus raise head of bead compression garments instruct in use of physical counter-maneuvers
47
what are the goals of PT for PD pts
slow disease progression optimize participation in ADLs optimize independence and safety for functional tasks preserve/improve physical functioning decrease fall risk
48
what are the parameters for aerobic exercise with pts with PD
F: 3X/week I: 60-85% HRmax T: 30-40 mins T: stationary cycling and treadmill training
49
what is the impact of treadmill training with pts that have PD
sae and feasible gait improvements of speed, stride length, symmetry improved balance and motor performance reduces fatigue
50
what are the parameters for balance training with pts with PD who is balance training most appropriate for
F: 2-3x/week I: moderate to high T: 20-120 minutes T: multi-modal balance training, dynamic gait training, balance with technology most appropriate for pt with H&Y stages 1-4
51
what are the parameters for resistance training for pts with PD
F: 2, non-consecutive days/week I: beginner at 40-60% for strength and 20-30% for power experienced at 80% for strength and 40% for power T: 30-60 minutes T: all major muscle groups with extensors targeted
52
what are the gait training parameters for pts with PD
F: 3-5 days/weeks I no specific parameters identified T: 20-60 minutes T: treadmill training, robotic-assisted training, over-ground training, nordic walking
53
what are the parameters for community based exerciese
F: 2x/week I: maximize intensity while optimizing safety T: 45-60 minutes for 12 weeks T: salient task
54
what are the 3 key features of LSVT BIG
target: amplitude mode: high intensity and effort calibration
55
what are the 5 positions for PWR! moves
quadruped sitting standing supine prone
56
who is task specific training indicated for what is the parameters for task specific training
indicated for pts who have idiopathic pD H&Y stage 1-3 without cognitive impairment F: 2-5 days/week I: high intensity T: 15-45 minutes T: 1-on-1 training
57
where in the CPG does LSVT BIG fit?
aerobic exercise balance training gait training behavior change approach
58
high amplitude of LSVT BIG addresses which cardinal sign of PD
bradykinesia
59
high intensity targets which neuroplasticity principle
use it or loose it use it to improve it repetition matters intensity matters
60
callibration targets which symptom of PD
bradykinesia poor implicit knowledge of performance
61
calibration targets which neuroplasticity principles
salience use it and improve it transference
62
what is the protocol for LSVT BIG
4 days/week for 4 weeks 1 hour 1-on-1 treatment homework completed once on therapy days and 2x on non therapy days training at intensity of 8/10 effort
63
what exercises are included in LSVT BIG protocol
maximal daily exercises BIG walking functional component task hierarchy tasks carry-over tasks
64
describe maximal daily exercises
7 exercises completed for 8-12 repetitions 2 sustained movement 5 multidirectional repetitive movements
65
list examples of functional component tasks
first exercise is sit to stands for all pts the motion of sweeping rolling in bed reaching overheard
66
how many functional component tasks does a pt work on at a time
5
67
how many hierarchy task does a pt work on at a time
3
68
what are examples of hierarchy tasks
fly fishing loading and unloading the dishwasher completing a load of laundry golfing
69
what are carry over tasks
a new daily homework assignment that tests transference different each day ex) opening the door BIG if pt freezes when walking through the door
70

Neuro II (4 decks)

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