Final: Parkinson's Examination

Question 1

What should be included in your observation of function for a pt with Parkinson’s?

Answer 1

Bed mobility, transitions, skill, transfers, ambulation, STOMs

Question 2

What characteristics of a tremor are important during observation?

Answer 2

Location, persistence, severity, resting vs action, triggers

Question 3

What test is highly recommended to assess for bradykinesia?

Answer 3

9 hole peg test

Question 4

What is a means of assessing for hypokinesia/amplitude?

Answer 4

Observation of arm swing during ambulation

Question 5

How do you assess for akinesia?

Answer 5

Duration, triggers, and ability to overcome freezing and reaction time

Question 6

What should you consider when assessing for rigidity?

Answer 6

Leadpipe vs cogwheel, PROM, spinal ROM, distribution, severity

Question 7

What scale is used to quantify rigidity?

Answer 7

UPDRS Rigidity Scale

Question 8

What is a 0 on the UPDRS Rigidity Scale?

Answer 8

Rigidity absent

Question 9

What is a 1 on the UPDRS Rigidity Scale?

Answer 9

Rigidity slight or detectable only when activated by mirror or other movements

Question 10

What is a 2 on the UPDRS Rigidity Scale?

Answer 10

Rigidity mild to moderate

Question 11

What is a 3 on the UPDRS Rigidity Scale?

Answer 11

Rigidity marked, but full range of motion easily achieved

Question 12

What is a 4 on the UPDRS Rigidity Scale?

Answer 12

Rigidity severe, ROM achieved with difficulty

Question 13

What are common posture deviations for a pt with Parkinson’s?

Answer 13

Forward head, rounded shoulders, kyphosis, hip/knee flexion, hand position

Question 14

What is the typical hand position for a pt with Parkinson’s?

Answer 14

MP: flexed
IP: extended
Wrist: flexion, ulnar deviation
Forearm: pronation

Question 15

What are sensory symptoms a pt with Parkinson’s may present with, and what tests and measures would be indicated?

Answer 15

Pain, tingling numbness - superficial, deep, cortical

Question 16

Will a pt with Parkinson’s have abnormal nerve conduction velocity?

Answer 16

No

Question 17

What are potential causes of sensory impairments for pt’s with Parkinson’s?

Answer 17

Age, comorbidity, perceptual

Question 18

What visual changes occur with Parkinson’s?

Answer 18

Blurring, smooth pursuit

Question 19

How will a pt’s perception of upright change in the late stages of Parkinson’s?

Answer 19

It will shift forward of vertical

Question 20

What clinical measure of postural control and balance are highly recommended for PD?

Answer 20

Mini BEST, ABC is also recommended

Question 21

What are gait parameters to observe?

Answer 21

Start time, gait speed, stride length, cadence, stability, turning, safety, quality

Question 22

What STOMs are highly recommended for Parkinson’s?

Answer 22

10 m walk, 6 min walk, FGA

Question 23

What does FOGA stand for?

Answer 23

Freezing of Gait Assessment

Question 24

What is the FOGA?

Answer 24

Assesses gait through a course under single, dual, and triple task conditions

Question 25

What does a 0 on the FOGA indicate?

Answer 25

No festination of FOG

Question 26

What does a 1 on the FOGA indicate?

Answer 26

Festination of hastening of steps/shuffling

Question 27

What does a 2 on the FOAG indicate?

Answer 27

FOG but overcomes

Question 28

What does a 3 on the FOAG indicate?

Answer 28

FOG, examiner intervenes or cues

Question 29

What cognitive assessment is highly recommended for PD?

Answer 29

MOCA - more sensitive to mild impairment

Question 30

What assessment is used to assess fatigue in pt's with PD?

Answer 30

Parkinson's Fatigue Scale

Question 31

What tools can be used to assess psychosocial barriers?

Answer 31

1. Geriatric depression scale 2. Hamilton depression rating scale

Question 32

What tools can be used to assess anxiety in pt's with PD?

Answer 32

1. Geriatric anxiety inventory 2. Parkinson's anxiety scale

Question 33

How can you assess for autonomic dysfunction?

Answer 33

Altered HR and BP in response to exercise, RPE

Question 34

How should you assess for orthostatic hypotension, and what changes in BP are significant?

Answer 34

Measure BP 1 min following position changes - drop is systolic of 20 mmHG or diastolic of 10 mmHG

Question 35

What three STOMS are specific to Parkinson's?

Answer 35

1. Hoehn-Yahr Classification of Disability 2. MDS-UPDRS 3. PDQ-39

Question 36

What does Stage I on the Hoehn-Yahr indicate in terms of disability?

Answer 36

Minimal or absent, unilateral

Question 37

What does Stage II on the Hoehn-Yahr indicate in terms of disability?

Answer 37

Minimal bilateral or midline involvement. Balance not impaired

Question 38

What does Stage III on the Hoehn-Yahr indicate in terms of disability?

Answer 38

Impaired righting reflexes, unsteadiness turning or rising from chair. Some activities restricted, be can live independently and continue employment

Question 39

What does Stage IV on the Hoehn-Yahr indicate in terms of disability?

Answer 39

All symptoms present and severe, standing and walking possible only with assistance

Question 40

What does Stage V on the Hoehn-Yahr indicate in terms of disability?

Answer 40

Confined to bed or wheelchair

Question 41

What is the gold standard for measuring disease progression for PD?

Answer 41

MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)

Question 42

What is the MDS-UPDRS?

Answer 42

Comprehensive tool designed to monitor the burden and extend of PD across the longitudinal disease course

Question 43

What ICF levels are included with the MDS-UPDRS?

Answer 43

Body structure, activity, participation

Question 44

What does part I of the MDS-UPDRS assess?

Answer 44

Non-motor experiences of daily living

Question 45

What does part II of the MDS-UPDRS assess?

Answer 45

Motor experiences of daily living

Question 46

What does part III of the MDS-UPDRS assess?

Answer 46

Motor examination

Question 47

What does part IV of the MDS-UPDRS assess?

Answer 47

Motor complications

Question 48

What does a higher score on the MD-UPDRS indicate?

Answer 48

Increased severity

Question 49

What is the timeframe of symptoms assessed with the PDQ-39?

Answer 49

Symptoms in the last month

Question 50

What does PDQ-39 stand for?

Answer 50

Parkinson's Disease Questionnaire

Question 51

What are the 8 QOL dimensions assessed by the PDQ-39?

Answer 51

1. Mobility 2. ADLs 3. Emotional wellbeing 4. Stigma 5. Social support 6. Cognition 7. Communication 8. Body discomfort