Lecture 6: Movement Disorders Flashcards
(158 cards)
1
Q
These are classified as conditions that produce inadequate or excessive movement
A
Movement disorders
2
Q
This is termed as Paucity, Slowness, Or Too Little Movement
A
Hypokinetic
3
Q
This is termed as Excessive, Involuntary, or Too Much Movement
A
Hyperkinetic
4
Q
This is termed as Abnormal movement
A
Dyskinesia
5
Q
Parkinson’s disease and Atypical Parkinsonian Syndromes are classified as what type of movement disorders?
A
HypoKinetic
6
Q
Essential Tremors, Huntington’s disease, And Dystonia are classified as what type of movement disorders?
A
Hyperkinetic
7
Q
Movement disorders impair the regulation of voluntary activity without directly affecting what 3 things?
A
- Strengths
- Sensation
- Cerebellar Function
8
Q
Movement disorders usually involve what structure in the brain?
A
The Basal Ganglia
9
Q
Inputs to the motor system
Descending systems from the cortex are classified as?
A
Upper Motor Neurons
10
Q
Inputs to the motor system
The motor cortex is responsible for what 3 tasks?
A
- Planning
- Initiating
- Directing Voluntary Movements
11
Q
Inputs to the motor system
The brainstem centers are responsible for what 2 things?
A
- Basic Movements
2. Postural control
12
Q
Inputs to the motor system
What is the responsibility of the Basal Ganglia?
A
Gating proper initiation of movement
13
Q
Inputs to the motor system
What is the responsibility of the Cerebellum?
A
Sensory motor coordination of ongoing movement
14
Q
Inputs to the motor system
The Basal Ganglia and the Cerebellum directly affect what aspects of the descending systems (UMN)?
A
Motor cortex and Brainstem Centers
15
Q
Inputs to the motor system
The Local Circuit neurons (LMN) receives information from what 3 regions?
A
- Motor Cortex (UMN)
- Brainstem Centers (UMN)
- Sensory Input (LMN)
16
Q
Inputs to the motor system
The spinal cord and brainstem circuits consist of? (2)
A
- Local Circuit Neurons (LMN Integration)
2. Motor Neuron Pools (LMN)
17
Q
Inputs to the motor system
Sensory inputs send information to what region of the body?
A
Local Circuit neurons (LMN Integration)
18
Q
Motor Neuron pools directly affect what aspect of the body?
A
Skeletal Muscle
19
Q
This is a collection of Grey Matter Nuclei located deep within the white matter of the cerebral hemispheres
A
Basal Ganglia
20
Q
What are the main components of the Basal Ganglia? (5)
A
- Caudate Nucleus
- Putamen
- Globes Pallidus
- Subthalamic Nucleus
- Substantial Nigra
21
Q
What 3 regions of the Basal Ganglia make up the Striatum?
A
- Caudate Nucleus
- Putamen
- Globus Pallidus
22
Q
What 2 parts of the Basal Ganglia make up the Lenticular Nucleus?
A
- Putamen
2. Globus Pallidus
23
Q
The Basal Ganglia has what 2 types of Pathways?
A
- Direct
2. Indirect
24
Q
Movement disorders associated with the Basal Ganglia are often explained by an (Blank) in the direct and indirect pathways.
A
Imbalance
-between the direct and indirect pathways in the basal ganglia
25
What are the Functional Attributes of the Basal Ganglia? (4)
1. Entire Cerebral Cortex Provides input to the BG
2. There is no direct sensory input to the BG
3. BG does not reject directly to UMN/LMN
4. BG lesions produce
- Motor, behavior, and/or cognitive impairments
26
Basal Ganglia Lesions produce what 3 impairments?
1. Motor Impairments
2. Behavior Impairments
3. Cognitive Impairments
27
Lesions of the Basal Ganglia motor circuits either produce? (2)
1. Poverty of movement/Hypokinesia
| 2. Unwanted movement/Hyperkinesias
28
What are the 3 types of Hypokinesia?
1. Akinesia
2. Bradykinesia
3. Rigidity
29
What are the different types of Hyperkinesias? (6)
1. Resting Tremors
2. Chorea
3. Athetosis
4. Tics
5. Hemiballism
6. Diatonic
30
Define: slowness of movement
Bradykinesia
31
Define: Loss or absence of movement
Akinesia
32
Define: Stiffness of muscle tone with passive movements
Rigidity
33
What are the 3 common signs seen in a patient with Parkinson's Disease?
1. Bradykinesia
2. Akinesia
3. Rigidity
34
What are the 4 main symptoms of Hyperkinesia movement Disorders?
1. Tremors
2. Chorea
3. Dystonia
4. Myoclonus
35
Define: Oscillatory, usually rhythmical and regular movement affecting one or more body parts
Tremor
36
Define: Random, quick, unsustained, purposeless movements that have an unpredictable, flowing pattern
Chorea
37
Tremors can be seen in what 2 disorders?
1. Parkinson's disease
| 2. Essential Tremors
38
Chorea can be seen in what 2 disorders?
1. Huntington's disease
| 2. Cerebral Palsy
39
Define: Torsional movements that are partially sustained and produce twisting postures
Dystonia
40
Define: Sudden, Brief, shock-like, involuntary movements usually caused by muscular contraction
Myoclonus
41
What is the prevalence of Parkinson Disease?
Cases per year?
160 cases per 100,000 people
6-7 million worldwide cases
1-2 million in US
At age 70, Increases to 550 cases per 100,000 people
42
What is the incidence of Parkinson's Disease
Male to Female Ratio?
Mean age of symptoms onset?
Male 2:1 Female
Mean age of symptom onset is 56 in both sexes
43
With Parkinson's disease, What is the etiology?
1. Most cases are sporadic-Unknown cause
- Idopathic PD
2. Genetic Contributions 5-40% of cases
3. Environmental Contributions
44
What is the phrase for Parkinson's disease etiology?
"Genes load the gun"
"The Environment pulls the trigger"
45
Parkinson's Disease is the degeneration of (Blank) neurons within the (Blank) and the (blank) in the brainstem
1. Dopamine-Producing Neurons
2. Substantial Nigra Pars Compacta
3. Locus Ceruleus
46
Where does Parkinson's disease effect the brain? (2)
Substantial Nigra Pars Compacta
Locus Ceruleus in the brainstem
47
With Parkinson's Disease, there is an accumulation of mis-folded protein alpha-synuclien that spreads through brain areas forming _______________
Lewy BOdies
48
With Parkinson's Disease, when symptoms become clinically evident, there is a 60% decrease in ...
Dopaminergic Neurons of the Substantia Nigra
49
With Parkinson's disease, dopamine levels have decreased by ____%
80% Decrease in Dopamine
50
What is the typical age of onset for Parkinson's Disease?
Young Onset?
Late Onset?
Typical Onset: 55-60 years
Young Onset: < 40 years
Late Onset: >78 years
51
Describe the timeline of Parkinson's Disease
1. Death of Dopamine Cells
2. Non motor symptoms (Loss of smell, constipation) and motor symptoms
3. Dx
4. Progression of all symptoms leading to probs with mobility
5. Bed Bound: Dementia
52
These two created the stages for Parkinson's Disease and there stage progression is called?
Hoehn and Yahr Stages
53
How long does it generally take to progression from one stage of Parkinson's to the next?
Several Years
54
Hoeing and Yahr Stages of Parkinson's Disease
Stage 1?
Stage 1: Symptoms 1 side of body
55
Hoeing and Yahr Stages of Parkinson's Disease
Stage 2?
Stage 2: Bilateral/Axial
| -No Balance Impairments
56
Hoeing and Yahr Stages of Parkinson's Disease
Stage 3?
Stage 3: Balance Impairments
| -Physically Independent
57
Hoeing and Yahr Stages of Parkinson's Disease
Stage 4?
Stage 4: Severe Disability
| -Able to stand or walk
58
Hoeing and Yahr Stages of Parkinson's Disease
Stage 5?
Stage 5: W/C Bound or bed ridden
59
In order to be diagnosed with Parkinson's Disease, what 2 things must be present?
1. Bradykinesia and/or Resting Tremors
2. 1 other disorder related to Parkinson's
- Non motor Symptoms
- Freezing
- Flexed Posture
- Loss of postural reflexes
- Rigidity
- Bradykinesia
- Resting Tremors
60
What are the 7 clinical findings related to Parkinson's disease?
1. Resting Tremors
2. Bradykinesia
3. Freezing
4. Nonmotor Symptoms
5. Flexed Posture
6. Loss of Postural Reflexes
7. Rigidity
61
What are the 6 Non-Motor Symptoms associated with Parkinson's Disease?
1. Fatigue
2. Sensory awareness
3. Sleep Disorders
4. Neuro-psychiatric & Cognitive
5. Autonomic Dysfunction
6. Bradyphrenia
62
What are the other clinical findings associated with Parkinson's disease.
Other Associated motor features? (5)
1. Hypophonia (Soft Voice)
2. Hypomimia (Masked Face
3. Micrographia (Small Writing)
4. Gait Abnormality (Shiffling, Freezing, En bloc turns (moving non-segmentally), Small Stride)
5. Stooped, Flexed (Simian) Posture
63
How do resting tremors appear?
At rest, the tremor is occuring
64
How does Bradykinesia Present?
Tested with finger tapping test
Can someone close their index and thumb as quickly and big as possible
-The sped of the movement slows down and the size of the opening decreases
65
What does a masked face look like?
The patient has no expression at all during any movement. Robot face if you will
66
How does postural instability present with Parkinson's Disease?
Patient is pulled backwards and the patient should be able to maintain balance.
-Parkinson's patients will fall backwards with no reflexive step. Looks like a trust fall
67
how does freezing and festinating gait present with Parkinson's disease?
Very Short Steps
Shuffling and freezing are one in the same
Festering means quick little short steps
68
What test is used to diagnose Parkinson's disease?
NO TEST
69
How does an MRI appear for a patient with Parkinson's disease
NORMAL
70
How is Parkinson's Diagnosed?
1.
- Clinically based on History
- Clinical Exam
- absence of incompatible clinical
- Laboratory
- Radiologic abnormalities.
2. Symptomatic Improvement with LEVADOPA helps to confirm Idiopathic PD
71
Symptomatic Improvement with Levodopa helps to confirm what diagnosis?
Idopathic Parkinson's Disease
72
How can a PT clinically diagnose a patient with Parkinson's Disease?
1. Asymmetric Onset
2. Gradual onset and progression
3. Tremor is not required
4. Two out of the following 6 symptoms
- Resting Tremor, Bradykinesia, Freezing, Flexed Posture, Rigidity, Loss of postural responses
* **At least one of these must be RESTING TREMOR or BRADYKINESIA
73
What are the 3 types of Parkinsonism?
1. Primary Idiopathic Parkinson's Disease
2. Secondary Parkinsonism
3. Atypical Parkinsonism syndromes
74
% of patients with...
1. Primary Idiopathic Parkinson Disease
2. Secondary Parkinsonism
3. Atypical Parkinson's Syndromes
1. 80%
2. 10-12%
3. 3-5%
75
With secondary Parkinsonism, what are the 7 causes?
1. Drug Induced (7-9%)
2. Vascular (1%)
3. Hydrochephalus (NPH)
4. Trauma
5. Metabolic
6. Tremors
7. Toxins
76
With Atypical Parkinsonian Syndromes, what are the causes?
1. MSA
2. PSA
3. Dementia with Lewy BOdies
4. CBD
77
How is Parkinson's Disease Prevented? (5)
1. Diet
2. Exercise
3. Environmental Agents
4. Neuro protection
5. early Detection and Treatment
78
With Parkinson's Disease, how is it treatment medically? (4)
1. Restore Dopamine producing cells
2. Restore Dopamine
3. Exercise
4. Drugs
79
For Symptomatic Parkinson's Disease, what is this treated? (5)
1. Drugs
2. Deep Brain Stimulation
3. Rehab Therapies
4. Exercise
5. Treat Symptoms
80
What is the Gold Standard for Treating Parkinson's Disease?
LEVADOPA
81
This drug converts Dopamine once it enters the brain
Levadopa
82
Dopamine alone does not cross what?
The blood brain barrier
83
What is the prognosis or Parkinson's Disease? (5)
1. Lifespan is a few years less than normal
2. Disease progression can be for 20 years or more
3. Currently, there is no cure
4. Usually slowly progressive, but with individual variability
5. death from other causes such as Heart Disease, Cancer, Secondary Complications like Pneumonia
84
What is the typical progression of Mild Parkinson's Disease (5-7 Years post DX)? (4)
1. Movement symptoms inconvenient, but do not affect daily activities
2. changes in posture, walking ability or facial expression
3. Parkinson's Medication Effective
4. Regular Exercise is important
85
What is the typical progression of Moderate Parkinson's Disease (7-15 years post DX)? (5)
1. Motor Fluctuations and Dyskinesias
2. Freezing Episodes occasional
3. Regular exercise and skilled physical therapy very important for good mobility and balance
4. Goal to keep them moving as often and safely as possible
5. Gait and Balance duel task difficulty
86
What is the Typical Progression of Advanced Parkinson's Disease (15-20 years post DX)? (6)
1. Cognitive problems may be prominent
- Balance and Gait dual task difficulty
2. Medication Less Effective
3. May have frequent Freezing or Falls
4. Swallowing - Dysphagia
5. Autonomic dysfunction
- Severe Orthostatic Hypotension
- Severe Constipation causing impaction
6. Weight loss
87
For PT's what is the clinical management of a patient with Parkinson's disease? (6)
1. Meaningful exercises the encourage power, extensor strengthening, body awareness, timing, coordination, and agility
2. Dual task training
3. Functional training with repetition, progression, and variability
4. Vigorous aerobic exercise
5. Skill-Specific practice
6. Stress Reduction
88
For Clinical management of the patient with Parkinson's Disease, what are the key things we need to identify in these patients?
1. Posture
2. Gait Difficulties (Shuffling, Freezing, Turns)
3. Balance
4. Functional Mobility
5. Dexterity
6. Brady Kinesia
7. Tremors
8. Fatigue
9. Difficulty Dual tasking
10. Pain
89
This can be known as Parkinson Plus Syndrome
Atypical Parkinsonian Syndromes
90
What are the 3 major syndromes for Atypical Parkinsonian Syndromes/
1. Progressive Supranuclear Palsy (PSP)
2. Multiple System Atrophy (MSA)
3. Corticobasal Degeneration (CBD)
91
What is the Prevelence of Progressive Supranuclear Palsy (PSP)?
More frequent in men
Mean age onset 65 years of age
92
What is the most frequent Atypical Parkinsonian Syndrome?
Progressive Supranuclear Palsy
93
This form of Parkinson's is marked by neuronal degeneration and neurofibrillary tangle and Tau-positive astrocytes in the basal ganglia and brainstem structures
Progressive Suprannuclear Palsy
94
This form of Parkinson's has a poor response to levodopa and dopamine agonists
Progressive supranuclear palsy
95
What happens in Progressive Supranuclear palsy to their striatal neurons and their post synaptic dopamine receptors?
Loss of Striatal Neurons
Loss of Post Synaptic Dopamine Receptors
96
What is the disease course for Progressive Supranuclear Palsy?
Insideous
Progressive
More rapid than PD
97
What is the lifespan associated with progressive supranuclear palsy?
Death in 5-10 years often due to aspiration
98
Describe the disease course for Progressive Supranuclear palsy
1. Parkinsonian Symptoms, cognitive involvement, early falls, Axial rigidity, and absence of tremors
2. Freezing, Supranuclear Gaze Palsy, Wide based Gait, Affected Speech, Facial Dystonia
3. Progressive dementia, Dysphagia, Dysarthria, Emotional lability, volatile mood
4. Progressive motor and cognitive decline until death
99
What are the key clinical findings for Progressive Supranuclear Palsy (PSP)? (6)
1. Progressive Parkinsonism
2. Vertical Supranuclear ocular palsy or slow vertical Saccades
3. Early onset of Falling
4. Axial Rigidity
5. Usually no Tremors
100
Thesepatients eventually develop symptoms of both Parkinson's disease, Autonomic Dysfunction, and Cerebellar Signs
Multiple Systems Atrophy (MSA)
101
What is Multiple systems Atrophy
1. Parkinsons disease
2. Autonomic Dysfunction
3. Cerebellar Signs
102
With Multiple system atrophy, there is marked Neuronal degeneration of what? (3)
1. Striatonigral pathways
2. Olivopontocerebellar pathways
3. Corticospinal pathways
103
Multiple system atrophy, unlike Parkinson's is more ________
Progressive
104
At what stage are patients with Multiple Systems Atrophy (MSA) wheelchair bound?
5 years
105
What is the mean survival rate of patients with Multiple systems Atrophy (MSA)
8-9 years
106
Describe the disease course for Multiple System Atrophy
1. Parkinsonian symptoms, Cognitive involvement, Autonomic dysfunction, cerebellar Ataxia
2. Postural Instability, UMN signs, Bowel and Bladder
3. Progressive Dementia, Dysphagia, Dysarthria
4. Progressive Motor and Cognitive Decline until death
107
What are the key feature for Multipe System Atrophy? (4)
1. Parkinsonism
2. Symptomatic Orthostatic Hypotension
3. cerebellar Ataxia
4. Poor Therapeutic Response to Levadopa
108
What are the additional Symptoms associated with Multiple System Atrophy? (5)
1. Increased DTR
2. Bowel/Bladder Dysfunction
3. Dysphagia and Dysarthria
4. Early Postural Instability
5. May not have tremors
109
This is diagnosed as Nerve cell loss and atrophy of multiple areas of the brain including cortex and basal ganglia.
Corticobasal Degeneration
110
Corticobasal Degeneration leads to significant parietal atrophy and is
A. Symmetric
B. Asymmetric
B. Asymmetric
111
When does Corticobulbar Degeneration typically occur?
60
112
Corticobasal degeneration usually starts to affect how much of the body?
1 side, but eventually becomes symmetric
113
Patient's with Corticobulbar Degeneration progress over the course of 6 to 8 years, but death is generally caused by ...
Pneumonia
114
What are the key features for Corticobulbar Degeneration? (3)
1. Parkinsonism
2. Unilateral arm rigidity and Dystonia
3. Cortical Sensory Deficits
115
What are the other possible symptoms of Corticobasal Degeneration aside from the key features?
1. UMN Features (Hyperreflexia and + Babinski)
2. Apraxia
3. Dementia
4. Rigidity
5. Dysphagia
6. Myoclonus
7. Alien Limb Phenomenon
116
With Atypical Parkinsonian Syndromes, patients are often initially diagnosed with Parkinson's Disease, but clinical findings and the fast rate of progression are indicative of Atypical progression. And MRI and PET can be performed, but are not diagnostic. PT's should look for neuropsychiatric cognitive involvement.
With Atypical Parkinsonian Syndromes, patients are often initially diagnosed with Parkinson's Disease, but clinical findings and the fast rate of progression are indicative of Atypical progression. And MRI and PET can be performed, but are not diagnostic. PT's should look for neuropsychiatric cognitive involvement.
117
This is a rhythmical sinusoidal movement of body parts
Tremor Syndromes
118
With tremors, what part of the body may be involved?
All parts.
119
In order to diagnose tremor syndrome, what must be checked?
Distinction that is made between rest and action tremor
120
What is the definition of the resting tremor?
Tremor in body part not activated or supported against gravity
121
What is a postural tremor?
Tremor in body part being supported AGAINST GRAVITY
122
This is a tremor during any voluntary contraction of muscle
Action Tremor
123
This is a tremor in a body part during any voluntary movement
Kinetic Tremor
124
This is a tremor in a body part during non goal-directed movement
Simple Kinetic Tremor
125
This is a tremor where the tremor in the body part increases during pursuit of a goal
Intention Tremor
126
What is the different between simple kinetic tremor and intention tremor
Simple kinetic tremor is non goal directed
Intention tremor is goal directed
127
What is the most common adult-onset movement disorder?
Essential Tremor
128
When can essential tremors occur?
Most common on early 20's or later in adulthood.
129
Who is more likely to have an essential tremor, males or females?
Both are likely
130
What is the Pathogeneis of Essential tremors?
Neuro Degeneration of the Cerebellum
Abnormal GABA function
131
What is the etiology of Essential Tremors?
Familial in 50-70% of patients with Autosomal dominant transmission
132
Essential tremors are not necessarily a progressive neurodegenerative disease, but tremor may do what?
Spread to different parts of the body
133
Essential tremors are what kind of tremors?
Action Tremors
134
What are the 4 clinical findings for Essential tremors?
1. Action tremor of arms, head, voice
2. Family history of tremors
3. Absence of Parkinsonism
4. Transient improvement of tremor with alcohol ingestion
135
How does one determine if a patient has essential tremors?
1. Absence of rest tremor
2. Symmetric onset of action tremor
3. Absence of other neurological signs (PD and Cerebellum)
4. 50% are alcohol responsive
136
What are the 3 differential diagnosis of Essential Tremors?
1. Parkinson Disease
2. Medication related tremor
3. Enhanced Physiological Tremor
137
How are essential tremors medically managed?
1. Primidone: Anticonvulsant
2. Propranolol: non-selective beta blocker used in treatment of hypertension
3. Botox
4. Surgical treatment: DBS in the thalamus
138
What clinical management can be given for patients with essential tremors?
Adaptive equipment
| -Tremor canceling spoons, pens weighted or larger utensils
139
PD is an extensive disease with both significant ________ and __________ involvement
Motor and Nonmotor
140
For the dx of PD, a person must have at least?
Tremors and/or Bradykinesia, and 1 other factor related to PD.
141
This is the most common adult-onset movement disorder
Essential Tremors
142
Essential tremors are what kind of tremors?
Action tremors
143
What is the key difference between Essential tremors and PD tremors?
Essential tremors do not occur at rest like PD tremors
144
What is the etiology of PD?
Unknown
| -Genetic and Environmental factors
145
What is the etiology of Atypical Parkinsonian Syndromes (PSP, MSA, and CBD)
- PSP: Progressive Supranuclear Palsy
- MSA: Multiple System atrophy
- CBD: Corticobasal Ganglionic Degeneration
Unknown
146
What is the etiology of Essential Tremors
50-70% inherited
| -Sporadic
147
What are the signs and symptoms associated with PD? (4 key)
1. Bradykinesia
2. Rigidity
3. Resting Tremor
4. Postural Instability
148
What are the signs and symptoms associated with Atypical Parkinsonian Syndrome?
- PSP: Progressive Supranuclear Palsy
- MSA: Multiple Systems Atrophy
- CBD: Corticobasal Ganglionic Degeneration
(4)
1. Early Falls
2. Gaze Abnormalities
3. Autonomic Dysfunction
4. Early Dementia
149
What are the signs and symptoms associated with Essential Tremors? (4)
1. Action Tremors
2. UE> Head
3. Voice > LE
4. Absence of other neurological signs related to PD
150
How is PD Diagnosed?
Clinically
1. Motor Signs/Symptoms
2. Asymmetric Onset
3. Gradual
4. Responsive to Levadopa
151
What is the Diagnosis for Atypical PArkinsinan Syndromes?
PSP: Progressive Supranuclear Palsy
MSA: Multiple Systems Atrophy
CBD: Cotricobasilar Ganglionic Degeneration
(2)
Clinical
1. Non-Responsiveness to Levadopa
2. Possible findings in MRI Imaging
152
What are the diagnoses for Essential Tremors?
Clinical
1. >50% alcoholic Responsiveness
2. Large Tremulous writing
3. Bilateral Symmetric Onset
153
What is the typical progression of PD?
Gradual Progression 20+ years
154
What is the typical progression of Atypical Parkinsonian Syndromes
PSP: Progression Supranuclear Palsy
MSA: Multiple Systems Atrophy
CBD: Corticobasaliar Ganglionic Degeneration
More Rapid Progression
155
What is the typical progression of Essential Tremors?
Stable or mildly progressive to other body areas
156
How is PD Treated? (3)
1. Medication (Levadopa)
2. DBS (Deep Brain Stimulation
3. Exercise!
157
How is Atypical Parkinsoniann Syndrome typically treated?
PSP: Progresive Supranuclear Palsy
MSA: Multiple Systems atrophy
CBD: Corticobasilar Ganglionic Degeneration
Medication less effective
Symptomatic
Exercise
158
How are Esential Tremors Treated?
1. Medication (Proponolol, Primidone)
| 2. DBS (Deep Brain Stimulation)
