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Neuroconditions 2022 > Parkinson's > Flashcards

Parkinson's Flashcards

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1
Q

What are the primary causes of PD?

A

idiopathic

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2
Q

what are secondary causes of PD

A

drug induced
stroke
tumors/ trauma

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3
Q

What the atypical syndromes of PD

A

progressive supra-nuclear palsy

multisystem atrophy

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4
Q

What is progressive supranuclear palsy?

A

onset over age 50
impaired eye movements: can’t look down
postural exension (extreme)
falls within the first year

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5
Q

What is multiple systems atrophy

A 
Parkinsonism 
cerebellar symtpoms-- gait ataxia 
autonomic symptoms -- orthostatic (30mm sys or 15 mm diast. drop)
impotence
urinary incontinence 
urinary retention
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6
Q

What are the cardinal signs of PD

A

TRAP

resting tremor, rigidity, bradykinesia (akinesia), postural instability (usually later in the disease),

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7
Q

What is festinating gait or festination

A

quickening and shortening of normal strides characterize festinating gait. steps are quicker, stride is shorter, very inefficient gait

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8
Q

What is freezing of gait

A

freezing of gait is characterized by a hesitation before stepping forward, or difficulties when initiating walking

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9
Q

What % fall a year

A

70% fall once a year

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10
Q

What % sustain fractures

A

17.1%

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11
Q

How much more likely are PD patients likely to sustain a facture than those without

A

3.2x more likely

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12
Q

Multiple studies suggest highly challenging balance training may reduce fall risk in pD. What defines highly challenging?

A

moving COM
narrowing base of support
used Horak’s framework

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13
Q

What are non-motor signs of PD

A 
cognitive 
pain 
depression 
hallucinations
dementia
sensory changes
autonomic dysfunction 
fatigue
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14
Q

What prequel and sequelae compund deficit of balance, gait, and function

A

prior hx of MSK issues before diagnosis
cardio function
flexibility
strength

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15
Q

What does the prognosis of PD depend on

A

type of PD
presence/absence of co-morbid illnesses
persoality characteristics
socioeconomic factors

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16
Q

What are the types of PD?

A

tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD

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17
Q

What are the types of PD?

A

tremor predominant
PIGD predominant
Parkinsonism vs. idiopathic PD

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18
Q

What is PIGD

A

postural instability and gait disorder
more problems with instability and gait dysfunction
more likely to have cognitive deficits
faster decline

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19
Q

What are supportice prospective postitive criteria for PD

A

unilateral onsset
rest tremor present
progressive disorder
persistentasymmetry affecting side of onset most
excellent response (70-100%0 to levodopa
sever levadopa induced chorea
levodopa response for 5 years or more

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20
Q

What is DBS (deep brain stimulation) used for in PD

A

primarily used to control motor fluctuations

symptom improvement usually last for 3-5 yeards after surgical procedure

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21
Q

What are common response to medications?

A 
on/off
wearing off
dyskinesia
dystonia
hallucinations
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22
Q

What is the gold standrad for PD

A

Unified PD rating scale (UPDRS)

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23
Q

What are the four sections of UPDRS

A
  1. mentation, behavior, mood
  2. activities of daily living
  3. motor examination
  4. complication of therapy

total of 176 poitns (motor subscale 108 points)

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24
Q

What part of the brain does PD affect

A

basal ganglia

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25
What are the modified Hoehn and Yahr stages
1. unilateral symptoms 1. 5 unilateral and axial symptoms 2. bilateral symmptoms, intact balance 2. 5, bilateral sumptoms and mild balance impairment 3. bliateral symptoms, postural instability (unable to recover on pull test, able to live independent) 4. severe diabbility (walk independently ) 5. w/c dependent, bedridden unless assisted
26
What does the Schwab and England scale for PD
rates overall function on a ten point scale | 100- completely independent
27
What is the 24 item scale with 96 points total for PD
Profile PD 11 items = body systems 10 items =activities 3 items- memory, depression, involvement
28
What is a clinician'sbottom line for patients with PD?
benefit from developing long term exercise habits develop initial intervention program focused on key issues for the patient transition the program unto activities that emphasize those key issues for long term adherence
29
What is the axial mobility exercise program?
helps with loss of mobility of axial structures helps posterure ROM, deep breathing, and relaxtion are included
30
What are does deep breathing target in axial mobility
deep breathing-- promote relaxation, improve mobility of ribs for increased thoracic expansion
31
What areas are involved within the the axial mobility for pts with PD
hook lying position to achieve lower trunk rotation trunk shoulder neck coordinated neck, shoulder, hip or trunk motion
32
What is stage II of axial mobility training
segmental motion of the spine and upper quadrant, with emphasis on the thorax helps with bed mobility, reaching for items, preparation for turning
33
What are the 4 mian components of power for PD wellness recovery
Power Up power rock power twist power step can be done standing, supine, sitting, quadraped
34
What does PWR up focus on?
antigravity extension
35
What does PWR Rock focus on
weight shifting
36
What does PWR twist focus on
axial mobility
37
What does PWR step focus on
transitions
38
How do yo uperform PWR moves for ridgitiy
(prepare) moves are performed slowly, rhythically and with sustained effort
39
How do you perform PWR moves for bradykinesia
(activate)moves are performed as big and fast as possible with repetitive effort
40
How do you perform PWR moves for incoordination
(flows) moves are linked together into longer and longer sequences that mimic everyday movement
41
How do you perofrm PWR moves for reduced self awareness
moves are performed with high attentional focus to engage across multiple motor systems
42
Whta is freezing in PD
sometimes called motor block, is a sudden, brief inability to start movement or to continue rhythmic, repeated movements such as finger tapping, writing
43
Whta is freezing in PD
sometimes called motor block, is a sudden, brief inability to start movement or to continue rhythmic, repeated movements such as finger tapping, writing or walking
44
What are the 5 "s" method for freezing
``` stop stand tall (bring head back and squeeze shoulders together) shake it off shift weight (from right to left) step with a marching step ```
45
What does Parkinsonism include?
PD progressive supranuclear palsy (PSP) multiple systems atrophy (MSA) ``` benign essentil tremor restless leg syndrome lewy body dementia (LBD) wilson disease drug induced Parkinsonism corticobasal syndrome vascular parkinsonism ```
46
What are symptoms of PSP (progressive supranuclear palsy)
typical scare appearance increased falls at onset-- typically backwards difficulty looking down
47
What are the symptoms of MSA (multiple systems atrophy)
dystonomia | parkinsoninan and/or cerebellar syndrome-- ataxia and dysarthria
48
What are the motor signs of PD
bradykinesia rigidity rest tremor postural instbaility
49
What is bradykinesia
slowness and progressively smaller movements (hyopkinesia) as an individual repeats a task
50
What is rigidity?
involuntary, velocity independent resistance to passive movement of a jiont with or without a cogwheel phenomenon
51
what is a resting tremor in PD
a 4-6 HZ temor in a fully resting limb, which temporarily dissapears when the kumb is outstretched and then returns and is not present during movement
52
What is postural instability>?
balance impairment affecting a person's ability to change or maintain pstures such as walking or standing
53
What are nonmotor signs of PD
``` olfactory loss sleep dysfunction autonomic dysfunction (constipation, urinary urgency, eretile dysfunction, orthostatic hypotension, BP variables) psychiatric distrubances cognitive impairments ```
54
What are the three steps to diagnose PD
classical clinical presentation (TRAP) opositive response to dopamine replacment determine the type
55
What are the dopamine replacment medications
Sinemet-- carbidopa/Levodopa rytary-- extended release of carbidopa/levidopa
56
How is levodopa different than carbidopa?
levodopa crosses the BBB and converts to dopamines | carbidopa inhibits the breakdown of levadopa
57
What are dopamine agoinists?
``` act on DA receptors may delay starting dopamine replacement parlodel/bromocriptine mirapex/pramipexole requip/ropinirol ``` possible adverse effect of shopping, gambling, earing and hypersexuality
58
What 2 types of medication slows the breakdown of dopamine for PD
COMT inhibitors comtan/entacapone tasmar/tolcapone- must check liver regulary stalevo-- MAO-B inhibitors may be used early in disease may have a neuroprotective effect
59
Where areas can/does deep brain stimulation target
globus pallidus subthalamic nucleus thalamus
60
What are the four buckets of PT interventions?
aerobic exercise flexibility strengthening task specific training (motor control training)
61
What are the guidelines for aerobic exercise ?
``` H&Y stage 1-, within 5 yers of dx and not on meds 4 days per/weel 5 min warm up/cool down 30 min at 80% mad HR 26 weeks/6 months ```
62
What does the acial mobility program address in terms of flexibility
flexibility with emphasis on rotation activating and relaxing muscles incorporates relaxed breathing incorporates parts of functional task
63
What are the strengthening guidelines oof progressive resistance exercise for PD
UE-- 30-40% of 1RM LE-- 50-60% of 1RM as long as form and perception was good, progress patient by 5%
64
What balance interventions for anticipatory postural adjustments for PD
step up (forward and lateral STS or squats lunges SL with reaching
65
What balance interventions for postural adjustments for PD
standing on foam pertebation on stable and unstable surfaces ball toss standing hip abduction and flexion
66
What balance interventions for gait
gait at varying speeds with auditory cueing gait with dual task gait with head truns, startsm stios walking backwards
67
What defines a highly challenging balance program for PD
12 weeks | 2x/weel
68
What is neural priming
priming is defined as a chnage in behavior based on previous stimuli general theory underlying priming is that the brain, which has been prime by a prior methos of activation , is generally more resposive to the accompanying training
69
what is movement based priming
includes bilateral or unilateral movements, mirror summetric active or passive movements, or any type of exercise such as aerobic, isometric and balance exercises
70
What is BIG and LOUD
Lee Silver Voice Treatment program
71
What does BIG and LOUD do for patients with PD for SLP
``` incrased loudness of speech improved intelligibility increased facial expression advancements in swallowing work on precise and clear speech sounds ```
72
What does BIG and LOUD do for PT/OT for patients with PD
increased walking speed and bigger steps emphasized movements with patterns rotational movements through exercise moving speed of movement balance
73
What brain area is the initial source of pathology located in PD
substantia nigra
74
The diagnosis of PD is most typically made by what?
clinical findings of cardinal signs of PD and positive response to dopamine replacment
75
descrice the progression of PIGD form of PD
faster delcine than the tremor form of PD more problems with instability and gait more likely to have cognitive deficits
76
Forward flexed posture contributes to what in pts with PD
festinating gait balance difficulties and increased falls increased risj for MSK impairments
77
WHat H&Y stage are describes as unilateral sumptoms only
stage 1
78
what H &Y stage of PD is described as bilateral symptoms with postural instabiltiy (unable to recover on posterior pull test)
stage 3

Neuroconditions 2022 (14 decks)

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