Parkinson's Flashcards by Nicole Nelson

which pathway facilitates movement?

direct

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which pathway inhibit movement?

indirect

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Name 2 medications for parkinson

levo dopa and carbidopa

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why do you typically use levo dopa and carbidopa togeher?

prevent l dopa conversion prior to entering the brain

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What does dopamine medication help with in parkinsons

bradykinesia/rigidity

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what is parkinsons meds not as effective for

trempr and postural instability

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side effects of parkinsons meds

DA receptors lose responsiveness
involuntary movements (dyskinesia)
On off phenomenon (on becomes shorter and shorter)

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a precursor of dopamine (meds)

L dopa

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combination of levodopa and carbidopa(meds)

sinemet

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important dosage insrtuction

30 mins before bed
not right before bed
consistent timing is important

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Common medication side effects

orthostatic hypotension
dyskinesia
confusion/memory loss
hallucinations (scary things)
HA, agitation, psychosis

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hallmarks of PD

resting tremor
akinesia
rigidity
postural instability
TRAP

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what is usually the first sign of PD

tremor

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what is cogwheel / lead pipe rigidity?

cogwheel : rigidity over tremor
lead pipe–all aspects of movement are difficult (both directions)

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Bradykinesia testing

rapid alternating movements (finger tapping, open close fist, pronation supination, toe typing)
BIG fast movements

look for: change in speed and amplitude

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Observation/testing for tremor

resting – hands
postural tremor – shoulders flexed at 90 elbows straight / fingers wide
Kinetic Tremor:

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rigidity testing

passive wrist circles, elbow flexion/extension
LE support knee flexion/ext or ankle circles

technique to activation maneuver (if meds are working or subtle)

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gait and balance defecit tests

sit to stand
pull test (brisk pull back to see how recover)

gait: symmetry, reduced heel strike/foot clearance. turns, arm swing

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common gait issues

increased knee flexion in stance
decreased hip and knee flexion early swing, decreased hip and knee ext in late swing
decreased clearance and pushoff
goot contact w entire foot
decreased trunk and pelvic rotation, armswing asymmetry
decreased stride length/walking speed

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ROM and strength deficits in PD

STIFF: decreased trunk ext w thoracic kyphosis, trunk rotation, hip and knee extension

gradual weakening - atrophy of T2 fibers, hypertrophy in T1
weak ankle mm and quads…

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non motor features of PD (6)

psych, cognitive disorders, sleep abnormalities, autonomic dysfunction (constipation, ortho hypotension!!!!!!), sensory–olfactory, misc (fatigue weight loss)

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SLP issues with PD (3)

motor speech–coordination and weakness (forming words/quiet)
Cognition–repeat phrases, minimize distractions
Dysphagia– swallowing/timing with breathing and swallowing, positioning food in mouth

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MSK changes in PD

BOS
everything flexed!
forward head, trunk,m rounded shoulders, kyphosis, down gaze,
short hip flexors/knee flexors, elbow flexors
strength–hip ext/PF…trunk ext
dec trunk pelvic rotation

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Cardio pulm function in PD

Ortho Hypotension!
reconditioning

Flexed posture: restricted lung function due to decreased chest expansion (PNEUMONIA!)

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4 measures of severity PD

Hoehn and Yahr stages of PD UPDRS (rating scale) MDS-UPDRS (movement disorder...rating scale) PDQ-8 PDQ-39 (participation level)

Which stage of Hoehn & Yahr tremor in one hand rigidity clumsy leg one side face affected impacting expression

Which stage of Hoehn & Yahr loss of facial expression in BOTH SIDES decreased blinking speech abnormalities rigidity of trunk mm

Which stage of Hoehn & Yahr BALANCE COMPROMISED inability to make rapid automatiuc and involunatry adj

Which stage of Hoehn & Yahr may be able to walk and stand but noticibly impacted unable to live independently

Which stage of Hoehn & Yahr pt fall when standing or turning might be bedbound freeze or stumble with walking hallucinations/delusions

Typical Course of PD

UPDRS 5 parts

1. mentation/behavior mood 2. ADLS 3. Motor examination 4. Complications of therapy 5. hoehn and yahr staging 6. schwab and england ADL scale\ higher score = worse

outcome measures that recommended for PD Body structure and function--

MDS UPDRS revision part 3 MDS UPDRS part 1 montreal cognitive assessment

outcome measures that recommended for PD activity

6MWT, 10MWT, BESTest, MDS-UPRDS part 2, FGA, 5TSTS, 9 hole peg test

outcome measures that recommended for PD participation

PDQ-8 or PDQ-39

outcome measures that recommended for PD fear of falling

ABC scale

outcome measures that recommended for PD dual task

timed up and go

BESTest looked at/assesses...

anticipatory/reactive balance, sensory organization, dynamic gait, times up and go cognitive

FOGQ has ___items to assess FOG severity, ___ items to assess gait. it is a ___point scale

4, 2, 5

If a patient has FOG, what could be a reason/what should we consider?

they may not have enough meds

10 areas of treatment for PD

aerobic, resistance, balance, flexibility, external cueing, community based ex, gait training, task specific, behavior change, integrated care, telehealth

what intesity should aerobic exercise be for PD?

mod to high

benefits of aerobic ex in PD

improve O2 consumption reduce motor disease severity improve functional outcomes MOST IMPORTANT reduction in tremor/bradykinesia, balance/gait, QOL

benefits of resistance training in PD

reduce severity improve strength and powr non-motor symptoms (anxiety/depression) funcitonal outcomes/QOL (GAIT SPEED, MOBILITY, BALANCE, REDUCE FALLS)

Recommendations for resistance training

progressive resistance + instability (unstable environments)

CPG Mild-mod PD aerobic exercise dosage

3-5 days mod intensity 60-70 HRmax high int 75-85 HRmax RPE: mod = 13/20 high = 15/20 30-40 progressing to 60 mins start progression with duration or frequency -- intensity as tolerable type: bike/TM

resistance training dosage freq, time, intensity, set/reps, type

freq - 2 non consecutive days time - 30-60 mins ber session (4-12 hrs month) intensity - as tolerated with good form strength - beginner: 40-60 1 RM, 1 set 20-30 reps progress to 2 sets of 15 experienced: 80% (3 x 12 to m fatigue) POWER beginner 20-30 1RM Experienced 40 1 RM ALL muscle groups, EXTENSOR mm (trunk/glutes)

Strong recommendations for balance

multimodal balance balance w dynamic gait on TM (mod to vigorous) Balance w tech balance vs resistance training (balance better for post control/balance outcomes/spatiotemportal gait impairments aquatics: (may improve FEAR of falling not balance outcomes)

CPG gait training recommendations (interventions/dosage)

TM with/without BW support, robo assist/overground 3-5d/wk 20-60 min 4-12 wks

Benefits of gait training CPG

reduced motor severity step length walking speed falls and FOF fatigue

Moderate evidence CPG

external cueing

benefits of external cueing

reduce severity of motor disease FOG Gait and functional mobility (TOG/dual task TUG) 20 mins 1 hour 2-5x/wk 3-8 wks

weak recommended

- flexibility exercise

- flexibility exercise CPG benefits

spinal flexibility, axial rotation, (not studies - extremity)

- flexibility exercise recommendations

general stretching/flexibility incorporate into warm up (dynamic) and cool down )static) or first thing in the morning all major muscle groups but particularly trunk rotation

Community based exercise dosage

1 hr 2x week 12-13 wks

community based exercise benefits

depression anxiety and cognition function -- TUG, turning, 3D motion analysis

task specific training examples

turning training, fall prevention (caregiver ed, movement stragtegies, external cuing, strength training) dual task training

what type of PD treatment caused a lower requirement of med dosage in pts over time

integrated care

benefits of integrated care (STRONG EVIDENCE)

reduced motor sx, non motor improvements, functional outcomes, QOL

benefits of behavior change approach (mod evidence)

(health behavior theories, goal setting, action plans) QOL, PA, walking capacity

WEAK evidence: Telehealth improved activities: may be better suited for...

balance and participation no cognitive impairments and low fall risk

Early stages of treatment should include:

- est. a baseline of function - design exercise program (strength/aerobic/balance/stretch) - maximize fitness and mobility guidance for community resources

moderate stages of treatment should include:

- modify exercises to maintain high level of intensity - focus to improve balance and prevent falls - problem solve mobility difficultiwes (bed, chair, freezing) - introduce strategies such as listening to music to make movement faster

later stages of treatment should include:

introduce and help obtain equipment

Parkinson's Flashcards

(65 cards)