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Neuro Dev/Control II > Parkinson's Disease Evaluation Part I > Flashcards

Parkinson's Disease Evaluation Part I Flashcards

1
Q

Describe stage I of PD

A
  • Unilateral involvement only, usually minimal or no functional impairment
  • One of the earliest signs is minimal arm swing unilaterally or lack of trunk rotation
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2
Q

Describe stage II

A
  • Bilateral or midline involvement without impairment of balance
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3
Q

Describe stage III

A
  • 1st signs of impaired righting reflexes
  • Unsteadiness as pt turns
  • Pt is somewhat restricted in their activities but may have some work potential
  • Pts are physically capable of leading independent lives & their disability is mild to moderate
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4
Q

Describe stage IV

A
  • Fully developed
  • Severely disabling disease
  • Pt is still able to walk & stand unassisted but is markedly incapacitated
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5
Q

Describe stage V

A
  • Confinement to bed or wheelchair unless aided
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6
Q

Define bradykinesia

A
  • Slow movement
  • General reduction of spontaneous movement (appearance of abnormal stiffness & decreased facial expressivity)
  • Causes reduction in speed & amplitude of repetitive movements (finger tapping, walking)
  • Short shuffling steps & hypo phonic speech are examples
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7
Q

Define hypomimia

A
  • Masked facies
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8
Q

Cardinal signs of Parkinson’s Disease

A
  • Bradykinesia
  • Rigidity
  • Resting tremor
  • Postural instability
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9
Q

Describe rigidity

A
  • Stiffness & inflexibility of the limbs, neck, & trunk
  • Muscle tone of affected limb never relaxes sometimes contributing to decreased ROM
  • Can manifest as: reduced arm swing, decreased trunk rotation, rolling & turning “en bloc”, reduced joint ROM during postural transitions & gait
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10
Q

Describe a resting tremor

A
  • Initial onset: a slight tremor in the hand or foot on one side of the body or less commonly in the jaw or face
  • Affected body part trembles when not performing an action
  • Tremor usually ceases when person begins an action
  • Tremor can be exacerbated by stress or excitement
  • Tremor often spreads to the other side of the body as the disease progresses
  • Not all people with PD will develop tremor
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11
Q

Describe postural instability

A
  • Loss or slowing of some reflexes needed for maintaining upright posture
  • PD pts may topple backwards if jostled even slightly
  • Tendency to sway backwards when rising from chair, standing, or turning
  • Difficulty when pivoting/turning/quick movements
  • Pull test
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12
Q

Describe a pull test for postural instability

A
  • Normal response: quick backwards step to prevent a fall
  • Parkinson’s Disease response: unable to recover & might tumble backwards if neurologist were not right there to catch them
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13
Q

During the progression of PD, mobility is progressively constrained by

A
  • Rigidity
  • Bradykinesia
  • Freezing
  • Sensory integration
  • Inflexible motor program selection (Set Switching)
  • Attention and cognition
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14
Q

Functional outcomes of rigidity, in general, include

A
  • Flexed posture
  • Lack of trunk rotation
  • Reduced joint ROM during postural transitions & gait
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15
Q

How is rigidity characterized

A
  • By an increased resistance to passive movement throughout the entire ROM in both agonist & antagonist muscle groups
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16
Q

For rigidity what should your exercises focus on

A
  • Minimize agonist-antagonist muscle co-contraction
  • Promote axial rotation
  • Lengthen the flexor muscles
  • Strengthen the extensor muscles to promote an erect posture
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17
Q

Characteristics of bradykinetic gait

A
  • Delayed time to lift the swing limb
  • Weak push-off
  • Reduced leg lift
  • Small stride length
  • Lack of arm swing
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18
Q

Poverty of Movement, Decreased Movement Amplitude, Delayed Initiation of Reactive and Anticipatory Movements, Hypokinesia cause/lead to

A
  • Poor use of proprioceptive info
  • Decreased perception of movement
  • Over-estimation of body motion
  • Over-dependence on vision
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19
Q

For bradykinesia what should your exercises focus on

A
  • Increase speed
  • Increased amplitude
  • Temporal pacing of their self-initiated & reactive limb & body center of mass movements
  • Promote weight shift control
  • Promote postural adjustments in anticipation of voluntary movements
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20
Q

Define cog wheel rigidity

A
  • Will feel a catch through the movement
  • When a patient has both rigidity and a tremor in the same affected body part
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21
Q

Define lead pipe rigidity

A
  • Will feel resistance/stiff throughout entire ROM
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22
Q

To reduce bradykinesia, patients should be encouraged to “__________” while increasing the speed and amplitude of large arm and leg movements

A
  • Think big
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23
Q

Define freezing of gait

A
  • A brief episodic absence or marked reduction of forward progression of the feet despite the intention to walk
  • One of the most common reasons for falls & dependency
24
Q

Freezing during gait occurs more often when a person is

A
  • Negotiating a crowded environment
  • Negotiating a narrow doorway
  • Making a turn
  • Attention is diverted by a secondary task
  • Stepping over obstacles
  • Change in surface
25
Q

Describe the 3 phenotypes of freezing of gait

A
  • Impaired set shifting ability: attention & executive function deficits are features of basal ganglia pathology even in early PD
  • Increased step time variability: indicative of impairments in gait automaticity due to dopaminergic denervation
  • Self reported anxiety & depression: may overload the capacity of the basal ganglia to process competing yet concurrent inputs
26
Q

Typically, FoG episodes are brief (1 s or less) and are associated with a subjective feeling of “the feet being glued to the floor” (True/False)

A
  • True
27
Q

How to screen for freezing of gait

A
  • Turning in place provoked freezing more than a 7m ITUG task
  • Asking pt to repeatedly make 360º turns is efficient to elicit FoG: 180º in ITUG is not sufficient to elicit FoG; continuous 360º turning with direction reversals may induce FoG
  • Often show longer turn durations & greater # of steps to complete turn even when walking speed is normal
28
Q

Cut off scores for fall risk tests in Parkinson’s disease patients

A
  • Functional reach test: 25.4 cm
  • Dynamic gait index: 19/24
  • Berg balance scale score: 45/56
  • Up and go test: 8.5 sec
29
Q

What should be considered the diagnostic gold standard for fall risk

A
  • Self reported fall history
30
Q

What fall risk assessment should be performed 1st

A
  • Dynamic gait index (DGI) followed by berg balance scale (BBS - contains functional reach test)
31
Q

What fall risk assessment has a ceiling effect in Parkinson’s disease patients

A
  • Berg balance scale (BBS)
32
Q

Which 3 tests moderately distinguish fallers from nonfallers in individuals with PD

A
  • Fullerton Advanced Balance (FAB) scale
  • Mini-Balance Evaluation Systems Test
  • Berg Balance Scale (BBS)
33
Q

Clinicians who analyze postural control deficits to identify patients being at risk for falls should particularly focus on the following items

A
  • FAB:“tandem stance/walk”
  • FAB, Mini-BEST, and BBS: “one-leg stance”
  • FAB & Mini-BEST: “rise to toes”
  • Mini-Best: “compensatory stepping backward”
  • FAB & BBS: “turning 360°”
  • BBS: “placing foot on stool.”
34
Q

What values do we want for specificity and sensitivity tests

A
  • Sensitivity: want is to equal 1.0
  • Specificity: want it to be in the 80s-90s
35
Q

Fallers with PD demonstrate the following

A
  • Reduced reactive postural control
  • Impaired tandem stand/walk
  • Impaired single limb balance
  • Increased number of steps (>7 steps) and time (>3.67) to turn 360º
36
Q

Non-motor features of Parkinson’s disease

A
  • Psychiatric depression
  • Neuropsychiatric symptoms (general anxiety, phobia, panic attacks)
  • Apathy
  • Hallucinations
  • Delusions
  • Autonomic Dysfunction
    constipation, orthostatic hypotension, sexual dysfunction, urinary disturbances
  • Cognitive impairment: involvement of executive functions, memory, and visuospatial functions up to dementia
  • Sleep disorders: Restless legs, REM sleep disorder, excessive daytime somnolence, vivid dreaming, insomnia
  • Olfactory dysfunction
  • Pain
37
Q

What non-motor features of Parkinson’s disease may be the earliest disease manifestations occurring years before any of the defining motor features are present

A
  • Hyposmia
  • Constipation
  • Rapid eye movement (REM) sleep behavioral disorder
38
Q

As the disease progresses, the therapeutic window for Levodopa ________________

A
  • Narrows
39
Q

How to manage end dose failure of Levodopa (wearing off)

A
  • Decrease L-dopa interval
  • ER formulation (Rytary)
  • Add a dopamine agonist
  • Add an L-dopa extender (COMT or MAO inhibitors)
  • Consider advanced treatments: DBS or intestinal infusion
40
Q

How to manage peak dose dyskinesias of Levodopa

A
  • Decrease individual dose & increase frequency
  • ER formulation (Rytary)
  • Add an agonist or and extender & lower L-dopa dose
  • Use amantadine (Gocovri)
  • Consider advanced treatments: DBS or intestinal infusion
41
Q

Medical management of motor fluctuations in PD

A
  • Adjust the dose of levodopa
  • Add different medications
  • Try a controlled-release or extended-release
  • Bring up surgical options like deep brain stimulation (DBS)
  • Levodopa
  • Dopamine agonists
  • Amantadine
  • Adenosine A2a antagonists
  • COMT inhibitors
  • MAO-B inhibitors
42
Q

Regardless of medication status, PwPD demonstrate immediate improvements in performance on core outcomes across multiple domains of function following forced exercise cycling intervention. (True/False)

A
  • True
43
Q

Motor fluctuations include

A
  • Wearing off
  • Delayed on
  • Partial on
  • No on
  • On off
44
Q

Describe dyskinesias

A
  • Choreic, ballistic, or dystonic involuntary movements
  • Can be classified into peak-dose, diphasic, and square-wave dyskinesia
  • Dystonia often accompanies motor fluctuations and dyskinesia and may appear in off and on phases
45
Q

Aerobic exercise recommendations for PD patients

A
  • 3 days/wk
  • 30 min/session of continuous or intermittent exercise
  • Moderate to vigorous intensity
46
Q

Strength training recommendations for PD patients

A
  • 2-3 days/week, non-consecutive
  • 30 minutes/session
  • 10-15 reps for major muscle groups
  • Focus on Speed or Power
  • Target ON time
  • Focus on extensors
47
Q

Balance training recommendations for PD patients

A
  • 2-3 days per week, ideally DAILY
  • Multi-directional stepping
  • Weight Shifting (e.g. Tai Chi)
  • Dynamic Balance Activities
  • Large Movements
  • Yoga, Dance, Boxing
48
Q

Stretching recommendations for PD patients

A
  • > 2-3 days/week; ideally DAILY
  • Sustained stretching with deep breathing
  • Dynamic Stretching before exercise
49
Q

Define primary prevention

A
  • Prevention of a disease or injury from occurring
50
Q

Define secondary prevention

A
  • Maintaining function, promoting QOL, & decreasing risk of cardiovascular complications
51
Q

Define tertiary prevention

A
  • Reducing the negative impact of ongoing illness or injury to improve function and QOL
52
Q

Define motivational interviewing

A
  • A collaborative, goal orientated style of communication with particular attention to the language of change
  • Designed to strengthen personal motivation for & commitment to a specific goal by eliciting & exploring the person’s own reasons for change within an atmosphere of acceptance and compassion
53
Q

What are the core skills of motivational interviewing

A
  • Open questions
  • Affirmations
  • Reflective listening
  • Summarise
54
Q

Signs of readiness to change

A
  • Decreased ambivalence
  • Decreased discussion about the problem
  • Resolve: client has reached some kind of resolution
  • Change talk
  • Questions about change
  • Envisioning
  • Experimenting
55
Q

What does DARN CAT stand for

A
  • Preparatory change talk (DARN)
  • Desire statements
  • Ability statements
  • Reasons statements
  • Need statements
  • Mobilizing change talk (CAT)
  • Commitment
  • Activation
  • Taking steps
56
Q

How to respond to change talk

A
  • Elaboration or details
  • Affirm change talk through reinforcement, encouragement
  • Reflect what the person is saying
  • Summarise
57
Q

How to evoke change talk

A
  • Explore a typical day
  • Asking evocative questions
  • Using the importance ruler
  • Querying extremes
  • Looking back
  • Looking forward
  • Exploring goals & values

Neuro Dev/Control II (19 decks)

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