Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Dev/Control II > Parkinson's Disease Evidence Based Interventions Part II > Flashcards

Parkinson's Disease Evidence Based Interventions Part II Flashcards

1
Q

Skilled exercise that entails perceptual and a higher level cognitive processing may specifically target

A
  • Prefrontal and associated cortical circuits important for executive function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What global factors may be activated due to exercise

A
  • Reduced oxidative stress
  • Reduced neuro-inflammation
  • Increased expression of neurotrophic factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PTs should implement moderate to high intensity aerobic exercise in Parkinson’s patients to improve

A
  • Oxygen consumption (VO2)
  • Reduce motor disease severity
  • Improve functional outcomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cycle to stopping falls in PD

A
  • Early & periodic PT evaluation
  • Balance training 3x/wk for 6 mo: individualized, can combine with other interventions, use caution in later stages of disease
  • Community based exercise program
  • Assess and treat fear of falling: Falls efficacy scale & behavior change strategies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

To improve overall blood flow and connectivity in the cerebellum do aerobic exercise but if trying to improve cognitive function use skilled exercise (True/False)

A
  • True
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Considerations when choosing interventions

A

-Falls are a potential risk with balance exercises but did not increase number of adverse events
- Type of exercise & level of supervision should be chosen based on individual’s safety profile
- Resistance training should be performed “ON” medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is integrated care

A
  • Medical providers who work together to understand you & your care partner’s needs
  • Can reduce the severity of the motor symptoms of PD & improve your QOL
  • Work with different clinicians based on needs
  • May encounter these providers in multiple settings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does mobility require

A
  • Dynamic neural control to quickly & effectively adapt locomotion, balance, & postural transitions to changing environmental & task conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is sensorimotor agility

A
  • Coordination of complex sequences of movement
  • Ongoing evaluation of environmental cues
  • Ability to quickly switch motor programs when environmental conditions change
  • Ability to maintain safe mobility during multiple motor & cognitive tasks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is the basal ganglia critical for sensorimotor agility

A
  • Automaticity
  • Self initiated gait/postural transitions
  • Quickly change motor programs
  • Sequencing actions
  • Using proprioceptive info for kinesthesia/multi segmental coordination
  • Task switching
  • Suppression of irrelevant info before executing an action
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the relationship between neuroplasticity and task specificity

A
  • Task specific exercises targeted at a single, specific balance or gait impairment in pts with PD have been shown to be effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Electryographic activity in bradykinetic muscles often is fractionated into multiple bursts & is not well scaled for changes in movement distance or velocity (True/False)

A
  • True
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Compensation strategies for gait impairments related to PD

A
  • External cues
  • Internal cues
  • Changing balance requirements
  • Altering the mental state
  • Motor imagery or action observation
  • New walking pattern
  • Alternatives to normal walking: bicycling, ice skating, crawling, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define freezing of gait (FoG)

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 and dependency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What current therapies for PD are inadequate for treating FoG

A
  • Deep brain stimulation (DBS)
  • Levodopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 5S to help a PD patient get unstuck during FoG

A
  • STOP
  • Stand tall
  • Shake it off
  • Shift your weight
  • Step or Shoot Up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What features does a U-Step walker for PD patients have

A
  • Reversed braking system
  • Rolling resistance control
  • Spring loaded front wheel
  • Laser & sound cueing module
  • Easily transported
  • Comfortable padded seat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mechanisms of cueing for FoG from habitual to goal directed motor control

A
  • Executive role: facilitate response generation & prioritize focus of attention
  • Stabilizing role: prevent deterioration of the gait pattern
  • Preparatory role: re-integrate coupling postural control with stepping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Success of executive function in mobility requires

A
  • Ability to divide attention
  • Ability to effectively focus attention on particular stimuli while ignoring others
  • May have to inhibit a response such as obeying the walk signal if if other important info is present like an oncoming car
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define divided attention

A
  • The ability to complete 2 different attention demanding tasks at the same time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Individuals with FoG may prioritize __________ task over mobility task during dual task analysis

A
  • Cognitive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define attention switching

A
  • Refers to alternation of the focus of attention between 2 different tasks or sources of information
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mobility in complex environments requires constantly switching attention including

A
  • Posture
  • Locomotion
  • Surrounding sensory input
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define sustained attention

A
  • Ability to maintain attention to a task over prolonged periods
  • Cognitive/environmental distractions may contribute to FoG & may increase risk for falls
26
Q

Define selective attention

A
  • The ability to intentionally focus attention on one source of information while excluding irrelevant information
  • Flanker test
27
Q

Executive dysfunction is most often associated with FoG including

A
  • Response inhibition
  • Switching attention
  • Performance on the Stroop task (names of colors are a different color than what it says) has been related to FoG
28
Q

What cognitive domains are most affected in people with PD who freeze

A
  • Inhibition: executive control & selective
  • Shifting: switching & divided
29
Q

Example of task prioritization during agility training

A
  • The patient completes a secondary cognitive task during agility training and is instructed to switch prioritization between the mobility/stepping component (left) and the cognitive component (right)
30
Q

Example of visual-auditory cue conflict during boxing

A
  • Simultaneously, the instructor visually cues for a left punch and verbally cues for a right punch. For this trial, the patient is instructed to respond to the visual cue only and ignore the auditory cue.
31
Q

Agility exercises should be performed in what kinds of environments

A
  • Environments in which freezing typically occurs
32
Q

To facilitate use of proprioceptive information and reduce overreliance on vision, an agility program should progress balancing and walking tasks by

A
  • Wearing dark sunglasses to reduce visual contrast sensitivity
  • Use of “no body” glasses to obscure the bottom half of the visual field so the body cannot be seen
  • Exercises can be performed on a variety of surfaces to require adaptation to altered somatosensory information from the surface
33
Q

It is even more difficult for a person with PD than age-matched elderly people to perform multiple tasks, possibly because the basal ganglia are responsible for

A
  • Allowing automatic control of balance & gait & for switching attention between tasks
34
Q

You can increase the challenge of an exercise using the principles for exercise progression which includes

A
  • Reducing the base of support (BOS)
  • Increasing surface compliance to reduce surface somatosensory info for postural orientation
  • Increasing speed or resistance with weights
  • Adding secondary cognitive tasks to automate posture & gait
  • Limiting visual input of the body with “no body” glasses or of the environment with dark sunglasses to increase use of kinesthetic info
  • Increasing the length of remembered sequences & improving the form of each subcomponent of the movements (Tai Chi, Pre-pilates)
35
Q

Key points of strategy training

A
  • Compensatory strategies to bypass the defective basal ganglia
  • Learning strategies to improve performance through practice
36
Q

Key points of management of secondary sequelae of disease

A
  • Affects on musculoskeletal and cardiorespiratory systems that occur as a result of deconditioning, reduced physical activity, advanced age, and comorbid conditions
37
Q

Key points of exercise and fall prevention

A
  • Promotion of physical activities that assist the person in making lifelong changes in exercise and physical activity habits as well as preventing falls
38
Q

Strategy training techniques include

A
  • Visual cues/targets for stepping
  • Rhythmic cues for cadence
  • Visualizing walking with long steps
  • Mentally rehearsing the desired movement pattern before the action is performed
  • Part practice
  • Avoiding dual task performance
  • Verbally reciting phrases such as “thinking big” or “long steps”
  • Mental singing for rhythmic cues
39
Q

For newly diagnosed individuals and those with mild to moderate disease, it is recommended that therapists provide

A
  • High intensity
  • Variable
  • Distributed practice
  • Regular booster sessions over longer term
40
Q

For people who are more severely affected or those with cognitive impairment, very advanced age, or comorbidities that compromise skill acquisition, ___________ strategies are recommended

A
  • Compensatory
41
Q

What are the secondary sequels of disease

A
  • Loss of ROM: may contribute to loss of postural control, gait, & decline in overall function
  • Loss of LE strength: contributes to problems with balance, falls, & functional decline win older people
42
Q

What does Levodopa, antiparkiinsonian medications, & dopamine replacement NOT improve

A
  • Levodopa: axial rigidity
  • Antiparkinsonian medications: Bradykinetic postural responses
  • Dopamine replacement: inflexible program selection
43
Q

Perceived barriers to engaging in exercise in people who have PD, are ambulatory, and dwell in the community include:

A
  • Low outcome expectation from exercise
  • Lack of time to exercise
  • Fear of falling
  • These barriers are potentially modifiable
44
Q

Advocate that vigorous exercise begin immediately on diagnosis, if possible, and continue throughout the course of the disease for as long as the individual is able to exercise (True/False)

A
  • True
45
Q

Dual-task gait assessment using targeted cognitive tasks should include assessment of

A
  • Cognitive flexibility
  • Task prioritization (trade-off effects)
  • Factors known to modulate susceptibility to dual-task interference (age, gender, processing speed, stress, and cognitive reserve)
46
Q

Task difficulty is determined by the combination of

A
  • Task novelty
  • Task complexity
47
Q

Define dual tasking

A
  • The simultaneous performance of two attention-demanding tasks with different goals, whereby one task can be denoted as the primary and the other as the secondary task
48
Q

Factors that affect dual task performance are

A
  • The environment in which the task takes place
  • The nature of the secondary task
  • The age and disease-specific factors of each individual
49
Q

Gait has been found to deteriorate during dual task (DT) performance in PD, resulting in

A
  • Decrease of gait velocity
  • Cadence and step length
  • Increase in gait variability
  • Increase in double support time
  • Falling and FOG are more commonly provoked in DT conditions
50
Q

Executive function refers to a set of abilities which flexibly guide behavior towards goals and includes

A
  • Switching between cognitive sets or tasks
  • Appropriately inhibiting & generating responses
  • Updating working memory contents
51
Q

Outcome measure for dual task training

A
  • Duality Trial
52
Q

Define consecutive and integrated task training

A
  • Consecutive: training 2 tasks separately
  • Integrated: practicing 2 tasks simultaneously
53
Q

Who benefits from dual task training

A
  • People with a lower DT gait velocity at baseline and better cognitive function were more likely to experience a greater benefit.
  • Individuals with PD seem to benefit from consecutive dual-task training regardless of disease severity, their cognitive capacity and UPDRS-III scores
54
Q

Describe the HiBalance Program

A
  • Targets 4 main subtypes of balance control: stability limits, anticipatory postural adjustments, sensory integration, & motor agility
  • Incorporates principles of motor learning & gradual integration of dual task exercises involving cognitive or motor tasks
55
Q

PRET-PD Trial- EMG Outcomes

A
  • Pts with mild-to-moderate Parkinson’s disease partially restores the triphasic electromyographic pattern and improves movement velocity
  • This finding is similar to the effect of medication and deep brain stimulation
  • The improvement in the triphasic electromyographic pattern and muscle strength is significantly associated with improvement in peak velocity
  • Findings indicate that resistance exercise can drive neurophysiological changes
56
Q

Bradykinesia is a cardinal feature of PD that is accompanied by impaired muscle activation patterns including

A
  • Reduction in the magnitude and duration of the first agonist burst
  • Increase in the number of agonist bursts during the acceleration phase of the movement
  • Reduction of the magnitude of the antagonist burst
57
Q

Describe forced exercise

A
  • A mode of aerobic exercise in which the exercise rate is mechanically augmented to assist the participant in achieving & maintaining an exercise rate that is greater than their preferred voluntary rate of exercise
  • Mechanically augmented cycling
  • Bodyweight supported treadmill training
58
Q

Proposed mechanisms for effects of forced exercises

A
  • Faster pedaling rates increase afferent input from muscle spindles & GTO’ which triggers increased release of neurotrophic factors & NTs
  • Activation of proprioceptors may improve sensorimotor integration leading to improved kinesthesia & decreased bradykinesia
  • Improvements in motor Sx with forced exercise are not seen with voluntary exercise at a self selected pace even though HR, power, & MET’s are higher
59
Q

What are the benefits of forced exercise

A
  • Global improvement in motor function for pts with PD
  • Supports angiogenesis and synaptogenesis, increases defense from oxidative stress, and improves mitochondrial performance
  • Increased cortical and subcortical activation (thalamocortical pathways)
  • Increases neurotrophic proteins
  • Enhanced UE function with LE intervention supports theory of improved neural drive with forced exercise
  • Evidence for improved cognition, learning, & memory
60
Q

What is rhythmic auditory stimulation (RAS)

A
  • Directly stimulates the neural circuitry that controls movement to activate our mechanism of action
  • Entrainment: a neurologic process in which the auditory & motor systems of the brain are coupled due to an external rhythmic cue
  • Entrainment over time can both enhance neuroplasticity & cause neuroplastic changes that produce improved motor outcomes

Neuro Dev/Control II (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions