Cardinal Features (TRAP)
Tremor
Rigidity
Akinesia/ bradykinesia
Postural instability
Tremor
- absent in 25% of pt
- brought about when patient distracted (asked to close eyes and count backward) or with stress, anxiety or fatigue
- can be a postural tremor
- often begins in one hand and remains more severs on that side throughout
- may also affect chin, lips and tongue but not usually the head
- often not a disabling feature
PD temor vs. essential tremor
- family history common with ET not with PD
- Never unilateral in ET
- head tremor in ET
Rigidity
- resistance to passive movement in both flexors and extensors throughout whole ROM
- patients may complain of feeling muscle stiffness, weakness or fatigue
- reduction in arm swing during gait often early sign
- may also begin unilaterally and remain asymmetric
- may be brought about by augmentation maneuvers
Bradykinesia
- slowness of movements
- speech becomes hypophonic and swallowing slowed (saliva pools, drooling)
- trouble with buttons and fine finger movements
- takes longer to get dressed and do ADLs
Micrographia
Akinesia
- poverty of movement and trouble initiating movements
- Facial- hypomomia- lack of facial expressions and amimia- decreased eye blinking
Posture and Gait
- short, shuffling gait (bradykinesia and rigidity)
- stooped posture
- may appear to drag one leg if asymmetric
- decrease in arm swing
- hesitancy in initiating and freezing
- may fesinate- centre of gravity forward so take show increasingly rapid steps to catch up
- postural instability as disease progresses
Other Secondary Common symptoms
- Cognitive dysfunction- dementia in 30%
- Depression- 30-40%
- sleep disturbance- due to rigidity, tremor, dystonia, restless leg syndrome, depression
- Sexual dysfunction
- excessive salivation 75%
- Olfactory hypofunction
- Autonomic dysfunction- constipation, hypotension, nausea
- urinary dysfunction
- Sensory- pain and cramps
- Dystonia
11.
Hoehn and Yahr Scale
Commonly used to describe the progression of Parkinson’s Disease
Stage 0- no signs of disease
Stage 1- Unilateral symptoms only
Stage 1.5- Unilateral and axial involvement
Stage 2- Bilateral symptoms. No balance impairments
Stage 2.5- Mild bilateral disease with recovery on pull test
Stage 3- Balance impairment. Mild to Moderate disease. Physically independent.
Stage 4- Severe disability., but still able to walk or stand
Stage 5- Needing a wheelchair or bedridden unless assisted
CMOP-E
Person- affective, cognitive, physical and spiritual
Occupation- self-care, productivity, leisure
Environment- physical, institutional, cultural and social
Primary assessment areas
- ADL
- Upper limb strength and ROM
- Balance
- Ambulation
- Tone and rigidity
- coordination
- vision
- writing
Secondary Assessment Areas
- Fatigue
- Sleep
- Cognition
- Depression
- Quality of Life
Challenges in Self-care
- ADLS take more time
- one and off times affect performance
- safety is compromised
- decreased desire or motivation to complete ADLs
Treatment Overview
- Patient-centered goals
- Make observations
- environment
- blocked practice techniques
- Self vocalization techniques
- energy conservation and work simplification techniques
Managing tremors and rigidity
- stretching and ROM exercises
- Use of non affected UE
- Positioning techniques and splinting
- Energy conservation and work simplification
- relaxation
- pain management
Feeding
- weighted utensils
- built up utensils
- scoop plates
- rocker knives
- adaptive strategies
Dressing and bathing
- reacher
- sock aid
- long shoehorn
- elastic or velcro
- long sponge
- robe for drying
Housekeeping and meal prep
- electric gadgets
- dycemto to prevent slipping
- trolley cart or walker trays
Computer Work
Adapted keyboards
hands free software
one handed typing
seating and positioning
Micrographia
- use lined paper
- adaptive writing aids
- practice
Challenges in functional mobility
- bed mobility
- sit to stand
- turning
- stairs
due to:
bradykinesia - smaller movements - freezing - rigidity - safety concerns postural instability
Challenges in Rigidity
- Increase in muscle tone
- Cogwheel, lead pipe- dystonia
- often increases with active movement- mental concentration- emotional tension
- Stooped forward posture
- pain
Treatment for Walking
- Cues
- Lines taped to floor
- Improve carry over
- Focused attention
- Reduced distraction
- auditory and verbal cues
- counting steps
- music
Treatment Overview
- simplify treatment
- max. change with minimal cognitive effort
- Visual cueing and demonstrations
- repetitive activities
- Focus on increasing functional communication
