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parkinsons Flashcards

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1
Q

how common is parkinsons

A

the secound most common neurodegenerative disorder of the CNS

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2
Q

is age an important factor in parkinsons

A

yes

the vaerage age of on set is 50-60

rare in those < 40

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3
Q

is park more prevalent in men or women

A

men

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4
Q

what is the cause of park

A

Mostly idiopathic/unknown (78%)

Some may be linked to genetic mutation (10%)

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5
Q

what is Secondary Parkinsonism

A

a group of disorders that have features similar to those of Parkinson disease but have a different etiology.

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6
Q

what are some examples of Secondary Parkinsonism

A

Infection

Drugs - Toxins

Tumors
Vascular
Metabolic disorders

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7
Q

what does the basal ganglia consist of

A

caudate

putamen

globus pallidus

sub thalamic nucleus

substania nigra

(CPGss)

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8
Q

what are the functions of the basal ganglia

A

goal directed behavior

self regulation

regulate emotions

regulate eye movements

Regulates skeletal muscle contraction

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9
Q

how specifically does the BG regulates skeletal muscle contraction

A

Regulates muscle force,

multi-joint movements,

sequencing of movements,

involved in motor planning

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10
Q

the motor coretex feeds into what two parts of the BG

A

putamen and sub thalamic nucleus

the excite these pathway s

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11
Q

all paths in the BG lead to the

A

motor part of the thalamus

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12
Q

Pathophysiology of Park

A

loss of the neuros in the substaia nigra that produce dopamine

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13
Q

how much cell loss do we need to show the signs of park

A

up to 80%

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14
Q

what does the loss of dope (ext/ihb) do to the BG pathway

A

causes less disinhibition of “Go” pathway and excess inhibition of “No-Go” pathway

this leads to brady and hypokinesia

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15
Q

clinical manifestation of park - motor

A

tremor

ridgity

impaired postural control

bradykinesia

(cardinal signs of Park)

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16
Q

what kind of tremors do we see with park

A

resting, pill rolling tremor

rhythmic

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17
Q

where do we normally see tremors in park

A

hands and feet

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18
Q

when do park tremors increase

A

with stress, fatigue, strain

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19
Q

does the tremor seen with park changes

A

yes it can chnage as the disease progresses

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20
Q

parkinsons and rigidity - type

A

Velocity independent resistance to stretch

cogwheel or lead-pipe rigidity

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21
Q

where is parkinsons and rigidity felt

A

a and a

may feel ‘stiffness’ or ‘heaviness

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22
Q

parkinsons and rigidity and gait

A

may have less arm swing

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23
Q

what is Bradykinesia

A

Slowness of movement

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24
Q

what causes brady

A

insufficient muscle force during initiation of movement

Weakness, tremor, and rigidity can be contributing factors

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25
what is Bradyphrenia
slowness of thought
26
what is Akinesia
poverty of movement inability to voluntarily move one's muscles and limbs "freezing" FOG
27
what is the cause of akinesia
Influenced by rigidity, stage of disease, attention, depression Difficulty or inability to initiate movement
28
what is Hypomimia
masked facial expressions
29
what is Hypokinesia
the underscaling of movements decrease in the range or amplitude of movements
30
Micrographia
small handwriting
31
what is Postural Instability
Abnormal postural responses due to Reduced limits of stability
32
what does decreased postural control lead to difficulties with
reactive and anticipatory postural control Responses are often too slow or too small
33
motor learning and park
Reduced ability to retain and transfer motor skills best to use block practice
34
what gait disturbances do we see with park
Freezing of gait Slowness of pace and rhythm decreased arm swing decreased postural control Retropulsion or anteropulsion - Stooped posture
35
do those with park have sensory dysfunctions
Parasthesias/pain Difficulty with integration of proprioceptive inputs Olfactory dysfunction Visual perceptual dysfunction
36
what is cog wheel rigidity
jerky resistance to the passive movement , this is because the muscle are relaxed and contracting
37
what is lead pipe
is a sustained resistance throughout the attempted movement
38
what is Hypokinetic dysarthria
present in some with park decreased volume, monotone, decreased articulation, uncontrolled rate
39
early MCI is a predictor for what
associated with increased risk of dementia in later stages
40
how do we diagnoses park
there is not one single test may be made on history and examination Continued observation of motor & non-motor symptoms Parkinson-plus syndromes must be ruled out
41
do we use imagine to help diagnoses park
some what used to rule out other central disorders
42
Hoehn and Yahr Classification - stage 1
unilateral involvement only min to no functional impairments
43
Hoehn and Yahr Classification - stage 2
bilat or midline involvement no impairment to balance
44
Hoehn and Yahr Classification - stage 3
impaired right reflexes unsteadiness pt can live independently - disability is mild to mod
45
Hoehn and Yahr Classification - stage 4
sym are severe standing and walking are only possible with assistance
46
Hoehn and Yahr Classification - stage 5
confined to bed or WC
47
what is a righting reflex
corrects the orientation of the body when it is taken out of its normal upright position
48
how long is the preclinical period
5 - 25 years
49
how long to park pt last
10-20 years
50
slower progression signs
younger age tremor as the predominant feature
51
rapid progression signs
postural instability gait disturbances
52
when do pt response to dope meds
beginning stages of disease  they will need an increase as the disease progresses
53
increased dose of meds leads to what after effect
Dyskinesias
54
what is the gold standard drug for PD
Carbidopa/Levodopa
55
what does Carbidopa/Levodopa help to control
bradykinesia and rigidity
56
what is the function of Carbidopa/Levodopa
compensate for dopamine deficiency
57
Deep brain stimulation (DBS) treatment
Involves surgically implanted, battery-operated device that delivers electrical stimulation to areas of the brain to block abnormal signals in the BG circuitry to decrease PD symptoms
58
what does Deep brain stimulation (DBS) treatment help with
tremor and other motor symptoms
59
High protein diet can do what
block effectiveness of levodopa
60
what kind of diet should the pt adhere to
high calorie, low protein diet
61
what is Bradyphrenia
slow thinking - be patient with these pt
62
what to do with CN
screen vision and eye movements olf swallowing speech
63
would we screen sensory or include it in our neuro pt exam
screen Ask about paresthesia and/or pain Light touch screen Proprioceptive information
64
screen motor
no fully assess
65
screen coordination
yes
66
screen balance
no
67
outcome measure for balance
Berg Balance Scale FGA ABC
68
screen function
no
69
what do we prioritize
motor balance functional
70
Restorative PT approach
Improving upon functional impairment/activity limitations
71
Preventative & Maintenance PT approach
moderate to high intensity exercise in early stages can slow the progression of the disease  Minimize secondary impairments/complications
72
Compensatory PT approach
Focus on modification of the task/environment and getting patient the necessary equipment needed 
73
Flexibility exercises for park
evidence is weak
74
Aerobic exercise Resistance training Balance training for park
all are reccomended
75
nonprogressive exercise intervention vs progressive resistance training program
A progressive resistance training program was shown to be more effective than a nonprogressive exercise intervention
76
common balance activities
Common interventions emphasize multidirectional stepping, motor agility, anticipatory postural control, and reactive balance
77
what type of training should PTs use for improve postural control, balance outcomes, and spatiotemporal gait impairments 
balance over resistance training
78
is gait training good
yes
79
external cueing good or bad
good
80
community-based exercise good or bad
good tai chi, ai chi, power yoga, hatha yoga, Pilates, group training, dance, noncontact boxing, Nordic walking, qigong, and meditation
81
what is LSVT (Lee Silverman Voice Treatment) BIG Treatment 
Focus on intensive exercise of large movement amplitudes
82
what is Parkinson Wellness Recovery (PWR!)
Free core set of exercises to target a skill known to deteriorate in people with PD
83
Later Disease Stages and PT
therapy shifts from restorative interventions to preventative and compensatory interventions
84

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