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Neuro Rehab 2 > Parkinsons - 2a PT management > Flashcards

Parkinsons - 2a PT management Flashcards

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1
Q

the majority of standardized tests recommended by the PD EDGE are in what domain

A

activity

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2
Q

which standardized tests recommended by the PD EDGE are in the participation domain (2)

A

PDQ-8 or 39
Parkinsons’ Fatigue Scale
- also activity measure

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3
Q

which standardized tests recommended by the PD EDGE are in the impairment domain (2)

A

MoCA
MDS-UPDRS
- also activity measure

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4
Q

what is the PD EDGE

A

group APTA formed to eval best standardized tests and measures for parkinsons’

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5
Q

what test is the gold standard for evaluating parkinsons

A

UPDRS
- unified parkinson’s disease rating scale

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6
Q

what does the UPDRS measure and what are its 6 sections

A

measures dz severity, progression, and effect of meds

6 sections of BSF & activity:
1. cognition
2. ADLs
3. motor exam
4. complications of therapy (SE of meds)
5. modified Hoehn and Yahr Scale
6. schwab and england ADL scale

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7
Q

what makes the UPDRS so comprehensive

A

sections and 5 and 6 are stand alone tools incorporated into test

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8
Q

what is the MDS-UPDRS and what are its 4 sections

A

movement disorders society UPDRS
- revised, condensed version of UPDRS

  1. non-motor aspects of experiences of daily living (nM-EDL)
  2. motor aspects of experiences of daily living (M-EDL)
  3. motor exam
  4. motor complications
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9
Q

what is the gold standard test specific to disease severity

A

hoehn & yahr scale

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10
Q

what are the 6 hoehn and yahr stages

A

0: no visible sx
1. PD sx unilateral
2: PD sx (B), no difficulty amb
3: PD sx (B), min difficulty amb
4: PD sx (B), mod diff amb
5: PD sx (B), unable to walk

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11
Q

what is a pull test

A

give someone forceful posterior perturbation & measure amt of steps to recover

(+) = >2 steps
(-) = recovers, only 1-2 steps

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12
Q

what is a concern w pts w a 3.0 on the modified Hoehn and Yahr scale

A

high risk for falls
- may need adaptive equipment

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13
Q

what is the modified hoehn and yahr scale

A

1.0: unilateral only
1.5: unilateral & axial
2.0: bilateral, balance is good
2.5: mild bilateral, (-) pull test
3.0: mild to mod bilateral, some postural instability, (I)
4.0: severe disability, able to walk/stand w ADs
5.0: wc bound or bedridden unless aided

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14
Q

what are 3 standardized tests to assess bradykinesia

A

10m walk test
9-hole peg test
5 xSTS test

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15
Q

what does the 10m walk test look at, what does it look like in parkinsons and what is the prompt you give pts w/o PD

A

looking at gait speed
walks at slower velocity
walk at preferred speed vs fastest

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16
Q

what is a predictor of falls in the 5xSTS test

A

16sec score predictor of falls in PD population

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17
Q

what standardized test is used to measure rigidity and how is this measured

A

UPDRS item 22

0 - absent
1 - slight
2 - mild to mod
3 - marked, full ROM easily
4 - severe, ROM difficult

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18
Q

what standardized test is used to measure resting tremor and how is this measured

A

UPDRS item 20

0 - absent
1 - slight/infrequent
2 - mild in amp, or mod but intermittently present
3 - mod amp and present most of time
4 - marked in amp, interferes w feeding/ADLs

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19
Q

what standardized test is used to measure dyskinesia and how is this measured

A

section IV of UPDRS

0 - non-existent
1 - mild
2 - present at rest, doesn’t interfere w activity
3 - mod, causes interference w activity
4 - severe

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20
Q

what is the most common reason we get a referral for someone w PD and what do we want to do ab this

A

falls

advocate for early referrals to dec risk of falls and progression of dz

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21
Q

at what point does postural instability usually present

A

middle stages of health condition

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22
Q

what type of balance test will be most challenging for people w PD and why

A

external perturbations
- d/t slow motor response

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23
Q

what are 5 standardized tests used to measure postural instability and what aspects do they each assess

A
  1. mini BESTest
    - looks at subsystems of balance, very comprehensive
  2. 5x STS
    - internal perturbations
  3. Pull Test
    - external perturbations
  4. FGA
    - stability w amb
    - focus on improving gait and balance
  5. ABC Scale
    - self report of confidence
    - help pinpoint activities they feel most unstable to incorporate
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24
Q

what ABC Scale score is predictive of falls and what is the MDC in PD

A

69
MDC = 13

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25
what are 3 ambulation standardized tests used and what do they each specifically assess
10m walk test - gait speed, fall risk 6MWT - amb endurance FGA
26
what is FGA score is a predictor of fall risk in PD? and what score is the MDC for PD?
27
what are 6 additional domains to assess w standardized tests and what domain is a specifically emerging area for us
cog (OT, SLP) sleep *** depression (psych) akinesia fatigue fear of falling
28
what is a standardized test for cog
MoCA
29
what is a standardized test for sleep
parkinson's disease sleep scale (PDSS)
30
what are 2 standardized tests for depression
geriatric depression scale beck depression inventory
31
what is a standardized test for akinesia
freezing of gait questionnaire
32
what is a standardized test for fatigue
parkinson's fatigue scale
33
what is a standardized test for fear of falling
ABC scale
34
what is a standardized test to assess participation level
PDQ39
35
what is the PDQ39 and its 8 subscales
disease specific measure of quality of life self-report questionnaire 8 subscales: - mobility - ADLs - emotional well-being - stigma - social support - cog - communication - bodily discomfort
36
how can stigma impact someone w PD's participation level
stigma ab a sx (ex: drooling) can be embarrassing and lead to pt self-limiting activities
37
what are 10 BSF impairments to look at/for in clinical exam
strength ROM sensation ms tone tremor dyskinesia vestib function pain respiratory function cardiac function
38
why is it important to assess if there is a strength impairment
won't see impaired isolated ACOM or abnormal synergies bc corticospinal tracts are intact
39
what ROM impairments do you commonly see in PD
joint play ms length trunk rotation
40
what does impaired ROM often result from and lead to in PD
from rigidity lead to developing flex posture w forward head, kyphotic posture, sedentary and sitting a lot -> won't see typical rotation and wt shift at trunk
41
at what point in the dz process do you see impaired sensation and why
common to be impaired later in dz process - not primary impairment - not direct result of PD - often older adults from typical aging changes in sensation and neuropathy
42
what are 3 common sensation impairments
proprioception light touch kinesthesia
43
why can you see impaired vestibular function, how does it present, and how is this integrated into our PT interventions
w trunk rigidity, lack of mvmt overall, dec rotation of head and trunk -> lead to slower firing of CNVIII vestibular firing d/t lack of activation and moving of head that would trigger signals of vestibulocochlear nerve see hypofunction where minimal mvmts of head will result in exaggerated responses - important to encourage more head motion and turns
44
what are 2 common reasons for a pain impairment
dec ms length rigidity
45
what are 2 ways that respiratory function is impaired and why
trunk rigidity and poor posture -> dec chest expansion & vital capacity
46
what are 2 common cardiac function impairments and why? why are these especially relevant to PT interventions?
orthostasis hemodynamic response bc of deconditioning often want to optimize CV health as much as possible bc common source of mortality in PD
47
what are 3 areas to assess in the activity level of the clinical exam
1. balance, trunk control, endurance 2. functional mobility - rolling, scooting, sup to sit, STS, bed to chair, amb, dual task, stairs 3. ADLs
48
what is a mainstay of PT treatment for PD and why
external cueing (ie auditory, visual cues) - can be very effective in initiation and keeping mvmts fluid
49
what was the traditional treatment paradigm for PT and how has this shifted today
compensate for paucity of mvmt by teaching behavioral and cog strategies to bypass BG circuits shifted to encourage exercise in managing PD
50
when is environmental modifications introduced in PD
pushed off for awhile
51
why is exercise so heavily supported in managing parkinsons now
inc dopamine and other neurotrophins (BDNF) which support functioning of BG circuits and mvmts
52
what is the contemporary framework for PT in PD
start PT EARLY in dz process - PT referral at time of dx focus on primary impairments, and prevent secondary impairments - "dental model"
53
what type of exercise does evidence support in PD
regular aerobic strongly supported evidence for resistive strength training, stretching, and balance exercises also
54
what is the most common trigger for referral to PT
a fall
55
why might a group exercise class be a good option in PD
less isolating dec stigma if PD exercise group
56
what are 9 PT interventions that there is strong evidence for
aerobic exercise resistance training balance training external cueing community based exercise gait training task specific training behavior change approach integrated care
57
recommendation for aerobic exercise and 3 reasons why
mod to high intensity inc VO2 dec motor dz severity improve functional outcomes
58
4 benefits to implementing resistance training
dec motor dz severity improve strength & power improve non-motor sx improve function and QOL
59
5 benefits to implementing balance training
improve postural control improve balance/gait improve mobility improve balance confidence improve QOL
60
what PT intervention is there low quality of evidence for its implementation
flexibility exercises
61
3 benefits to implementing external cueing
dec motor dz severity dec freezing of gait improve gait outcomes
62
3 benefits to implementing community based exercise
dec motor dz severity improve non-motor sx improve function & QOL
63
5 benefits to implementing gait training
dec motor dz severity improve stride length improve gait speed improve mobility improve balance
64
benefit to implementing task specific training
improve task specific impairment levels and functional outcomes
65
benefit to implementing a behavior change approach
improve physical activity and QOL
66
benefit to implementing an integrated care approach
dec motor dz severity and improve QOL
67
what intervention was there moderate quality of evidence for and what was the recommendation
telerehabilitation to improve balance
68
what was the statistically significant outcome of the SPARX Trial
significant difference b/w high intensity exercises (80%MHR) and controls - only applicable to early stages
69
parameters for aerobic exercise in PD
3-5x/wk duration: inc 20min -> 60min (progress duration/freq before intensity) mod intensity: 13 on RPE scale - 60-80% MHR mode: walking, cycling - early stages overground *during "on" cycle w meds
70
parameters for resistive exercise in PD
2-3x/wk w min of 1 rest day between training sessions - can be same day as aerobic exercise training 1 to 3sets of 8-12reps - rest each ms group 2-4min between sets resistance of 40-80% of 1RM modes: machines, free wts, elastic bands
71
what are 6 current trends in neurorehab
tai chi kayak boxing agility course pilates boot camp
72
what does tai chi help to improve in PD (2)
anticipatory postural control -> improves balance improve bradykinesia thru emphasis on timing & fluidity and continuing mvmt pattern once initiated
73
what does kayaking help to improve in PD (3)
promote axial rotation improve rigidity address brady & hypokinesia - inc speed and encourage faster/larger amp mvmts
74
what does boxing help to improve in PD (4)
internal/external perturbations -> improve balance improve akinesia of gait axial rotation counters brady and hypokinesia in UE
75
what does an agility course help with in PD (3)
direction changes, turns improve sequential coordination dec akinesia or freezing
76
what does pilates help with in PD (2)
strengthening spinal ext and rotation
77
what does a boot camp for PD entail (4)
10min of each activity - progress w dual/cog - progress w wt/resistance - progress by inc speed/amp
78
how to manage tremors: PT, equipment, meds
use mvmt to diminish tremor - gesture, pass object from hand to hand travel mugs w lids half fill to avoid spills adaptive spoons, pens meds: MAOIs, DBS, ablation
79
what are PT interventions for rigidity and flexibility
focus on trunk and spine ms PNF B UE D2 w DBE hook lying LTR, counter rot frequent position changes rocking chair (parasym) yoga & tai chi kayaking boxing daily stretching - low evidence but include
80
how do you structure PT management for bradykinesia and what is a primary example of an intervention
goal directed high amp mvmts multiple reps LSVT-BIG - 1hr 4x/wk for 4wks
81
what PD population does LSVT-BIG have the best outcomes
earlier stages of PD
82
what are 3 characteristics in PD does LSVT-BIG help improve
improve gait velocity improve stride length improve reaching velocity
83
what are 3 major factors associated w recurrent falls in PD
progressing PD postural instability cog impairment
84
what are characteristics that distinguish fallers from non-fallers
hx of falls presence of FOG preferred gait speed <1.1m/s
85
PT interventions to improve balance (strengthening, ROM, anticipatory/reactive, sensory input, gait) led to what significant outcomes
37% decline in fall rates in active phase significant dec in fear of falling and improved balance (mini BESTest)
86
what evidence is available on Tai Chi and Qigong
low level evidence studies, don't have a large scale RCT definitely worth doing for anecdotal evidence if someone is interested
87
what are PT interventions for postural instability (7)
internal perturbations (proactive or anticipatory) - wt shifts - alt stances - reaching - axial rotation + reaching - throwing/boxing external perturbations (reactive) - SR, RS to upper and lower trunk - nudges - catching balls alter tasks, positions, environment falls diary environment changes ADs tai chi
88
what are 3 interventions to help w someone who has difficulty w direction changes
TUG obstacle course figure 8 pattern
89
what are 5 compensations in later stages of PD if the pt has difficulty w direction changes
avoid sharp turns turn in large arc attention/cog strategies clock turn strategy concentrate on high stepping
90
what are PT interventions and cueing to work on a STS (5)
part -> whole task training mental rehearsal proprioceptive cues auditory cues environmental modifications
91
what are PT interventions and strategies for improving rolling and bed mobility in PD (4)
part task, log-roll wake up 30min early - take meds - HEP for AROM/stretching mental rehearsal, imagery environmental modifications - bed rail, silk sheets or pjs
92
what are strategies for negotiating doorways (2)
vertical strip of colored tape thru doorway visual spotting of object past the doorway
93
what are 2 types of cues and 4 examples of each to manage hypokinesia in gait
visual cues - laser line walkers/canes - theraband on walkder - tape lines on floor - pennies behavioral cues - postural alignment - inc UE swing - trunk rotation - cadence
94
what are 3 PT interventions for akinesia or FOG and why does each work
rhythmic auditory stim (RAS) - music, metronome, counting cycling program - external pacing cue of pedals BWSTT, treadmill training - inc gait speed
95
what are 5 benefits to group classes for someone w PD
educational component social interaction/support address impairment & activity add music, make it fun improved adherence rates

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