Parkinsons Disease Flashcards
What is Parkinson’s disease?
A group of disorders which involve tremor and disturbance to voluntary movement,balance and posture. It’s a progressive disease resulting from degeneration of the neurones in the substantia Nigra of the basal ganglia, which results in decrease in the production of dopamine.
Dopamine sends impulses to many brain regions including the cortex, which is why movement is affected( motor cortex).
Is there a clear causing factor of Parkinson’s disease?
No, however they say 15% is due to a genetic factor, and the rest appear to be environmental factors.
What is the role of the basal ganglia?
Regulates the planning, initiation and termination of movement.
It also regulates muscle tone and inhibit unwanted movement.
What 2 loops is the basal ganglia apart of and what do the loops do?
The basal ganglia is part of the DIRECT PATHWAY and the INDIRECT PATHWAY. The direct pathway promotes movement by having an excitatory effect on the thalamus causing more movement through the motor cortex where as the indirect pathway inhibits movement by having an inhibitory affect on on the thalamus.
However dopamine works on these pathways by exciting the direct pathway (causes movement) and by inhibiting the indirect pathway (meaning that dopamine stops the inhibition of movement therefor causing more movement)
What happens in Parkinson’s patients on the direct and indirect pathway due to the lack of dopamine?
A lack of dopamine means that there is a lack of excitement of the direct pathway, leading to lack of movement.
A lack of dopamine means that there is a lack of inhibition of the indirect pathway, leading to a lack of movement.
What are the 3 cardinal signs of Parkinson’s disease?
Bradykinesia and akineasia.
Resting tremor.
Rigidity.
What is bradykinesia and akinesia?
Lack of or slowness in a movement, with the size of movement also decreasing.
What is a resting tremor?
This occurs when he muscle is relaxed and shaking occurs. When movement occurs the tremor is not apparent as it is inhibited.
What is rigidity?
Stiff or inflexible muscles, which results in resistance to passive movement
What are some of the secondary clinical features of Parkinson’s disease?
Difficulty initiating movement, Difficulty sleeping, Freezing when walking, Festinating gait (slow shuffling gate), Difficulty with motor task, Monotone speech, Microphagia(difficultly writing), Depression, Loss of facial expressions, Kyphosis( flexed position and pokey chin).
What scale is used for the grading of Parkinson’s disease?
Hoehn and yahr scale
What medications can be given to people with Parkinson’s disease?
Dopamine replacements- replace dopamine levels eg mad or par and sinemet
Dopamine copycats-
Dopamine protectors- work by protecting the dopamine already in the body by blocking the enzymes that break it down.
Antichlonergics- decrease the amount of acetylcholine to help increase the amount of dopamine in the body.
What surgery’s can help patients with PD?
Deep brain stimulation to help with tremors,
Pallidotomy,
Thalamotomy- destroys the thalamus,
Stem cell research.
What’s the 2 types of rigidity?
Cogwheel- movement is start stop throughout the ROM (jerky)
Leadpipe- movement is tense and resisted throughout
What can we use as physios to help PD patients during movements? And why does it work?
As physios we can use cueing (verbal, visual, physical) to help stimulate movement.
In people with PD there supplementary motor cortex (SMA) which is involved in the automatic subconscious(automatic) initiation of movement is impaired however they still have the premotor area (PMA) which has the role of voluntary planning and executing movement. Due to this the PD patient is unable to subconsciously plan movement properly however with the use of ques, the PMA can override the SMA and movement can still occur.
