Parkinsons - Motor Symptoms - 2

Question 1

cardinal signs

Answer 1

TRAP

Question 2

TRAP

Answer 2

tremor

rigidity

akinesia

posture

Question 3

tremor –> TRAP

Answer 3

resting

stereotypical “pill rolling” tremor

Question 4

rigidity –> TRAP

Answer 4

lead pipe or cog wheel

Question 5

akinesia –> TRAP

Answer 5

bradykinesia

inability to initiate movement or slowed movement

Question 6

postural instability –> TRAP

Answer 6

late stage finding

decreased balance and coordination

Question 7

what does dx require

Answer 7

2 of the 3 early motor signs

Question 8

what is the most common clinical manifestation

Answer 8

tremor

75%

Question 9

what are tremors generally

Answer 9

unilateral UE

can be bilateral

Question 10

how are tremors first seen

Answer 10

in fingers

pill rolling

Question 11

tremors are present

Answer 11

at rest

w/ exertion or tension

disappear w/ sleep or action

Question 12

what side do symptoms start on

Answer 12

right side

61%

Question 13

role of the BG

Answer 13

imbalance b/w Cb and BG inhibition

cholinergic activity

Question 14

what will occur overtime –> tremor

Answer 14

will spread to other body parts

Question 15

tremor will spread to

Answer 15

LEs

face (blepharospasm)

shoulder and neck/trunk (titubation)

may become bilateral

Question 16

non-velocity dependent hypertonicity

Answer 16

uniform resistance to PROM throughout ROM

different from spasticity

Question 17

types of rigidity

Answer 17

lead pipe

cog wheel

Question 18

lead pipe

Answer 18

slow

sustained resistance to ROM

Question 19

cog wheel

Answer 19

jerky

ratchety

catch & release to ROM

Question 20

where can rigidity appear

Answer 20

agonist and antagonist muscle groups

Question 21

how could rigidity appear

Answer 21

unilaterally before bilaterally

Question 22

what does rigidity typically affect

Answer 22

proximal muscles

then extremities and face

Question 23

early sign of rigidity

Answer 23

loss of arm swing in gait

Question 24

prolonged rigidity

Answer 24

contractures and postural deformity

fatigue secondary

resting energy expenditure

Question 25

akinesia

Answer 25

difficulty w/ the initiation of movement

Question 26

akinesia is different from

Answer 26

bradykinesia both are motor planning deficits

Question 27

how is movement initiated

Answer 27

co-contraction of agonist and antagonist

Question 28

drugs that limit bradykinesia

Answer 28

do not affect akinesia results from problems in the preparation for movement

Question 29

what is akinesia associated w/

Answer 29

fixed postures "freezing" "glue foot"

Question 30

where does akinesia frequently occur

Answer 30

tight/enclosed spaces approaching a change in floor surface

Question 31

what is freezing exacerbated by

Answer 31

stress

Question 32

what can akinesia be overcome w/

Answer 32

external cues or attentional strategies

Question 33

bradykinesia

Answer 33

slow or decreased movement

Question 34

bradykinesia includes

Answer 34

a decrease in arm swing slow shuffling gait lack of facial expression

Question 35

what does bradykinesia have difficulty w/

Answer 35

initiating or changing direction of movement stopping movement once is has started

Question 36

posture

Answer 36

typically flexor-bound often considered diagnostic

Question 37

posture --> often diagnostic

Answer 37

neck/trunk flexion hip/knee flexion ankle PF

Question 38

there is a loss of --> posture

Answer 38

natural heel to toe progression becomes to to heel instead rotation

Question 39

what are posture and gait changes d/t

Answer 39

combination of rigidity and bradykinesia

Question 40

what is common --> postural instability

Answer 40

festination and retropulsion COG is too far forward

Question 41

what does postural instability lead to

Answer 41

difficulty in bed mobility

Question 42

what does postural instability cause

Answer 42

decrease heel strike decrease step length decrease stride length

Question 43

what does gait turn into

Answer 43

"en bloc"

Question 44

in early stages

Answer 44

there is shuffling

Question 45

in later stages there is

Answer 45

festination

Question 46

motor SXS (1)

Answer 46

TRAP stooped posture shuffling gait or festination freezing decrease arm swing

Question 47

motor SXS (2)

Answer 47

difficulty arising from a chair difficulty turning in bed imbalance & falls dystonia (esp leg/foot) hypophonic speech

Question 48

motor SXS (3)

Answer 48

dysphagia dysarthria micrographia masked face slowing of ADLs sialorrhea

Question 49

dystonia

Answer 49

twisting, sometimes bizarre, movements

Question 50

what is dystonia caused by

Answer 50

involuntary contractions of the axial and proximal muscles of the extremities

Question 51

hypophonic speech

Answer 51

soft speech

Question 52

what does hypophonic speech result from

Answer 52

lack of coordination of the vocal musculature

Question 53

dysphagia

Answer 53

difficulty swallowing

Question 54

what does dysphagia result from

Answer 54

lack of coordination of the vocal musculature

Question 55

individuals w/ PD --> dysphagia

Answer 55

often unaware that they are experiencing it

Question 56

dysarthria

Answer 56

motor speech disorder resulting in poor articulation

Question 57

what is dysarthria often termed

Answer 57

hypokinetic dysarthria in PD

Question 58

micrographia

Answer 58

abnormally small handwriting progressively smaller handwriting

Question 59

masked face

Answer 59

bradykinesia of the facial muscles reduction of facial expression of emotion

Question 60

slowing of ADLs

Answer 60

combo of TRAP causing increased challenge w/ ADLs

Question 61

sialorrhea

Answer 61

hypersecretion of saliva impaired or frequent swallowing

Question 62

% of PD pts that experience falls

Answer 62

66% 13% fall more than once a week

Question 63

why do PD pts fall

Answer 63

delayed equilibrium rxns lack of anticipatory postural control inability to adequately respond to perturbations

Question 64

other factors of fall risk

Answer 64

mm weakness meds S/E postural hypotension fatigue depression dementia

Question 65

what are common in PD

Answer 65

procedural learning but declarative learning is usually intact

Question 66

why is dual tasking difficult for PD pts

Answer 66

involves shifting of attention and motor programs

Question 67

what type of practice do we use

Answer 67

block practice