PD Flashcards by Heather Stephens

The basal ganglia are involved in

a. volitional control
b. automatic control
d. both
e. neither

both volitional and automatic

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The cortical basal ganglia loop is responsible for

a. automatic control
b. volitional control
c. planning strategies
d. motor strategies

volitional control

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Which process is the strongest volitional control?

paremetal system

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What are the main structures of the basal ganglia?

caudate
putamen
globus palidus

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The BG is part of the _ _ system

extra paramydal system

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(afferent/efferent) input to caudate and putamen from areas of cerebral cortex and thalamus

afferent

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the output from the substantia nigra is governed by

dopamine

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The globus pallidus sends info to the _ then to the _

thalamus

motor cortex

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What are the functions of the BG?

skeletal motor circuit
oculomotor circuit
prefrontal circuit
limbic circuit

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The circuits are in the regulation of

movement and cognitive behavior

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What are functions of the BG?

adapt behavior as task requirements change
organize sensory input
motivation to move

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This circuit prepares for and executes movement, selective activation, initiation of complex movements organized here

a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit

skeletal motor circuit

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This circuit is responsible for saccadic eye movement, and quick movements from one point to another

a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit

oculomotor circuit

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This circuit is respobile for organizing behaviors, governing and executive function, dampens on certain behaviors

a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit

prefrontal circuit

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This circuit is responsible for motivated behavior, procedural learning, verbal cognitive stage of learning

a. oculomotor circuit
b. limbic circuit
c. prefrontal circuit
d. skeletal motor circuit

limbic circuit

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what disorders involve the action system

involuntary movements, difficulty initiating movements, akinesia, bradykinesia, postural instability

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movements are (internally/externally) generated

internally

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What is the average age of onset in PD?

50-60 years

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Incidence (increases/decreases) with age

increases

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what is the youngest onset of PD?

<21 years

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2/3 of patients with PD present initially with

a. tremor
b. postural instability
c. rigidity
d. bradykinesia

tremor

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1/3 of patients with PD present initially with

a. tremor
b. postural instability
c. rigidity
d. bradykinesia

postural instability

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Postinfectious 
toxic and drugs
tumors
normal pressure hydrocephalus 
vascular 
metabolic 
these re

secondary parkinsonism

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The direct loop represents _ movement

volutitional

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Which loop is related to hypokinesia? a. indirect loop b. direct loop

direct loop

The indirect loop role is _

inhibition

The indirect loop has a role in _ movement

automatic

What is the most affected with the indirect loop?

regulation of trunk and limb muscles for posture and balance

The _ _ communicates with striatum

substania nigra

What is the role of the substania nigra?

produce dopamine inhibitory to neurons in indirect pathway

Dopamine has an (inhibitory/excitatory) effect on the indirect pathway

inhibitory

Dopamine has an (inhibitory/excitatory) effect on the direct pathway

excitatory

Production of dopamine is the largest problem due to

lost of receptors

(underactive/overactive) indirect pathway gives rise to akinesia and rigidity

overactive

an overactive indirect pathway leads to a. akinesia and spasticity b. rigidity and bradykinesia c. akinesia and hypokinesia d. akinesia and rigidity

akinesia | rigidity

an underactive direct pathway leads to a. akinesia b. rigidity c. spasticity d. bradykinesia

bradykinesia

an overactive direct pathway leads to

dyskinesia dystonia athetosis

What is caused by a release of inhibition in basal ganglia?

tremor

What are the cardinal motor symptoms?

``` TRAP tremor rigidity akinesia postural instability ```

This symptom is shown initially in about 70% of PD patients a. rigidity b. akinesia c. postural instability d. tremor

tremor

Tremor is a. resting b. intentional c. during movement d. constant

resting

A resting tremor (increases/decreases) with movement

decreases

Tremor (appears/disappears) during sleep

disappears

Tremors can be aggravated by

stress and fatigue

The later the stage the (better/worse) the tremor is

worse

What is the cause of tremor

overactive indirect pathway

Rigidity is felt a. at fast velocity b. at the end of the range c. slow and fast velocity and most of the range d. at slow velocity at mid range

slow and fast velocity and most of the range

This is defined as difficult to move, feels completely stiff a. cog wheel b. rigidity c. lead pipe d. low tone

lead pipe

This is when there is jerking throughout the range a. cog wheel b. rigidity c. lead pipe d. low tone

cog wheel

Rigidity makes it difficult to

motor plan

Movement preperation deficits are

start hesitation | freezing

this difficulty with motor planning is a difficulty with initiating or changing direction a. akinesia b. hesitation c. freezing d. rigidity

freezing

difficulty perfoming _,_,_ movements

complex stimultaneous sequential

This is defined as a slowness of movement a. hypokinesia b. akinesia c. hypomimia d. bradykinesia

bradykinesia

This is defined as reduced amplitude and slowness a. hypokinesia b. akinesia c. hypomimia d. bradykinesia

hypokinesia

This is defined as a poverty of movement a. hypokinesia b. akinesia c. hypomimia d. bradykinesia

akinesia

What is hypomimia?

masked face

this is defined as masked face where there is a loss of expression, lifeless in the face a. hypokinesia b. akinesia c. hypomimia d. bradykinesia

hypomimia

What type of posture do patients with PD show?

kyphosis

What types of contracture can patients have?

hip and knee flexion

What is the biggest problem with patients who have PD? a. tremor b. rigidity c. falls d. small movement

falls

(increased/decreased) body sway

increased

Base of support is a. wide b. narrow c. normal

narrow

Patients show difficulty in dynamic _ initiated movements

self

How do they react to a perturbation?

decreased reaction

patients show difficulty in _ postural control

feedforward anticipatory

What cardinal sign is the last to develop?

postural instability

Clinical diagnosis is based on the presence of

2 of first 3 cardinal signs

What are the torque production deficits seen?

decreased at all speeds disuse weakness as disease progresses extensors weakness more noticeable increased weakness in off periods

What is the main byproduct of rigidity?

fatigue

What type of gait is seen?

festinating gait

This type of gait is an increased step frequency with shortening of stride

festinating gait

Common deviations seen with gait

``` reduced stride length increased variability decreased speed shuffling initial contact with foot flat or toes first decreased trunk rotation and arm swing freezing difficulty turning, dual-task, attentional demands of complex environments ```

``` (increased/reduced) stride length and (increased/decreased) variability (decreased/increased) speed shuffling initial contact with _ (increased/decreased) trunk rotation and arm swing difficulty _ difficulty in _ _ difficulty in _ _ ```

``` reduced increased decreased foot flat or toes first decreased turning dual task attentional demands of complex environments ```

Patients have problems with (procedural/declarative) learning deficits

declarative

Which type of practice is best for motor learning? a. random practice b. blocked practice c. massed practice d. constant practice

blocked practice

Patients experience _ type of sensation

paresthesia and pain

This is described as a sense of need to move, restlessness

akathisia

Proprioception is impaired (true/false)

true

The sensation is impaired in all patients with PD (true/false)

false

What autonomic NS dysfunction occurs?

excess sweating slow pupillary responses GI problems

Dementia is a (direct/indirect) effect

direct

``` visual disturbances with some drugs orthostatic hypotension arrhythmias decreased circulation and edema deconditioning decreased chest expansion these are (primary/secondary) features ```

secondary

What walking category are most patients?

least limited

fMRI is used to

rule out secondary and parkinson-plus syndromes

stages 0-1: a. severe stage b. bilateral signs and balance problems c. no signs or unilateral

no signs or unilateral

stages 2-3: a. severe stage b. bilateral signs and balance problems c. no signs or unilateral

bilateral signs and balance problems

stages 4-5: a. severe stage b. bilateral signs and balance problems c. no signs or unilateral

severe stage

What neuroprotective medication is taken?

MAO inhibitor

MAO inhibitor purpose is to

improve metabolism of dopamine

What symptomatic medications are taken?

levodopa dopamine agonists anticholinergic drugs

The purpose of this medication is to control symptoms related to a limited about of dopamine a. dopamine agonist b. MAO inhibitor c. levodopa d. anticholinergic drugs

levodopa

The purpose of this medication is to act on post synaptic receptors to decrease amount of l-dopa needed a. dopamine agonist b. MAO inhibitor c. levodopa d. anticholinergic drugs

dopamine agonists

This medication is taken to help decrease l-dopa dosage needed a. dopamine agonist b. MAO inhibitor c. levodopa d. anticholinergic drugs

dopamine agonists

This medication is used to control tremor and rigidity a. dopamine agonist b. MAO inhibitor c. levodopa d. anticholinergic drugs

anticholingergic drugs

How should their nutrition be managed?

high calorie, low protein

This surgery is a permanent fix to help tremor and akinesia

ablative surgery

During this stage, the goal is a preventive exercise program a. early middle b. late c. late middle d. early

early

During this stage, the physical goal is a corrective exercise program a. early middle b. late c. late middle d. early

early middle

During this stage, the physical treatment is compensatory and corrective exercise a. early middle b. late c. late middle d. early

late middle

During this stage, the physical treatment is compensatory exercise, dietary concerns, skin care, hygiene, pulmonary function a. early middle b. late c. late middle d. early

late

This test has 4 parts and measures mentation, behavior, mood, sleep, speech, tremor, walking, motor exam, freezing, dyskinesia, and more a. MOCA b. unified parkinsons disease rating scale c. Parkinsons Disease questionnaire

unified parkinsons disease rating scale

This scale measures cognitive function a. MOCA b. unified parkinsons disease rating scale c. Parkinsons Disease questionnaire

Montreal Cognitive Assessment (MOCA)

What visual changes are seen?

saccadic eye movement

What motor function is expected to be seen?

``` rigidity bradykinesia tremor dyskinesia postural instability ```

Which test is better for postural instability in early stages?

miniBEST

TUG with cognitive should not increase more than _ seconds with cognitive task

What are you assessing for with 10MWT?

``` speed stride length cadence stability variability safety ```

This test looks at quality of life and how they perceive their abilities? a. MOCA b. unified parkinsons disease rating scale c. Parkinsons Disease questionnaire

parkinsons disease questionnaire

ability to turn, gait speed, and stride length are most highly correlated with

severity of disease QoL confidence

Which is the most common neuromuscular movement system diagnoses?

hypokinesia

Dual task should be practiced in _ stages

earlier

What cues should be used for initiation, freezing, and gait problems?

external cues

What are external cues for PD?

auditory visual combined

PNF rhythmic initiation, rotation, rocking, distal to proximal relaxation and yoga used as what treatment a. strength training b. functional training c. rigidity and bradykinesia d. ROM and flexibility

rigidity and bradykinesia

PNF, Traditional stretching, Positioning – prolonged stretch, Trunk/joint mobs, Music – facilitates movement used for what treatment type a. strength training b. functional training c. rigidity and bradykinesia d. ROM and flexibility

ROM and flexilbity

For strength training focus on _

extensors

What stages is it better to do strength training

mild to moderate

Avoid _ with strength training

isometrics

PNF, NDT assisted to cueing, mobility and transitional movements, adaptive equipment used as what type of treatment a. strength training b. functional training c. rigidity and bradykinesia d. ROM and flexibility

functional training

Dynamic balance training is

most engaging | high level of physical and cognitive

What is key with gait training?

bigger and faster

This type of intervention addresses flexibility, balance, gait, kinesthetic awarenss, dual tasking, agility, aerobic and function

Big and PWR

Big and PWR address a. tremor b. rigidity c. bradykinesia d. hypokinesia

hypokinesia

This treatment if 4 foundational movements, the building blocks of function, 5 body positions in variety of ways, used across all levels of disease severity, framework not protocol, patient centered-dosing a. PWR b. LSVT Big

PWR

This treatment is 7 movement exercises, 2 body positions, protocol is not adaptable, requires 4x/week for 4 weeks, followed by HEP a. PWR b. LSVT Big

LSVT Big

What stage is balance disturbed? a. 2 b. 3 c. 4 d. 5

At what stage do gait impairments begin? a. early b. early middle c. late middle d. late

early middle

What stage are they severely disabled, dependent with ADL's? a. early b. early middle c. late middle d. late

late

Fatigue is caused by

rigidity

Postural response:

co-activation

Which tool is best to use to measure muscle performance?

5 x sit to stand

Which outcome measures are best for postural instability?

miniBEST | Berg

Which outcome measures should be used to measure gait?

TUG FGA 10MWT

Cause of tremor is a. overactive direct pathway b. underactive direct pathway c. overactive indirect pathway d. underactive indirect pathway

overactive indirect pathway

Visual processing is completed in the a. thalamus b. cerebellum c. brainstem d. basal ganglia

brainstem

This structure receives ascending information from the SC a. cerebellum b. thalamus c. brainstem d. motor cortex

thalamus

freezing is a difficulty _ or _ direction

initiation | changing