PD

Question 1

BG function

Answer 1

assist motor cortex in running motor skills
output to supplemental motor cortex for internal cuing and premotor cortex for readiness
decreases need for attention during movement

Question 2

features of defective BG

Answer 2

degrading prgrammed movements
difficulty with well earned complex tasks
slow adaptation to changing environment
decreased movement amplitude
trouble switching between tasks
imprecise release of sub movements
inaccurate movement termination

Question 3

physiological changes in PD

Answer 3

BG loses dopaminergic neurons, decreasing substantia nigra

Question 4

cardinal signs of PD

Answer 4

resting tremor
rigidity - cogwheel
akinesia/bradykinesia - freezing, slow, hesitation, decreased arm swing and facial mvvmt
postural instability

Question 5

PD s/s

Answer 5

inability to voluntarily control ADLs
akinesia - hard to initiate mvmt
bradykinesia - slowness of movement
rigidity
tremor - resting
gait slow shuffling festination
monotone and quiet speech

Question 6

features of PD resting tremor

Answer 6

starts UL and progresses BL
pill rolling motion in thumb/forefinger

Question 7

hypokinesia

Answer 7

reduced movement speed and amplitude, reduced step length
altered rate and timing

Question 8

freezing gait

Answer 8

hard to initiate movement
distraction causes sudden cessation of mvmt due to loss of attn
hard to restart movement

Question 9

festinating gait

Answer 9

involuntary shortened steps and faster cadence partway through doing a task

Question 10

non motor aspects of PD

Answer 10

orthostatic hypotension
flush/sweating
constipation
sphincter/sexual dysfx
paresthesia
pains
akathisia
seborrhea
edema
fatigue
weight loss

Question 11

bxal abnormalities in PD

Answer 11

apathy, lack of confidence, fear, anxiety, emotionally labile, social withdrawal, dependent
slow thought, loss of concentration, hard to form concepts
dementia
paranoia/hallucination
depression
sleep disturbance

Question 12

PD evaluation standardized tests

Answer 12

UPDRS
PDQ39
Schwab and England ADL

ROM/MMT/flexibility
functional reach
berg
tinetti
TUG
6MWT
10m walk test

Question 13

Hoehn and Yahr stages

Answer 13

0 - no s/s PD
1 - unilateral symptoms like slight tremor, stiffness, slow mvmt
2 - BL symptoms, no difficulty walking, adding speech and facial mask impairment
3 - BL symptoms and some difficulty walking, independent with balance problem
4 - BL symptoms and mod difficulty walking, need assistance for ADLs
5 - BL symptoms and unable to walk, wheelchair

Question 14

issues PD pts have with bed mobility

Answer 14

rigidity, initiation, spinal immobility, flexor domination, forward head, decreased rotation

Question 15

PD pts have issues with rising to stand bc

Answer 15

forward head, kyphosis, post pelvic tilt, inability to weight shift anterior

Question 16

features of PD gait

Answer 16

hypokinesia
decreased postural adjustments
delayed balance reactions
decreased stride length
shuffling steps
increased double support
decreased rotation, arm swing

Question 17

PD goals

Answer 17

approach undelrying cause of ROm/reaction limitations
approach through use of ADLs
repetitive ADL practice
family involvement

improve QOL, arrest progression and degradation of fxal status

Question 18

PD medication

Answer 18

levodopa carbidopa, metabolized into dopamine
side effects include nausea, hypotension, constipation, confusion, edema, hallucinations, psychosis, dystonic, choreiform dyskinesia

Question 19

elements of PD PT

Answer 19

teach ability to move with postural stability strategies depending on disease progression
manage secondary problems
promote physical activity and prevent falls

Question 20

compensation in PD PT

Answer 20

bypass defective BG
rely on cortical control to initiate movement
rely on attention to sustain execution
break down activity into parts with focused attention and mental rehearsal/visualization

Question 21

external cues help with PD by

Answer 21

compensation!
use premotor cortex
visual: lines on floor
auditory: metronome, music

Question 22

strategy training

Answer 22

early stages: change task conditions to improve neuroplasticity (speed, surface, direction, sensory input)

Question 23

secondary problems to be managed by PT

Answer 23

deconditioning: aerobic, endurance, strengthening
decreased mobility
comorbidities medical or orthopedic

Question 24

freezing constraints

Answer 24

more likely with long skills
anxiety/stress determine severity and presence of freezing
occurs in off phase of medication

Question 25

strategies to avoid freezing

Answer 25

sensory cuing, rhythmic relaxation stop, pause, restart avoid complex long sequenced movement cognitive compensation stairs

Question 26

LSVT big

Answer 26

used to teach attentional strategy to increase motor output for bigger and faster movements use only relevant exercises, not all multidirectional sustained movements sensory recalibration: pt should feel like they are moving too big

Question 27

PD and aerobic training

Answer 27

60-70% max HR 3x week 30-40 min for HY 1-3

Question 28

PD and resistance training

Answer 28

2x week 30-60 min 40-60% rep max preogressing to 80% max

Question 29

task specific training

Answer 29

dual tasking: meant to improve gait speed fall prevention: bladder training UE: improve sensation and goal attainment turning

Question 30

balance training for PD

Answer 30

2-3x week, 5-10 weeks 30-120 min

Question 31

PD gait training

Answer 31

3-5x week, 30-60 min session treadmill overground robotic

Question 32

should PD exercise focus on one modality or many?

Answer 32

Many, multimodal more effective than any one

Question 33

rehab strategies for mild PD

Answer 33

vigorous exercise maintain flexibility strength CV function relearn strategies - task specific training active lifestyle fall prevention

Question 34

rehab strategies for mod PD

Answer 34

compensation promote active lifestyle encourage participation in on state strategy training fall prevention reduce multitasking exercise to reduce CV/MSK complications

Question 35

rehab strategies for severe PD

Answer 35

emphasize compensation safety instruct caregiver for ADLs, cuing for pt compensation active assisted exercise to prevent worsening sequelae change positions to avoid skin breakdown

Question 36

H&Y stage 1 PT model

Answer 36

promote health/fitness education train movement strategies for later use maintain physical activity maintain LE strength practice functional movement

Question 37

H&Y stage 2 PT model

Answer 37

BL involvement movement strategies for symptoms monitor medication effects educate pt and caregiver fall prevention (home enviro) maintain physical activity maintain LE strength practice functional movement muscle stretching

Question 38

H&Y stage 3 PT model

Answer 38

train movement strategies prevent falls recognize on and off medication status promote regular physical activity educate caregiver fall diary

Question 39

H&Y stage 4 PT model

Answer 39

disabling disease, rely on AD train caregiver in compensation and fall prevention train for what to do with fall meds education maintain aerobic, walking distance, endurance, muscle force strategies to prevent MSK sequelae maintain phys activity fall diary upright posture LE strength stretching

Question 40

H&Y stage 5 PT model

Answer 40

reliant on wheelchair maintain activity/participation/QOL prevent falls reinforce movement strategies train caregiver for transfers prevent skin breakdown, change positions airways assisted walking/standing/supine lying/neutral sidelying prescribe AD