PD - Nature of Impairment and Clinical Implications of Research Findings

Question 1

What is PD and what does it affect?

Answer 1

PD = neurodegenerative disease affecting many parts of the CNS including the basal ganglia; pt’s lose the ability to perform automated tasks without directing attention to them

Question 2

Primary motor impairments in PD?

Answer 2

TRAP
T = Tremor
R = rigidity
A = akinesia (brady/hypo) - worse with movement+dual tasking
P = postural instability

Question 3

Morris et al (1994) - examined bradykinesia and hypokinesia during gait in people with PD. What did that find?

Answer 3

Normal walking at preferred speed: reduced velocity (bradykinesia) and reduced stride length (hypokinesia); cadence is increased but the OVERALL effect is still reduced velocity

Fast walking: PD mainly increases cadence not stride length in order to walk faster

Walking with auditory cue (metronome): they can match cadence to auditory cue but this alone doesn’t do anything for stride length or velocity

Question 4

Morris et al (1994) - TAKE HOME MESSAGE

Answer 4

Speed is reduced mainly d/t a reduction in STRIDE LENGTH and compensated for by an increase in CADENCE

So you see short steps, slow walk, increased cadence

Question 5

Akinesia (freezing) - when do you get it?

Answer 5

• initiating standing, walking, rolling over
• turning
• dual tasks
• end of medication

MORE LIKELY in narrow doorways or in busy environments

Question 6

Define freezing of gait

Answer 6

• feeling that feet are glued to the floor when walking through narrow spaces, making a turn, initiating walking, crowded spaces
• can be accompanied by trembling of the legs + small shuffling steps

Question 7

Secondary motor impairments in PD?

Answer 7

Dyskinesia
Dystonia (thought to be related to L-dopa use) - painful and abnormal mm contractions resulting in abnormal postures
MM weakness + reduced power

Question 8

Name some activities that are limited by impairments of PD

Answer 8

Standing
Rolling over
Turning
Eating
Walking
Speaking
Reaching, holding, and manipulating objects

Question 9

What does the UPDRS test and what are teh components?

Answer 9

Test impairments:

1. Action tremor
2. Finger taps
3. Hand grips
4. Hand pron/sup
5. Heel taps
6. Postural instability test
7. Rising fromchair
8. Rigidity of neck
9. Compensatory stepping correction (trust test)

Question 10

What are some tools to assess for ACTIVITY LIMITATIONS in PD (and MS and MND)

Answer 10

TUG
6MWT
Berg Balance
Spiral test
Step test
9 hole peg test

Question 11

List 5 strategies to promote safety during unsupervised exercise in PD patients

Answer 11

1. Exercise with another person nearby
2. Exercise when ON meds
3. Minimize distractions (although this might be introduced later on)
4. Ensure stable/firm surface nearby for support
5. Stop exercising if symptoms arise and seek help/advice