Week 4 - PD and outcome measures Flashcards
what is parkinsons disease?
- when the cells that produce dopamine die, the symptoms of parkinsons appear
- progressive complex neurodegenerative disease
- everyone’s experience is different
- no cure
- movement is controlled by dopamine
-dopamine is a chemical that carries signals between nerves in brain
Stages of PD 1-5
Stage 1
mild
- unilateral movement
symptoms:
- tremor of one hand
- rigidity
- clumsy leg
- one side of face may be affected
Stage 2
mild
- bilateral involvement
or
- midline
symptoms
- loss of facial expression on both side
- decreased blinking
-speech abnormalities
-rigidity of muscles in trunk
Stage 3
moderate
- loss of balance and slowness of movement
symptoms
- balance is compromised
- inability to make rapid and automatic and involuntary adjustments
- other symptoms of pd are present
Stage 4
moderate
- severely disabling
symptoms
- pt can walk and stand unassisted but noticeably incapacitated
- pt can’t live an independent life and needs assistance
Stage 5
severe
- symptoms are severe
- inability to rise
symptoms
- falls when standing or turning
- freeze or stumble when walking
- hallucinations or delusions
what are clinical signs of pd?
- RIGIDITY
- BRADYKINESIA
- TREMORS
cogwheel vs leadpipe in PD
cogwheel:
jerky response to passive movement as muscles alternately contract and relax
leadpipe:
smooth uniform resistance with no fluctuations to passive movements
what are the clinical manifestations of pd?
1.postural changes:
2. fatigue
3. festinating gait
4. autonomic nervous system dysfunction:
5. cognitive- behavioural changes
what are some PT management for PD? - goals
goals
- delay effects of symptoms
- prevent development of secondary complications
-maintain / maximize function
what are the principles of LSVT BIG approach?
LSVT - Lee silverman voice treatment big
- thinking big to make big improvements
- big size amplitude whole body pt movements of improving flexibility, flow and movement pattern
- emphasis on rotation movements
- encourages sensory input to brain
- count out late as voice therapy same time as exs
- reduces pd symptoms and slow down progression of the disease
what are some walking patterns in pd?
- freeze in narrow spaces
- needs to practice walking in order to improve walking
- pt needs to practice turning to sit down in a chair and turning in tight spaces
- pt needs to practice taking longer step lengths, increasing trunk rotation, swinging their arms and looking forward
what are the 4 S’s to break a freeze?
S - Stop
S - Stand tall and breath
S - Shift weight side to side
S - Step out BIG and think BIG movements
how to assist in turning patterns in pd?
strategies
- walk around large arc
- clock face method
- high marching
- clapping
stage 4 assist
- they can walk without assistance but most likely need a cane or walker for safety
- assistance with adls and unable to live alone
stage 5 assist
- may be bedridden or confined to a wheelchair
what is neurogenic orthostatic hypotension?
- 20-30 mmhg drop in bp when moving from dependent position to a position of higher gravity
example: supine to sit or sitting to standing
how is NOH happening in patients with pd?
- damage in brain cause by pd results in nervous system not being able to make norepinephrine. this causes dizziness or lightheadedness
- can occur in any position but most obvious when moving to a position of gravity
what is norepinephrine?
chemical that constricts blood vessels and raises bp
how can NOH present?
common symptom in mid and late stages of pd
presents as
- lighthead
-dizzy
- weakness
how to manage NOH?
- reducing or eliminating medications like anti hypertensives
- drink more fluids
- sleep with head elevated between 10 and 30 degrees
hallucinations and delusions in people with pd
hallucination : false perception
- visual hallucinations are common in people with pd like vivid colour and happens at night
delusion : fixed conviction that something is real when it is not
- some delusions may be dominated by suspiciousness, fear and concern about safety
slight, mild, mod, and severe halluc/delu
slight:
- illusions with no form like a movement in the shadows
- person recognizes it is not real
mild:
- formed hallucinations, sees child or animal, looks real, but person knows its not real
mod:
- formed hallu, like person
- loss of insight, and person thinks hallu is real
severe:
- negative
- or positive
what is catatonia?
complex neuropsychiatric syndrome characterized by range of motor, speech, and behavioural abnormalities
can be subtle, or acture, come and go or change during episodes
includes:
- stupor
- catalepsy
- staring
-mutism
-negativism
- agitation
these are not affected by external stimuli, withdrawal from human contact and refusal to eat, stereotypy (repeating meaningless phrases
what can you use for a neuro patient as a outcome measure?
- 2 min walk test
- 6 min walk test
-10 metre walk distance
the 4 stage balance test…
- stand with your feet side by side
- place the instep of one foot so it is touching the big toe of the other foot
- tandem stand: place on foot infront of the other, heel touching toe
- stand on one foot
what are the repetitive sit to stand tests?
- 5 times sit to stand
- 30 second chair test
what is the single leg stance test?
- pt is required to stand on one leg motionless as long as possible for 30 seconds
- test is performed with or without vision
- shoes or no shoes
