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N Parkinsons

lecture notes

life expectancy of Parkinsons pt around 30 years so not very different from non-Parkinsons
causes of Parkinsons dx usually idiopathic. occasionally-encphalitis, alcohol abuse, ext exposure to toxins, TBI, vascular insults, phychotorphic drugs
Parkinsons pathology dopamine producing cells die (regulates posture & mvmt) 70-80% of neurons that produce dopamine are damaged & replaced w/lewy bodies before onset of symptoms-contain neurophilaments & hyaline
4 cardinal signs of Parkinsons rigidity, bradykinesia, tremor, postural instability
Parkinsons rigidity resist to passive mvmt, speed doesnt matter), leadpipe(constant resist), cogwheel (let go then catch) leads to fatigue
Parkinsons bradykinesia akinesa(trouble starting mvmt), hypokinesia (decrease speed, ROM), freezing
Parkinsons freezing circumstances break in pattern, trying to go thru door, negotiat an obstacle, turn almost to bed or chair, multitask
Parkinsons managing strategies for freezing step over line on floor, rhythm, music, sing to self, 4 step strategy (1 stop, 2 put wt on heels, 3 lat wt shift 4 think abt taking BIG step)
Parkinsons tremor resting/pill rolling (1st symptom initially seen unilaterally, progresses to all 4 limbs)
Parkinsons postural instability/balance loss of auotmatic postural adjustments, delay, decrease, loss of equilibrium rx (inner ear), they are fall risk
Parkinsons posture fwd head, lose trunk ext, increase kyphosis, more shd ADD & IR, hip & knee flex contracture, ankle plantarflex (walk on toes), later bedridden w/elbow, wrist & hand contractures
Parkinsons gait loss of reciprocal arm mvmt & trunk rotation, slow, small shuffling steps (balls of feet), festinating gait (chase COG), may freeze, will start to have bed mob probs
Parkinsons rest of clinical pic masked face, dysphagia, drooling, voice changes (quiet, slur), dementia in 1/2, decrease attn &concentration, depression, micrographia, pn, slow processing of info, fatigue, decond, decrease chest mob, contractures
Parkinsons dx 2 out of 4 cardinal signs, no major test
Parkinsons meds 1ST-selegiline, then sinemet. sinemet main one, only works 5-7 yrs, comb levadopa (Ldopa) & carbidopa, has kind of on/off cycle if used a long time, off periods have dykenesia & psychotic episodes
Parkinsons prognosis gradual decline-death from pneumonia or infection (from being bedridden)
Parkinsons sx pallidotmy-remove or disconnect globus pallidous. deep brain stimulator-decrease symptoms (stimulates brain kind of like dopamine)
Parkinsons progression- early at home, Ind w/ADL, start to have difficulties, may be seen in OP or given HEP, work on fall prevention, educate on energy conservation
Parkinsons progession- moderate decrease in functional mob, may start to use AD or WC, not out in community as much, decrease bed mob & trsfs, increase assist from caregivers, increase adaptation for compensatory strategies & equip, increase falls & injuries, more energy conservation
Parkinsons types of mvmts big mvmt, encourage ext, trunk & extremity rot, wt shift, rocking, reciprocal mvmt
Parkinsons motor learning strategies help them understand what they need to be working on, mentally rehearse, parts to whole, rhythmic initiation, rhythmic rotation, start proximal
Created by: jessigirrl4



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