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3/3 PD: Etc
Extra stuff from PD case - Tremor descriptions & Home safety eval
| Question | Answer |
|---|---|
| Describe a resting tremor. | Slow & coarse tremor at rest. Voluntary movement reduces tremor. |
| What causes a resting tremor? | May be c/b basal ganglia disturbances. Common causes inc. PD, Wilson’s, heavy metal poisoning, & certain drugs (lithium & some anti-psychotics). |
| Where does a resting tremor normally occur? | Affects arms more than legs & can interfere with fine motor activities. Occurs in a body part which is not voluntarily activated & is fully supported by gravity. |
| How is resting tremor diagnosed? | Complete neuro exam looking specifically for Parkinsonism. |
| Describe an intentional tremor. | Slow, broad tremor that occurs when attempting voluntary, fine mvmts. Occurs towards the end of a purposeful mvmt. Absent at rest & during first phase of voluntary mvmt. |
| What causes an intentional tremor. | C/b cerebellar damage which can be d/t MS, stroke, Wilson’s disease, alcoholism, or overuse of sedatives or anticonvulsants. |
| How is an intentional tremor diagnosed? | CT or MRI to check for brain damage, finger-to-nose test. |
| Describe a flapping tremor. | Coarse, slow, nonrhythmic. Occurs when arms are outstretched & hands are extended. The hand will drop d/t sudden loss of sustained muscular contraction & then return to its position suddenly d/t overcompensation by wrist extension muscles. |
| What causes a flapping tremor? | C/b liver, kidney, or metabolic disorders that result in brain damage. Mechanism = sudden, temporary lapse in muscle tone. |
| How is a flapping tremor diagnosed? | Blood tests to evaluate liver & kidney function. |
| Describe an isometric tremor. | Medium frequency & variable amplitude. Occurs upon muscle contraction against stationary objects: holding/squeezing/resisting. Rhythmic muscle contraction in legs & trunk that occurs immediately after standing but stops when seated. |
| Describe a psychogenic tremor. | Occurs at any age & is incredibly variable in presentation & course. Will go away if patient isn’t observed or after administration of a placebo. |
| How is a psychogenic tremor diagnosed? | Ask patient to keep a rhythm (different than the tremor’s rhythm) with an uninvolved body part & see if tremor miraculously starts matching the assigned rhythm. |
| What is a physiologic tremor? | A.k.a. enhanced tremor. Most easily seen by holding arms outstretched, fingers apart. Exaggeration of normal physical response such as fear, anxiety. |
| What causes a physiologic tremor? | Seen in hyperthyroid, hypercortisol, hypoglycemia, extreme physical exertion, alcohol/drug/caffeine withdrawal. Can be induced via IV injection of epinephrine or beta agonists. |
| How is a physiologic tremor diagnosed? | Blood tests from hyperthyroidism, hypercortisol, etc. |
| What is an orthostatic tremor? | A rare tremor where the pt shakes when standing still but it goes away upon walking. |
| What is a neuropathic tremor? | A rare tremor c/b demyelinating neuropathies. |
| What is a palatal tremor? | A rare tremor involving rhythmic, involuntary movements of the soft palate. |
| How do you treat a tremor? | Treat underlying disorder first (PD, etc. if present)& then: β-blockers (esp. propanolol), anti-convulsants (mysoline, primidone, etc.), mild tranquilizers. Avoid stimulants. If surgery is required: thalamotomy or deep brain stimulation. |
| Describe rigidity. | Increased tone present t/o ROM. Affects flexors & extensors equally. Can have cogwheel quality – periodic interruption of rigidity as joint is moved passively. Occurs w/ certain extrapyramidal disorders. Ex: PD. |
| Describe spasticity. | Velocity-dependent, with sudden release after a set maximum. Occurs in flexors of upper limb & extensors of lower limb (the antigravity muscle groups). D/t upper motor neuron disease. |
| What is an essential tremor? | Rapid, fine tremor. A.k.a. senile, tension, or familial. Usually starts early adulthood & slowly worsens w/ age sometimes=> disability. Some forms familial. MC tremor: affects 5-10 million Americans. Usually doesn't indicate disease or neuro condition. |
| Describe an essential tremor. | Usually begins symmetrically in arms (sometimes in dominant arm), f/b head “nodding” tremor, which disappears when head is supported. May also affect vocal cords=>shaky voice. Better at rest, worse when limb outstretched or in uncomfortable position. |
| How is an essential tremor diagnosed? | Ask about medications, anxiety, stress, family history. |
| PD falling stats: | Mostly forward falls. 70% of PD pts fall at least once/year. The risk of falling in PD is ~2x that of community-dwelling older people. |
| Why do PD pts fall so much? | Postural inflexibility (kyphotic position & loss of arm swing), proprioceptive disturbances, gait disorders, transfers, dual tasking. |
| Describe proprioceptive disturbances in PD. | Unable to process changes in peripheral input. Loss of normal sense of limb & trunk position. |
| Describe gait disturbances in PD. | Shuffling, freezing of gait (hard time starting mvmt). Festinating Gait: difficulty initiating walking, then gait possibly speeds up => difficulty stopping. |
| What are some tests to see if pt is at risk for falling? | Retropulsion test: rxn to sudden jolt to shoulders (2+ steps backward is abnormal). Fxnal reach test: reach fwd as far as possible w/ feet in place. Timed Up & Go test: pt gets up from chair, walks 10 ft & returns; based on time (>30 sec abnormal). |
| What can be done about falling? | Reduce # meds if possible (sedatives, etc), treat contributing medical conditions (Bone/muscle degeneration, vision problems, insomnia, etc.), Home Safety Evaluation. |
| What is a home safety evaluation? | Visit by home-health RN, PT or OT to ID a risky environment. Look for: Obstructed paths (throw rugs, extension cords, etc.), Lighting, (change bulbs from 60 to 100 watts, etc), Safety equipment (handrails in bathroom, “booster” on toilets, sofas, etc.) |
| What else does a Home Health OT assess with a PD pt? | Instrumental Activities of Daily Living (IADLs). Transportation, shopping, cooking, using phone, managing $, taking Rx, housecleaning, laundry. Social isolation & loneliness. Family stress. Nutrition problems. Financial concerns. Alcohol abuse. |
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