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Parkinson’s Disease
| Question | Answer |
|---|---|
| Cardinal signs of PD? | Tremor Rigidity Akinesia Postural Instability |
| Subtypes of PD? | Tremor Dominant Non-Tremor Dominant |
| Name some motor symptoms of PD | Gross: Balance instability, gait impairments, reduced arm swing, physical fatigue Fine: tremor, micrographia, dexterity loss Head/ neck: hypophonia, speech intelligibility, masked face |
| Non motor symptoms of PD | Depression, anxiety, apathy, RBD, cognitive impairments (attention, set shifting, executive functioning,etc), pain, fatigue |
| What is the average life expectancy of PD? | 13 years |
| What is the etiology of PD? | Degeneration of dopaminergic neurons *30-60% are lost before motor sx show |
| What is the gold standard for PD diagnosis? | Post Morten autopsy: presence of substantia nigra degeneration with Lewy pathology |
| What is the average age of onset for PD? | 60-70 years old. (4% <50 yo, 40% <60 yo) |
| True or false. Older age of onset of PD is associated with more severe motor and non- motor sx? | TRUE |
| True or false. PD is more common in women. | FALSE. Men > women (3:2) |
| What are some + prognostic indicators of PD? | Younger age, tremor dominant, women, Hispanic or Asian American |
| What are some - prognostic indicators of PD? | Older age at onset, African American, non-tremor dominant, cog impairment, dementia/depression/psychosis |
| True or false. Genetics play a role in ~90% of people with PD. | FALSE. In ~ 10% |
| At what stage on the Hoehn and Yahr scale is “unilateral and axial involvement”. | 1.5 |
| At what stage on the Hoehn and Yahr scale is “unilateral involvement only” | 1.0 |
| At what stage on the Hoehn and Yahr scale is “wheelchair bound or bedridden unless aided”? | 5.0 |
| At what stage on the Hoehn and Yahr scale is “mild bilateral disease but with recovery on the pull test”? | 2.5 |
| At what stage on the Hoehn and Yahr scale is “severe disability but still able to walk or stand unassisted”? | 4.0 |
| At what stage on the Hoehn and Yahr scale is “bilateral involvement without impairments in balance”? | 2.0 |
| At what stage on the Hoehn and Yahr scale is “mild to mod bilateral disease with some postural instability but still physically independent”? | 3.0 |
| What sensory loss can precede PD diagnosis by 10-20 years? | Olfactory loss |
| This is an Atypical Parkinsonism that presents with B symmetric tremor, with large, irregular handwriting rather then micrographia. Tremor is 8-12 Hz. | Essential Tremor |
| This is an Atypical Parkinsonism that most commonly causes bradykinesia and cogwheel rigidity. Caused by drugs that influence dopamine levels. | Drug-induced secondary Parkinsonism |
| This is an Atypical Parkinsonism that presents with akinetic- rigid type PD with symmetric axial onset, impaired vertical gaze, and early freezing/falling with dysphasia and dysarthria. More rapid progression than PD (6-10 years) | PSP |
| This is an Atypical Parkinsonism that presents with symmetrical onset, orthostatic hypotension, bladder/ erectile dysfunction, dysmetria, dysarthria. More rapid progression and does not respond to dopaminergic meds. Shy- Drager Syndrome is most common. | Multiple System Atrophy (MSA)- multiple brain areas atrophy, mostly impacting the autonomic nervous system. Usually diagnosed in the 50s |
| This is an Atypical Parkinsonism that presents with dementia after 1 year of motor symptoms. Has akinetic rigid PD symptoms. Causes intellectual and functional decline. Anti PD meds can lead to increased confusion. | Dementia with Lewy Bodies (DLB) |
| This is an Atypical Parkinsonism that is also known as “lower body PD”. It results in shuffling gait, retropulsion, backward LOB. Due to lacunar strokes or large basal ganglia strokes. PD meds may or may not help. | Vascular Parkinsonism |
| This is an Atypical Parkinsonism that presents with Parkinsonian gait disorders, urinary incontinence, and dementia. Treated usually with a VP Shunt. | Normal Pressure Hydrocephalus |
| This is an Atypical Parkinsonism that is the least common. It presents with asymmetric onset with rigidity and dystopia of the involved arm. Apraxia, sensory loss, reflex myoclonus in affected limb. | Corticobasilar Degeneration (CBD) |
| What are some dopamine replacement options? | Levodopa, L-dopa, Sinemet, Parcopa |
| True or false. Levodopa works better in late stage PD? | FALSE. Works well at controlled sx in early PD but in later stages it requires Increase the dosage which comes with increased side effects |
| What type of drugs are frequently the first drugs tried? | Dopamine agonists. |
| This drug is usually given early on and improves the metabolism of dopamine. | MAO-Is |
| This drug is used independently to treat tremor, rigidity, bradykinesia or in combo with Levodopa to slow medication 1/2 life | MAO-B inhibitors (ie selegiline, rasagiline) |
| This drug is usually used in combo with Levodopa to treat motor fluctuations, improves crossing of dopamine through BBB | COMT inhibitors |
| This drug is used in combo with Levodopa to decrease motor fluctuations and dyskinesia | Amantadine (Symmetrel) |
| This drug is used to treat tremor. | Anticholinergics |
| Which PD drug is contraindicated in the elderly due to cognitive side effects? | Anticholinergics |
| True or false. With long term use of dopaminergic medications, a patient may experience a decrease in function and other problems such as choreiform movements, increased involuntary movements, and dyskinesia. | TRUE |
| TRUE OR FALSE. If a high carb meal is eaten with Levodopa, pts may have less absorption into the blood stream | FALSE. High protein meal because Levodopa is absorbed by the same receptors in your gut as protein. If meds aren’t kicking in, ask them what they are last night |
| True or false. Deep brain stimulation is used for all patients with PD. | False, only those pts with good response to medications (people with on/ off fluctuations). Improves sx to the best ON but not better than that. |
| What are some PT precautions after DBS surgery? | Avoid neck manipulation, massage/ direct contact with implanted wires/ pulse generator, high impact activities, no diathermy or total body MRI, ultrasound > 6” from wires |
| Where are PD pts most likely at risk for contractures? | Hip adductors, hip flexors, knee flexors, ankle PFs |
| What is Camptocormia? | Average 60 degree forward bend in thoracolumbar spine (up to 90 degrees) |
| What are some autonomic nervous system impairments related to PD? | Dysautonomia (excessive sweating, temp variations), GI dysfunction, urinary bladder incontinence, constipation |
| What are some cardiopulmonary impairments related to PD? | Decreased CV response to exercise, OH, low resting BP, respiratory impairments in 84% of PD |
| Define the different types of attention. | Focused: specific stimuli; Sustained: attending to a continuous stimuli; Selective: avoiding distractions, inhibiting irrelevant stim; Alternatkng: set shifting, back and forth between 2; Divided: multitasking |
| This PD impairment involves reduced interest and motivation in goal directed behaviors, indifference and flattened affect | Apathy |
| This PD impairment is the single most disabling symptom in 1/3 of people with PD. It has to do with impairments in the frontal-subcritical connections and serotonin. | Fatigue 1. peripheral (muscular fatigue) 2. central (general fatigue) |
| What considerations about training environments is important for PD? | Test setting and practice setting should align |
| What are some motor learning considerations for pts with PD? | - practice practice practice (intact acquisition but impaired retention) - context dependent challenges to improve carry over or retention |
| When cueing pts with PD what is better early on vs later? | Early on: less cues, fading frequency Later stages: motor learning is cue dependent; pts with PD may rely on sensorimotor networks to complete tasks |
| True or false. Random practice for PD is worse during the acquisition phase but shows better retention | TRUE |
| At what stage on the Hoehn and Yahr scale due to want to introduce compensatory strategies into PT Treatments? | Stage 4 |
| At what stage of the Hoehn and Yahr scale does PT intervention focus on health promotion, maintenance, education and mvmt strategies? | Stage 1 |
| TRUE OR FALSE. With PD, exercises selection should be task specific but NOT highly repetitive. | FALSE. Should be highly repetitive. Make them salient, enjoyable and targeting deficits as well. |
| This is an exercise precaution in PD after 45-60 min of taking medications that can put someone in a dangerous HR range for exercise | Peak Dose Tachycardia |
| True or false. There is good evidence for Progressive Resistance Exercises in PD. | TRUE. Gym machines, weighted vests, ankle weights. (2x/wk for 8 weeks) - start 1 set of 8-10 reps at 60% 1RM and progress to 3 sets of 8-10 reps to fatigue |
| What is considered normal for the Tragus to Wall Assessment? | <15 cm |
| True or false. Treadmill training vs. Virtual Reality + treadmill training had lower incidence of falls than treadmill alone. | FALSE. Projection of real life challengers (obstacles, multiple pathway, distractions) required continual adjustments of steps = more context dependent = better |
| What is FOG and when does it mostly occur? | FOG is the absence of forward progression despite the intent to walk. It occurs with initiation of movement (turning, obstacle, etc), narrow spaces/ doorways/ crowds/ elevators, stressed/ rushed |
| What 3 things make use the Fall Risk Clinical Prediction Rule for PD? | 1. H/o fall in the past year 2. FOG in the last month 3. Gait speed <1.1 m/s |
| What is Acute Akinesia? | Sudden deterioration in motor performance that persists for >/= 48 hrs despite tx due to bodily stress - infection (UTI, URI, pneumonia) - post op (elective or emergent surgeries) - fracture/ pain |
| What’s the treatment for acute akinesia? | - Medication management - mobility training with compensatory techniques - “wait and see” possible SNF placement for bone healing until safe to go home |
| The MDS- UPDRS scores range from ...? | 0-264 with higher scores = more severe PD |
| What are the differences between the MDS-UPDRS parts? | Part 1: non- motor; depression, sleep, constipation Part 2: motor experiences of daily living; speech, tremor, balance, walking, freezing Part 3: motor exam; rigidity, finger tapping, posture, bradykinesia |
| TRUE OR FALSE. In the FOG questionnaire, higher score = better. | False. Higher scores = more severe. 0-24 |
| What are some outcome measures for Apathy in PD? | - Starkstein Apathy Scale (0-42, higher scores = less apathy) - Lille Apathy Rating Scale - WHO-5 (higher scores = poorer wellbeing) |
| What outcome measure can be used for PD specific fatigue? | Parkinson’s Fatigue Scale (lower scores= more fatigue) -16 items based on previous 2 wks - scores: 16-80 |
Created by:
aaussems
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