Term
| PD = _____, ________ neurological disease |
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Definition
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Term
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Definition
bradykinesia/akinesia,
tremor,
rigidity,
postural instability |
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Term
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Definition
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Term
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Definition
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Term
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Definition
decr dopamine from substantia nigra;
degeneration of nigrostriatal fibers |
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Term
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Definition
substantia nigra,
caudate nucleus,
putamen,
globus pallidus,
subthalamus |
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Term
| Nuclei composing the striatum |
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Definition
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Term
| Input to basal ganglia from... |
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Definition
| cortex (mostly into putamen) |
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Term
| Output from basal ganglia to... |
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Definition
| portions of cortex involved in motor fxn |
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Term
| Portions of cortex involved in motor fxn: |
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Definition
| prefrontal, premotor/supplemental, motor cortices |
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Term
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Definition
| incr in neural activity before initiation of mvmt sequence |
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Term
| SMA involved with two things: |
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Definition
initiation of mvmt sequence;
termination of mvmt sequence |
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Term
| Functions attributed to basal ganglia |
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Definition
-initiation/regulation of gross intentional mvmt (c SMA)
-planning/execution of complex learned mvmt (c SMA)
-facilitating desired motor responses, inhibiting unwanted responses
-maintain normal background mm tone
-involved in motor learning |
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Term
| How does basal ganglia help to maintain normal background mm tone? |
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Definition
| inhibition of motor cortex & brainstem motor areas |
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Term
| Dysfunction of basal ganglia (motor) >> |
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Definition
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Term
| Hoehn & Yahr Staging (PD): 0 |
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Definition
| no visible symptoms of PD |
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Term
| Hoehn & Yahr Staging (PD): 1 |
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Definition
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Term
| Hoehn & Yahr Staging (PD): 1.5 |
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Definition
| unilateral plus axial involvement |
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Term
| Hoehn & Yahr Staging (PD): 2 |
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Definition
| symptoms bilaterally - NO difficulty walking |
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Term
| Hoehn & Yahr Staging (PD): 2.5 |
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Definition
| mild bilateral disease; recovery on pull test |
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Term
| Hoehn & Yahr Staging (PD): 3 |
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Definition
| symptoms bilaterally - minimal difficulty walking |
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Term
| Hoehn & Yahr Staging (PD): 4 |
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Definition
| symptoms bilaterally - moderate difficulty walking |
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Term
| Hoehn & Yahr Staging (PD): 5 |
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Definition
| symptoms bilaterally - unable to walk |
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Term
| Walking rating: normal stride |
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Definition
| heel of one foot clears toe of other foot |
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Term
| Walking rating: short stride |
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Definition
| heel of one foot does not clear toe of other foot |
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Term
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Definition
| stride gets progressively shorter |
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Term
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Definition
| stride shortens until person is stuck; can't move |
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Term
| "Short stride" = minimal or moderate difficulty with walking? |
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Definition
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Term
| "shuffle" or "freeze" = minimal or moderate difficulty with walking? |
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Definition
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Term
| taking extra steps in turning to right OR left = = minimal or moderate difficulty with turning? |
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Definition
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Term
| taking extra steps in turning to right AND left = = minimal or moderate difficulty with turning? |
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Definition
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Term
| Three aspects of rating PD postural stability/balance |
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Definition
stand c feet together,
turn to right,
turn to left
("Do you feel steady or unsteady?") |
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Term
| "Moderate" difficulty in stability testing |
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Definition
| unsteady on 2-3 of 3 postural stability tests |
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Term
| Clinical signs of PD: early (first 10 yr) |
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Definition
bradykinesia,
mild gait hypokinesia,
resting tremor,
micrographia,
decr speech volume |
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Term
| Clinical signs of PD: later |
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Definition
festination,
dyskinesias,
akinesia,
incr hypokinesia,
postural instability & falls |
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Term
| PD dysfunctions: usually unilateral OR bilateral? |
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Definition
| bilateral, but more pronounced on one side |
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Term
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Definition
| active mvmt, sleep, complete relaxation |
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Term
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Definition
| emotional stress, fatigue |
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Term
| First symptom reported in PD: |
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Definition
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Term
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Definition
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Term
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Definition
| stress, anxiety, postural stress (e.g. standing) |
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Term
| Neural component of rigidity DOES/DOES NOT appear to affect volitional mvmt |
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Definition
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Term
| Deficits associated c akinesia |
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Definition
bradykinesia,
hypokinesia,
delayed initiation of mvmt,
"freezing",
loss of spontaneous mvmt |
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Term
| Motor control deficits assoc c PD (4) |
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Definition
decr in rxn/mvmt time,
problems executing sequential mvmt,
execution of simultaneous mvmt,
dyskinesias assoc c prolonged use of L-dopa |
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Term
| Why PD pts have problems executing sequential mvmt (3) |
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Definition
individual sequences are slower AND mvmt is hypokinetic (undershoots),
each successive sequence gets slower/more hypokinetic |
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Term
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Definition
| mvmts of normal amplitude decr c repetition |
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Term
| Underlying mechanism behind micrographia |
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Definition
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Term
| SMA fails to terminate mvmt sequence 2º to decr input from... |
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Definition
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Term
| Motor performance deficits assoc c PD |
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Definition
Gait deficits,
balance problems |
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Term
| Causes of gait deficits in PD |
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Definition
bradykinesia,
inability to initiate gait,
pattern of gait,
step length : ground clearance ratio |
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Term
| Typical pattern of gait in PD pts (5) |
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Definition
short, shuffling, uneven steps;
fixed flexed posture;
decr UE mvmt;
freezing;
festinating gait |
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Term
| Potential causes of balance problems in PD pts (6) |
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Definition
decr output from BG to brainstem nuclei for stance/balance,
slow rxn times,
defective utilization of sensory info,
shortening of mm,
deficient preparatory postural adjustments,
decr mm torque (hypokinesia) |
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Term
| Normal rxn to "pull test" |
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Definition
| ankle DF, raise arms >> hip/step strategy |
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Term
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Definition
take small, quick steps backward OR
fall rigidly backward |
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Term
| Mvmt patterns are determined by (3) |
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Definition
strength/flexibility of musculoskeletal system,
goal of the task,
environmental context |
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Term
| Deficits that may actually be ADAPTIVE changes (rather than primary deficits) in PD pts (3) |
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Definition
bradykinesia (improve accuracy of impaired limb),
freezing (adaptation to avoid balance challenges),
rigidity (adaptation to avoid balance challenges) |
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Term
| Cause of cardiopulmonary problems in PD pts |
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Definition
| bradykinesia of respiratory motor fxn (as well as decr thoracocostal motion 2º to rigidity/posture) |
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Term
| Major complication and cause of death for many PD pts |
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Definition
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Term
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Definition
Levadopa,
Carbidopa,
Sinemet |
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Term
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Definition
decr bradykinesia & rigidity (not tremor),
precursor to dopamine,
crosses blood-brain barrier (99% metabolized >> side effects) |
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Term
| Timeframe of effectiveness for L-dopa |
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Definition
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Term
| Dyskinesias 2º to L-dopa "end of dose deterioration" (4) |
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Definition
chorea,
athetosis,
tics,
dystonias |
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Term
| Dyskinesias 2º to L-dopa use MORE/LESS likely to occur in younger patients |
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Definition
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Term
| "On and off phenomena" (re: L-dopa use) |
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Definition
| sudden episodes of immobility & dyskinesias |
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Term
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Definition
| modified release preparation (L-dopa) |
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Term
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Definition
dopamine agonists,
anticholinergics,
stereotactic sx,
deep brain stim of thalamus (VIN)transplantaion of fetal cells or adrenal medulla cells |
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Term
| Example of dopamine agonist |
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Definition
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Term
| Benefit/drawback of dopamine agonist v. levadopa |
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Definition
+ decrease symptoms c reduced risk of motor complications
- less efficacious than levadopa |
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Term
| Mechanism behind benefit of anticholinergics in PD pt |
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Definition
lack of dopamine >> relative overabundance of ACh;
anticholinergic inhibits ACh activity >> decr tremor |
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Term
| Types of stereotactic sx (2) |
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Definition
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Term
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Definition
| pearl-sized heat lesion to correct abnormally neural activity in globus pallidus |
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Term
| pallidotomy alleviates... |
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Definition
| akinetic & hyperkinetic symptoms (dyskinesia, bradykinesia & rigidity; perhaps tremor) |
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Term
| thalamotomy alleviates... |
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Definition
| tremor (no effect on bradykinesia/akinesia) |
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Term
| deep brain stim of VIN >> |
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Definition
| reduced tremor (both PD/resting and essential) |
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Term
| deep brain stim of globus pallidus >> |
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Definition
| reduction in akinetic symptoms |
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Term
| deep brain stim of subthalamic nucleus >> |
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Definition
| reduced tremor, rigidity, bradykinesia, & postural instability |
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Term
| Adverse rxns of deep brain stim(6) |
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Definition
paresthesias in head & hands,
depression,
paresis,
dysarthria (slurred speech),
loss of balance,
impaired mm tone (dystonia) |
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Term
| Historically, 1º approach to PD Rx: |
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Definition
| incr mvmt by decr rigidity |
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Term
| Historical Rx methods for PD (4) |
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Definition
rhythmic rotation/relaxation (PNF),
bilat symmetrical & reciprocal mvmt (PNF),
rhythmic/auditory cues to stimulate mvmt,
facilitation of normal mvmt patterns (NDT) |
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Term
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Definition
PT >> improvement in ADLs, stride length, walking speed,
but not neurological signs |
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Term
| First step of determining PT intervention for PD |
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Definition
| determine stage of progression of PD |
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Term
| Appropriate Rx for PD pt in EARLY stage |
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Definition
educate on prevention of sequelae of inactivity/minimization of deconditioning effects,
work on problem-solving fxnl difficulties (e.g. rolling in bed under blankets) |
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Term
| Appropriate Rx for PD pt in LATER stages |
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Definition
time Rx to be in "middle hour" of meds dosages;
preserve whatever independence possible,
compensatory strategies,
educate caregivers (mobility skills, positioning skills) |
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Term
| Sequelae of inactivity (PD pts) |
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Definition
decr fxnl abilities,
decr sense of well being,
decr cardiovascular/general health,
decr flexibility (esp trunk) |
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Term
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Definition
appear in PD pts' nervous systems,
coincide c cognitive deficits |
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Term
| Areas to consider in PD Rx |
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Definition
Traditional approach (relaxation before other Rx),
flexibility ex (esp trunk flex),
mobility training (e.g. STS),
augmented feedback (incr use as disease progresses),
strength training,
balance activities,
gait training,
group/home ex,
fxnl adaptations (where required),
UE dexterity "homework",
aerobic conditioning,
pt/family ed |
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Term
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Definition
Slow rocking/rotational ex,
rhythmic initiation |
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Term
| Examples of slow rocking/rotational exercises |
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Definition
slow side-to-side head rotations in supine,
hooklying lower trunk rotations,
sidelying upper/lower trunk rotations,
sidelying trunk rotations c scapular patterns |
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Term
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Definition
passive positioning for prolonged stretches,
stretch calves/hip flexors on stairs,
slant board stretches |
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Term
| Sit to stand training: pt demonstrating hypokinesia |
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Definition
teach person to use mental rehearsal of mvmt before initiating sequence,
use verbal cues to self |
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Term
| Sit to stand traning: pt demonstrating akinesia |
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Definition
use proprioceptive cues (rock fwd/bkwd before mvmt),
use verbal cues to self |
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Term
| Major problems for PD pts turning over/getting out of bed |
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Definition
complexity of task,
it's done at night (L-dopa levels low, no visual cues in dark) |
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Term
| Suggestions for PD pts having issues with rolling in/rising from bed |
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Definition
slow-acting levodopa meds,
night light,
lightweight quilt & silk sheets/nightwear,
mental rehearsal before getting up,
conscious attending to each subtask,
consider bed height,
commode near bed |
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Term
| Subtasks of rolling in/rising from bed |
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Definition
throw back covers,
shift pelvis toward center of bed,
turn head,
bring arm across body to roll,
swing legs over edge,
push up,
adj posture to sit upright |
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Term
| If pt has fallen, find out... |
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Definition
WHEN they fell,
WHAT they were doing when they fell |
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Term
| Possible causes for PD pt falls |
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Definition
mvmt disorders 2º to PD,
cognitive impairment,
multitasking,
environmental factors,
meds,
factors outside PD |
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Term
| Balance activities for PD pts: |
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Definition
wt shifting,
reaching for objects in challenging ranges,
mvmt transitions (STS, floor to chair, etc),
perturbations (swiss ball, balance boards),
grids on floor,
obstacle courses that challenge balance,
darken room/close eyes, busy/noisy environments... |
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Term
| PRIMARY problems with gait in PD pts: |
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Definition
| bradykinesia, hypokinesia |
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Term
| Rx approach/strategy for hypokinesia |
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Definition
cueing (visual, auditory),
attentional strategy (self-cueing, "big step") |
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Term
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Definition
| standing stretches of PFs to decr tone |
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Term
| COMMON problems with gait in PD pts: |
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Definition
bradykinesia/hypokinesia,
dystonic PFs,
dual-tasking,
turning around |
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Term
| Normal 360º turn = ____ steps |
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Definition
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Term
| Strategies for PD pt for turning |
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Definition
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Term
| Functional adaptations for PD pt |
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Definition
firm mattress (bed mobility)
satin sheets/PJs (bed mobility)
firm chair c armrests
leather/hard soles (shuffling gait)
toe wedge/lowered heel (festinating gait) |
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Term
| Aerobic conditioning for PD pt |
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Definition
submax intensities 3-5 days/wk,
type of activity depends on what pt will or can do,
do NOT push to extremes (risk of early fatigue) |
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Term
| Elements of PD pt & family ed |
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Definition
effects of immobility & deconditioning,
problem solving training,
positioning to reduce contractures/skin breakdown,
transfers while allowing for independence,
community support groups |
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