Clin/tech- 6 Parkinson's

Front 1

What is Parkinson's Disease?

Back 1

Most common basal ganglia motor disorders

Front 2

What are the 3 subtypes?

Back 2

-Akinetic/Rigid
-Tremor-Dominant
-Mixed

Front 3

What is Akinetic/Rigid Parkinson's Disease?
-Prevalence
-Characterized
-Interferes w/
-Difficulty
-Gait

Back 3

-Prevalance: apprx 50% of all cases
-Characterized: mm rigidity, shuffling, gait, dropping posture, rhythmic muscular tremors and mask-like facial expression
-Interferes w/ voluntary and automatic movements
-Difficulty sitting to standing
-Gait: flexes posture, shuffling of feet, decreased/absent arm swing

Front 4

What are the distinctive signs of Akinetic/Rigid Parkinson's?

Back 4

-Akinesia/hypokinesia
-Rigidity
-"Freezing" during movement
-Postural instability
-Resting tremor
-Nonmotor signs: depression, psychosis, Parkinson's dementia, autonomic dysfunction

Front 5

What are some characteristics of rigidity?

Back 5

-Increased resistance to movement in all mm
-Output from nervous sys causes active mm contraction, directly increasing resistance to movement
-Present during sleep

Front 6

What is Akinesia?

Back 6

-Absence of movement
-Opposite from hypokinesia described as decreased movement
-Parkinson's pts have less control over amt of force mm produce

Front 7

What is Hypokinesia?

Back 7

-Decreased AROM and lack of automatic movements (facial expression, normal arm swing during walking)
-Related to decreased ability to control force output of mm

Front 8

Parkinson's:

Back 8

-Prone to falls bc inability to generate adequate mm force quickly
-Postural corrections too slow to fix
-Pts may abruptly ceases (freezing gait)

Front 9

What are the stages of Ankinetic/Rigid Parkinson's Disease?

Back 9

Stage 1: Unilat signs and symp, typically mild tremor of 1 limb
Stage 2: Bilat signs, posture & gait affected, minimal disability
Stage 3: Moderately severe generalized dysfunction, significant slowing of body movements, early impairment of equilibrium on walking or standing
Stage 4: Severe signs, able to walk to limited extent, rigidity, bradykinesia (slowness of movement), unable to live alone
Stage 5: Extreme weight loss, cannot stand or walk, requires constant nursing care

Front 10

What are Visuoperceptive Impairments?

Back 10

-Pt difficulty moving past visual movement blocks EX. door way
-Markers placed on floor as cue to get to places
-Associated w/ abnormal processing in termporal lobe visual identification pathway

Front 11

What is postural Instability?

Back 11

-Extreme stiffness of postural flexors and extensors (severe orob)
-Clinical diag: hypokinesia affectign upper body combined w/ rigidity and/or resting tremor

Front 12

What are the hyperkinetic signs for Parkinson's?

Back 12

-Resting tremor: involuntary, rhythmic shaking movements by contractions of antagonism
-Resting tremor of hands: rhythmic movement like thumb rolling pill along fingertips while rest and diminishes during voluntary mvmt (freq 3-6 tremor/sec)
-May persist during sleep
-

Front 13

What are some disorders that Akinetic/Rigid Parkinson's associated w/ psychopathology?

Back 13

-Depression, psychosis (usually visual hallucinations), Parkinson's dementia, autonomic dysfunction (constipation, orthostatic hypotension) further decrease the person's independence

Front 14

What is dementia? What is the difference btwn Alzheimer's dementia and Parkinson's dementia?

Back 14

-Dementia: deterioration of intellectual function
-Alzeimer's: primarily affects memory
-Parkinson's: interferes with the ability to plan, to maintain goal orientation, and to make decisions.

Front 15

Tremor-dominant Parkinson's Disease:
Prevalence?
Most disabling feat?
Sign/Symp?

Back 15

-Prevalence: apprx 40% of all cases
-Most disabling feat: presence of both action (occur during voluntary movements EX. eating) and resting tremors
-Sign/Symp: rigidity slowing of movement mild, tremors primary factor interfering w/ ADL

Front 16

Mixed Parkinson's Disease:
Prevalence?
Described as?

Back 16

-Prevalence: 10% of all cases
-Combo of both akinetic/rigid and tremor-dominant

Front 17

What is the pathology of Parkinson's?

Back 17

-Death of dopamine-producing cells by oxidative stress, mitochondrial dysfunction and programmed cell death
-Cell death occurs long before clinical presentation of disease (80% of dopamine-producing cells die before signs of the disease appear)
-Loss of dopamine reduce activity in motor areas of cerebral cortex (decreases voluntary movements)

Front 18

Tx of Parkinson's?

Back 18

-Medications (L-dopa), invasive procedures, physical therapy and OT
-Dyskinesia (involuntary movement that resembles chorea – brisk, jerky movements), and/or dystonia (involuntary sustained postures or repetitive movements) even with L-dopa patient will experience bouts of normal mobility and bouts of immobility (ON-OFF PHENOMENON)
-Deep Brain Stimulation (DBS) to treat dykinesia, tremors and hypokinesia, used as adjunt to meds, require surgical implantation of stimulator and electodes (stim: inf to clavicle, electrodes: thalamus to treat tremors, Continuous high frequency electrical stimulation inhibits the firing of overactive thalamic neurons)

Front 19

DBS:

Back 19

-To treat dykinesia, tremors and hypokinesia
-Used as adjunt to meds
-Require surgical implantation of stimulator and electodes (stim: inf to clavicle, electrodes: thalamus to treat tremors)
-Continuous high frequency electrical stimulation inhibits the firing of overactive thalamic neurons)
-Bilat DBS improves speed of movement, rigidity, gait, postural stability and decreases L-dopa dosage
-Can only be used/administered to relatively healthy, young and cognitively intact pts

Front 20

Assessment of Parkinson's Pt?

Back 20

HH #:
-ADL’s
-Present symptoms and previous
-Any other interventions? Physiotherapy?
-The role they would like massage therapy to play?
OBS:
-Gait
-Posture
-Coordination of movements (gross and fine)
-Balance
-Facial expression
-Spasticity
OBJECTIVE:
-AROM of affected jts (how move thru ROM)
-PROM of affected jts
--Mild spasticity – allows for gross movements and fine coordination will be clumsy or unable to perform
--Moderate spasticity – allows for slow movements and abnormal coordination
--Severe spasticity – limited spastic movement and active movements are impossible

Front 21

Signs and Symp of Parkinson's Pt?

Back 21

-Often insidiously- slow movement, weakness and resting tremor
-Resting tremor affects distal segments of the limbs – mainly hands, feet, head, neck, face, lips and tongue/jaw
-Rhythmic, alternating flexion and contraction movements (4-6/minute)
-Usually unilateral at first and progresses to both sides of the body
-Difficulty initiating walking and difficulty turning
-Walking they lean forward to maintain center of gravity and take small steps without arm swing
-Postural changes and gait disturbances continue to become more pronounced

Front 22

MT Tx:

Back 22

-Contraindications: Deep & painful techniques may increase symptoms – start with lighter techniques & progress with depth of treatment
-Hydrotherapy: Deep moist heat work well (caution with the first application, testing sensation is important)
-Remex: PROM to affected jts and compensatory jts, Diaphragmatic breathing to maintain thoracic mobility
-Homecare: Relaxation exercises and diaphragmatic breathing, Appropriate hydrotherapy, Moderate and regular exercise program