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585-17
Parkinson's Disease
| Term | Definition |
|---|---|
| Parkinson's Disease | Neurodegenerative Gradual onset more common 2nd most common disease Disease of extrapyramidal tract |
| PD statistics | 1% More common over age 60 5-10% diagnosed under 40 years Similar rates around the world Males affected more often |
| primary parkinsonism | No known cause |
| secondary parkinsonism (acquired) | Drug induced- antipsychotics Env toxins- pesticide Post head traumas Vascular- multi-infarcts, arteriosclerosis Infections- brain inflamm Genetics |
| pathology of Parkinson's | Disease of extrapyramidal tract Less dopamine producing cells in substania nigra in people w/ PD Imbalance in motor systems Proteins bind to damage cells & make Lewy bodies |
| deficiency in dopamine causes | Tremor Rigidity Bradykinesia Postural instability |
| diagnosis based on | Clinical symptoms/ presentation Responsiveness to medications Functional imaging (PET & SPECT) |
| prognosis of PD | Average 10 years but depends on age of onset (under 70yo when diagnosed may live less) Depends on symptoms and dopamine loss |
| side effects of drugs depends on | Long term effects of levadopa in younger people Older people may develop autonomic disturbance, cog changes, dementia |
| tremor | Resting tremor presented as pill rolling tremor & asymmetrical Starts unilaterally, decreases w/ activity, increases w/ stress LE tremor is rhythmic & slow while moving around Very common symptom |
| rigidity | Impedes voluntary action resulting in slow, effortful mvmnts In flexor muscles of neck/ trunk/ limbs Freezing- unable to start next movement On/off phenomenon Muscle pain, cramps, stiffness |
| lead pipe vs. cogwheel | Increased resistance to passive movement vs. Less common. Intermittent resistance to passive movement |
| bradykinesia | Slowness of mvmnt & diff in initiating of voluntary mvmnt Mask like expression, slow/ quiet/ monotone voice Swallowing diff Sweating & bladder control Micro-graphia- slower writing Gait- slow shuffle |
| postural instability | Difficulty initiating mvmt Freezing & festering gait Feel unsteady, limp, stoop Falls easily Trouble w/ trunk control & rotation |
| other symptoms | Fatigue Non-specific limb pain Restlessness Mental slowness -> dementia (15-20%) of people Depression |
| other problems | Med side effects Confusion Continence Communication Sexual function/ relationships Sleep disturbances Stress Mood changes |
| stage 1/ mild PD | Unilateral symptoms Resting tremor Change in posture, slowed locomotion, facial expression affected No to minimal functional implications |
| stage 2 PD | Midline or bilateral symptoms No balance difficulties Mild problems w/ trunk mobility & postural reflexes Perfect time to manage w/ drugs Encourage exercise |
| stage 3/ moderate PD | Postural instability Medication wearing off Dyskinesias (involuntary writhing) People may experience mild to moderate functional disability |
| stage 4/ advanced PD | Increasing postural instability, able to walk Decreased fine motor control Tremor might decrease Gait aids may be offered Moderate to severe impairment |
| stage 5/ severe PD | Unable to ambulate Motor fluctuations, sensitive to complications (meds, continence, autonomic dysfunction) Cognitive impairment 24h care |
| PD tx | Medication management Surgical options Rehab Symptomatic tx |
| levadopa | Converts to dopamine in brain at post-synaptic receptor site Most common, first line of med management Improves bradykinesia & rigidity |
| side effects of levadopa | Decreased BP Light headed On/ off effect Insomnia Nausea/ vomiting Depression associated w/ long term use, dyskinesia |
| sinemet | 2nd most common Combines tx of carbidopa & levodopa Reduces daily dosage required & has less side effects than just levodopa Possibly less wearing off effect |
| dopamine agonists | Act on dopamine receptor sites, reduces freezing Allows more dopamine to remain in the system, so symptoms aren't as prevalent May experience hallucination, psychosis |
| selegiline vs. amantidine | Increases dopamine by inhibiting MAO Reduces the uptake of dopamine of MAO vs. Antiviral drug that helps rigidity |
| deep brain stimulation | Based on eligibility Electrode planted deep in the brain Connection to device under collarbone, develops electrical stim to basal ganglia Helps control the symptoms Reversed non-surgically |
| stage 3 rehab focus | Mobility Transfers Balance Safety |
| stage 4 rehab focus | ADLs Productivity Leisure Fine motor coordination/ dexterity |
| stage 4-5 rehab focus | Swallowing Communication Cognition |
| depression | Can occur in any stage Change in function usually contributes to depression |
| physiotherapy focus | Gait and balance Coordination of movements |
| LSVT BIG | Based on neuroplasticity Forced use of bigger & faster mvmts to reduce stuckness in small mvmts Intense practice Repetition Complexity/ challenge Feedback/ motivation Gold standard |
| SLP focus | Communication Swallowing SPEAK OUT program Outpatient dysphagia clinic |
| LSVT Loud | Focus on effort, recalibration, intensity, simplification Need to go to clinic 4x/week + daily practice Home companion software |
| what OT approach should we do | Rehab- if can relearn skills Compensatory- when they are no longer able to have capacity |
| physical symptoms | Tremor, rigidity, bradykinesia, postural instability, lack of postural reflexes Fine and gross motor coordination, balance |
| impaired cognition | Information processing Concentration Distraction Problem solving Memory Change from one idea to another |
| impaired psych states | Adjustment Depression Motivation Anxiety Hallucinations |
| OT intervention | Edu- energy conservation & sleep hygiene AT Cog strategies Hand function Env adapt Seating/ wc Driving |
Created by:
craftycats_
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