Term
| What are the four cardinal signs of PD? |
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Definition
| 1. Rhythmical resting tremor. 2. Cogwheel rigidity. 3. Difficulty initiating movement/poverty of spontaneous movement (akinesia). 4. Bradykinesia (slowness of movement) |
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Term
| What is the rate of the typical PD resting tremor? How is it measured? |
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Definition
| 4Hz. Measured w/ EMG - can't tell the rate without EMG. |
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Term
| There is no clinical test for PD, but there is one cardinal sign that is so characterisitic of the disease it's often used as diagnostic criteria. What is it? |
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Definition
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Term
| what is cogwheel rigidity? |
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Definition
| Cocontractions on both sides of the joint that make the joint move in a jerky motion when performing PROM. |
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Term
| What kinds of things induce akinesia? |
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Definition
| when things change, like the color of the floor or going around a corner or through a doorway. |
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Term
| What is the typical age of onset for PD? |
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Definition
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Term
| What races are most affected by PD? |
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Definition
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Term
| There are several theories as to the cause of PD. What are they? (4) |
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Definition
| 1. Idiopathic. 2. Infectious parkinsonism. 3. Toxic parkinsonism. 4. Pharmacologic. |
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Term
| describe infectious parkinsonism |
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Definition
| Infectious pathogen infects the substantia nigra |
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Term
| What is toxic parkinsonism? |
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Definition
| Some environmental substances are associated w/ PD ie: CO and cyonide. |
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Term
| What evidence supports the theory toxic parkinsonism? |
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Definition
| There are some islands w/ large populations of parkinsons pts, and it is thought there's something environmental that results in the development of PD. |
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Term
| What are the two pharmacologic causes of PD? |
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Definition
| Narcoleptics/traquilizers and MPTP. |
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Term
| Describe the PD that results from use of some neuroleptics and tranquilizers. |
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Definition
| These drugs sometimes induce parkinsons like symptoms, but usually stop if the drug therapy is discontinued. = Reversible parkinsonism. |
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Term
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Definition
| It's a heroin derivative that causes irreversable PD. It's used experimentally in animals to study PD. |
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Term
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Definition
| In the 70's young ppl in SF began developing PD. The kids were heroin users who were manufacturing the drug. |
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Term
| What is the pathology of PD? |
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Definition
| Loss of Dopamine from substantia nigra. |
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Term
| What is 6 Hydroxydopamine? |
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Definition
| A drug that causes parkinsons-like syndrome |
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Term
| What is the clinical picture of PD? (7) |
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Definition
| Slowness of movement, tremor, stooped posture, proximal instability, rigidity, festinating gait (later on), dead pan face. |
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Term
| What does festinating gait look like? |
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Definition
| Pt has stooped posture w/ hip and knee flexion and it looks like their trunk is falling forward and they're running to catch up with their body to get BOS under COG. Very rapid, small, shuffling steps. |
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Term
| What are the initial complaints from the pt? (3) |
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Definition
| They are general complaints, and although tremor is usually an initial sign it's not often an initial complaint. 1. Aching back, neck, shoulders or hips. 2. Fatigue. 3. Slight stiffness/slowness. |
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Term
| What are the facial changes? (2) |
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Definition
| decreased blinking rate, widening of palpebral fissures creating a stare. |
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Term
| What does the PD pts postural tone look like? |
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Definition
| The person makes fewer and smaller shifts and adjustments; their sitting is very rigid. |
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Term
| Can pts be trained to increase their speed of movement? |
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Definition
| Yes, but it has to be a focus of therapy. If it's not, they won't be successful at changing their speed? |
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Term
| What are the major quality of movement issues? (4) |
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Definition
| 1. Rapid movements are not possible. 2. Alternative movements become unsuccessful. 3. Problems w/ dual task performance ie: walking while carrying something, walking & talking, etc... 4. Gait disturbances. |
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Term
| What are the major gait disturbances you'll see? (8) |
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Definition
| 1. Absence of arm swing. 2. Power generated by muscles can be normal or near normal. 3. Festinating gait. 4. Retropulsion. 5. Rigidity and shuffling. 5. flexed trunk. 7. LEs stiff and flexed at knees and hips. 8. Short steps, feet barely clearing the ground. |
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Term
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Definition
| The COG tends to go back, so they have a tendency to fall backward. |
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Term
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Definition
| Writing becomes very small; decreased magnitude of all movements. |
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Term
| What are the voice tone changes you may find? |
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Definition
| They are monotonous; not at lot of inflection changes. |
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Term
| Why do they have nutrition problems? |
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Definition
| Movement iss low, so chewing and swallowing is slow, and moving food to the mouth is slow. It takes them a long time to eat, so everyone else finishes before them and they stop when others finish even though they didn't eat much. |
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Term
| Why do PD pts have poor righting responses? |
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Definition
| Because movements are slow - so responses to perturbations are slow. |
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Term
| Drooling is a common characteristic, and troubling for the pt. |
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Definition
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Term
| Describe the reflex changes. |
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Definition
| Reflex changes are variable and are not diagnostic of PD. Do not typically see babinksi. Sometimes see impairment of upward gaze and convergence. There's often delay of initiation of gaze to one side, slowness of conjugate eye movements, and breakdown of puruits into small saccades. |
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Term
| What is the major cognitive change you may see w/ PD? |
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Definition
| Parkinsonian Dementia. Incidence increases w/ increasing age. |
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Term
| Describe the sensation issues you may encounter, and the cause. |
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Definition
| They sometimes complain of weird sensations. And you may find sensation deficits, It's usually attributed to positioning, lack of movement or rigidity. not due to CNS problems. |
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Term
| What are the secondary impairments that may be present w/PD. (8) |
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Definition
| 1. disuse muscle atrophy and weakness. 2. Postural deformity. 3. Loss of flexibility/contracture b/c of consistent poor posture. 4. Osteoporosis. 5. Venous pooling due to immobility. 6. Decreased circulation. 7. Nutrition changes. 8. decubitus ulcers. |
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Term
| Where is decreased flexibility most commonly seen? What is the direction of flexiblity loss? |
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Definition
| Most common in knees, hips and spine. Proximal -> Distal development. |
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Term
| Why do PD pts develop decubitus ulcers? |
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Definition
| Because of immobility, not sensory loss. |
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Term
| How is the Dx of PD made? (4) |
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Definition
| 1. Primarily symptomatic/Dx by clinical signs. 2. Response to L Dopa. 3. Rate of onset. 4. Testing for differential Dx: EEG, CATscan. |
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Term
| What is the BEST indicator of the disease? |
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Definition
| The response to L Dopa. If Sx respond positively to meds, they most likely have PD. |
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Term
| What is the typical rate of onset? |
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Definition
| Slow. If there is rapid onset, suspect meds. |
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Term
| What is the initial, and primary Tx for PD? |
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Definition
| Pharmacological Tx. - primarily LDopa. |
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Term
| What effect does Ldopa have on PD? |
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Definition
| It's a precursor to dopamine that improves Sx but doesn't change the course of the disease. There is still degeneration of the substantia nigra while they're on the drugs. |
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Term
| What are the side effects of LDopa? |
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Definition
| very abnormal movement patterns can occur w/ LDopa toxicity - movements become excessive. After a number of years on the drug, pts may also become unresponsive to it. |
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Term
| What is a drug holiday, and why is it done? |
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Definition
| The pt goes off LDopa and go into the hospital (because PD Sx are very severe during the holida) for a couple of weeks, and then they go back on meds.This helps maintain their efficacy. |
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Term
| What is the surgical intervention for PD? |
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Definition
| Lesions are made in the globus pallidus or the ventrolateral thalamus contralateral to the side of the body that is most affected. |
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Term
| Why do they make lesions in the globus pallidus or ventrolateral thalamus to treat PD? |
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Definition
| Because there's overactivity in the GPI that inhibits the thalamus. So a lesion is made in the GPI to decrease the activity and therefore increase the the thalamic activity which allows for more movement. |
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Term
| How does the surgeon know if they're making a lesion in the right area of the brain? |
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Definition
| It is done while the pt is awake. The dr. stimulates areas of the brain w/ electricity, and they can mimic the effect of a lesion before making a lesion. This allows them to narrow down where the lesion should be without causing permanent damage until they're in the right place. |
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Term
| Surgery is best for treating which PD Sx? (2) |
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Definition
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Term
| What Sx does surgery treat least successfully? (4) |
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Definition
| 1. postural imbalance and instability. 2. Akinesia. 3. Dystonia. 4. Speech Difficulty. |
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Term
| What happens to the response to L Dopa after brain surgery? |
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Definition
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Term
| Implantation surgery is also used to treat PD. What things are implanted? |
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Definition
| 1. Fetal Tissue. 2. Striatal implant of fetal or porcine nigral cells. 3. Electrical stimulators in the basal ganglia to decrease activity. |
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Term
| What is the benefit of of using implanted estim vs. creating leasions? |
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Definition
| estim is reversable. Lesions are not. |
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Term
| describe stage one of the hoehn and yahr classification of disability. |
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Definition
| minimal or absent, unilateral if present. |
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Term
| describe stage two of the hoehn and yahr classification of disability. |
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Definition
| Minimal bilateral or midline involvement. Balance not impaired. |
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Term
| describe stage three of the hoehn and yahr classification of disability. (3) |
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Definition
| Impaired righting reflexes, unsteadiness when turning or rising from chair, some activities are restricted but pt can live independently and continue some forms of employment. |
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Term
| describe stage four of the hoehn and yahr classification of disability. |
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Definition
| All Sx are present and severe. Standing and walking are possibly only w/ assistance. |
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Term
| describe stage five of the hoehn and yahr classification of disability. |
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Definition
| confined to bed or wheelchair. |
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