Term
| What is the on-off phenomenon w/ meds? What is the implication of this on PT Tx? |
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Definition
| There are fluctuations in the efficacy of PD meds. The goal is to avoid off periods when diagnosing, but they're not unavoidable. So we want to know if we're treating them during an on or off phase of the day. |
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Term
| Do you want the pts to be on an on or off period for Tx? |
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Definition
| Usually we want them to be 'on' so that they get the most out of Tx. However, they have 'off' periods that they need to deal with as well, so we want to see some of both. But for most effective tx we want to see them when they're 'on'. |
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Term
| What does the strength testing look like for PD pts? |
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Definition
| You won't necessarily find deficits. |
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Term
| Why is it important to perform PROM before strength testing in PD pts? |
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Definition
| because if they're dominated by tone or rigidity it will be nearly impossible to accurately assess strength through MMT. |
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Term
| Why might PD pts have sensation deficits? |
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Definition
| Poor positioning, rigidity or a comorbidity - not CNS problems. |
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Term
| In what three ares of the body are you likely to find ROM limitations? |
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Definition
| Shoulder, Trunk (chest expansion, extension and rotation), and cervical spine. |
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Term
| What are the important things to note about tremor? |
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Definition
1. Location. 2. W/ activity or @ rest? 3. If bilateral is one side more affected?
*you can't measure speed without EMG* |
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Term
| What are the common motor control issues you may find in PD pts? |
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Definition
| Slow execution time, Slow reaction time, poor motor planning, inability to perform rapidly alternating movements. |
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Term
| When evaluating balance in the PD pt and you provide an externally initiated perturbation from the front, what do you hope to see in response? |
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Definition
| See the arms and toes come up - because that's a normal reaction. Not all PD pts have this response, so if they do it's a good sign. |
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Term
| What are the most common posture deviations in PD pts? |
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Definition
| Head forward and trunk flexed. |
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Term
| Why is it important to evaluate ROM w/ relation to posture? |
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Definition
| Because if they have full range but still have poor posture you have an opportunity to help work on that posture. But if there's a lack of range, posture exercises won't help until range has been gained. |
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Term
| What are you looking for when you evaluate gait in PD pts? (11) |
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Definition
| 1. Initiation of gait. 2. Base of support (ink, powder). 3. Step length. 4. Foot clearance. 5. Heel strike. 6. Posture. 7. Assitive device use. 8. Attention to surroundings. 9. Ability to scan the environment. 10. freezing episodes. 11. Dual task performance. |
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Term
| What's the easiest way to measure step length? |
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Definition
| w/ # steps in a specified distance, and divide distance by steps. |
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Term
| What is the most imperative objective measure you obtain when observing gait? |
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Definition
| TIME! You must time them. |
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Term
| Sondra provided us w/ a technique to relax trunk musculature prior to stretching. What was it? |
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Definition
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Term
| It's really important to teach PD pts to stretch their trunk on their own. Why? |
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Definition
| Because mobility is greatly improved by increased trunk ROM, but the effects of stretching are short-lived. So even if you stretch them in the office it won't last long. They need to be able to stretch before they perform activities at home, like sit-stand. |
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Term
| PNF techniques in what direction are good for PD pt posture? |
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Definition
| Extension (chops and lifts) |
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Term
| What are the first spine mobility components to be lost? |
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Definition
| Rotational components. (lifts) |
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Term
| Do PD pts respond better to internal or external cues? |
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Definition
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Term
| What are some visual cues to use for gait? (Give one for inside and one for in community) |
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Definition
| Tape on the floor to increase step length inside. Use of a cane to set step length when out in public. |
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Term
| How do auditory cues help gait? |
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Definition
| They won't directly increase step length, but increase step rhythmicity to slow their steps down (decrease cadence). |
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Term
| what are some useful auditory cueing strategies? |
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Definition
| 1. music. 2. metronome. 3. having pt say a word like 'go' or 'walk'. |
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Term
| What are two dynamic balance activities Sondra gave us in our handout? |
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Definition
| 1. Braiding. 2. Stopping and starting quickly. |
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Term
| Why is it important to train w/ starting and stopping for dynamic balance? |
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Definition
| Because this is often when they lose balance. Also, if they have freezing problems, starting again becomes difficult - so need to practice it. |
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Term
| How is mental imagery useful in PD pts |
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Definition
| They can imagine how they're going to get somewhere/how fast they're going toi walk, etc... before they do the activity. So when they actually do it, they perform better. |
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Term
| What are important Tx strategies to improve performance of ADLs? (3) |
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Definition
| 1. Energy conservation techniques. 2. Relaxation of tone. 3. Adaptive home equipment. |
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Term
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Definition
| We can't cure it of course, but studies have shown when there's an effort at PT, pts do improve in strength, balance reactions, compensatory strategies, ROM and cardiovascular health. |
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Term
| Is there carryover of exercise/PT benefits? |
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Definition
| NO! If they stop exercising they will lose what they've gained. They MUST continue exercising in order to maintain their benefits. |
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Term
| **Look over the PD case study she handed out and answer the questions.** |
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Definition
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