PD Exam & Intervention

What H&Y stages will commonly have daily falls?

• 2.5

• 3

• 4

What is the most common medication for PD?

Levodopa/Carbidopa

If someone has PD and has been taking Levodopa/Carbidopa but the condition progresses, what other medications may they take?

• Dopamine agonists

• MAO-B inhibitors

• Anticholinergics

• COMT inhibitors

• Amantadine

What is the acronym for fall risk factors for those with PD?

• SPLATT

  • Symptoms

  • Previous falls

  • Location

  • Activity

  • Time

  • Trauma

What ICF model construct does the Montreal cognitive assessment (MoCA) assess?

Body structure and function

What ICF model construct does the freezing of gait questionnaire and Parkinson’s fatigue scale measure?

Body structure and function

What ICF model construct does the PDQ-8 assess?

Participation

What is the MDC for someone with PD for the FGA? What score is the fall risk cut off?

• MDC = 4 points

• Fall risk cutoff <15

What is the MDC for the 6MWT for someone with PD?

82 M

What is the MDC for the berg for someone with PD?

5 points

What is the SEM for the 5TSTS for someone with PD?

0.6 seconds

A time greater than what on the 5TSTS indicates that someone with PD is a fall risk?

>16 seconds

What is the MDC on the activities-specific balance confidence scale for someone with PD? A score under what percentage indicates that someone with PD is a fall risk?

• MDC = 13%

• Fall risk cut off <69%

A score of what or above on the MoCA is considered normal for someone with PD?

26+

Which assessment for someone with PD has been found to have a ceiling effect?

MoCA (37% of peeps get 100%)

What is the MoCA assessing?

11 different cognitive domains

What problem does a pt need to report in order for the freezing of gait questionnaire to be appropriate for them?

Freezing gait

Does higher or lower scores correspond to a more severe FOG on the freezing of gait questionnaire?

Higher scores

What kind of fatigue does the PFS-16 measure?

Physical fatigue

The PDQ-8 looks at peoples abilities over the last ____

Month

If you are doing an eval with someone with PD, what details about their tremor (if they have one) should you document?

• It’s location

• The amplitude

• Constancy

• Resting, postural, or kinetic

What are the two types of rigidity?

• Cogwheel

• Lead pipe

What are dyskinesias?

Uncontrolled, involuntary movements seen at peak dose or when levodopa lvls are rising or wearing off

Define dystonia

Involuntary sustained muscular contractions that cause abnormal movements and/or posture

When dystonia is present during “off” periods, what will it typically lead to?

Dystonic inversion of the foot

When dystonia is present at peak dose, what parts of the body does it often affect?

• Neck

• Face

The pull test on the MDS-UPDRS assesses what?

Postural instability

What would a score of 0 be for the pull test?

• Normal

  • No problems

  • Recover in 1-2 steps

What would a score of 1 be for the pull test?

• Slight

  • 3-5 steps

  • Able to recover without help

What would a score of 2 be for the pull test?

• Mild

  • More than 5 steps needed to recover

  • Recover without help

What would a score of 3 be for the pull test?

• Moderate

  • Stands safely

  • No postural response, would fall if not caught by the examiner

What would a score of 4 be for the pull test?

• Severe

  • Very unstable

  • Loses balance spontaneously

You have been taking HR throughout a session with a pt with PD and notice that their HR is not increasing sufficiently with position changes, why might that be?

Result of dysautonomia

What percentage of people with PD have depression?

30-49%

What percentage of people with PD have anxiety?

25-49%

What percentage of people with PD have apathy?

40%

Define apathy

Lack of interest, motivation, enthusiasm for activities that were once enjoyable

Are obessive-compulsive and impulsive behaviors seen in those with PD a result of the condition or the meds they are taking?

The meds (dopamine agonists)

What fraction of people with PD have rapid eye movement sleep behavior disorder (RBD)?

1/3

Describe RBD

Violent dreams that a person acts out with talking, yelling, punching, kicking, and other potential injurious activities to bed partner

Define restless leg syndrome

Throbbing, pulling, or other unpleasant sensations in the legs with an uncontrolled urge to move

Define periodic leg movement disorder

Periodic rhythmic movements of the limbs that last a few minutes to several hours

Someone with PD could have what movement system diagnosis’?

• Movement pattern coordination deficit

• Hypokinesia (more common)

What interventions should you do to address motor disease severity for PD?

• Aerobic exercise

• Gait training

• Resistance training

• Integrated care

• Community-based exercise

What interventions should you do if you want to improve functional mobility for someone with PD?

• Aerobic exercise

• Resistance training

• Community based exercise

• Task-specific training

What interventions should you do when wanting to improve walking in someone with PD?

• Gait training

• Balance training

• External cueing

What are some interventions one can do when wanting to improve balance in someone with PD?

• Balance training

• Gait training

• Telerehab

What interventions would you want to do for someone with PD if you want to improve their QoL?

• Balance training

• Resistance training

• Community-based exercise

• Behavior change approach

• Integrated care

What interventions would you want to do to improve non-motor symptoms in someone with PD?

• Resistance training

• Community-based exercise

• Integrated care