PT 536 Neurodegenerative Conditions of Basal Ganglia PT Implications

decrease

PD involves a decrease or increase in movement?

sporadic (idiopathic)

are most cases of PD sporadic or familial?

True

True or False? PD involves BOTH motor and non-motor symptoms

bradykinesia, rigidity, resting tremor, postural instability

Cardinal Signs of PD

bradykinesia

term for slow movement, seen with PD

hypokinesia

term for small movement, seen with PD

face (mask-like face)

common area of hypokinesia for PD patients?

akinesia

term for difficulty initiating movement (freezing), seen with PD

festinating gait

feet take slow, choppy steps that are jerky, especially when taking turns

rigidity

this clinical symptom of PD involves and increased response in muscle stretch in antagonist AND agonist muscles

arms and trunk

first parts of the body that typically become rigid first in those with PD

extension, rotation

what motions are typically the ones that are limited with rigidity?

cogwheel rigidity

muscle tension that intermittently halts movement as an examiner attempts to manipulate a limb

leadpipe rigidity

Uniform, constant resistance as limb is moved

stooped, narrow BOS

posture often observed in PD patients?

unilateral to bilateral

typical progression of the resting tremor in PD patients

pill rolling tremor

flexing and extending the fingers while moving the thumb back and forth, as if rolling something in the fingers; common tremor seen with PD

engage limb in other activity

how can patients with PD often alleviate the pill rolling tremor

Clinical symptoms, responsiveness to DA replacement drugs

Clinical diagnosis of PD can be based on what two things?

False. (Rule IN PD)

True or False? If resting tremor symptoms are asymmetrical AND they are given DA replacement drugs and their symptoms improve, then we can rule out PD

ruling out other diagnoses

How would imaging be useful for a patient with PD?

DaTScan

imaging modality used to evaluate parkinson's disease, measures dopaminergic activity in the brain via ligands that bind to DA transporters.

autopsy

How do we get a definitive diagnosis of PD?

DA has a difficult time crossing BBB

what is the biggest set back of giving dopamine replacements as a treatment for PD?

DA Replacement

treatment preferred for early to moderate cases of PD

L-DOPA, carbidopa

DA replacements given to tx PD

L-DOPA

A drug for Parkinson's disease that contains the precursors to dopamine so that once it is in the brain, it will be converted to dopamine.

tremor, bradykinesia, walking issues

What symptoms of PD is L-DOPA effective in improving?

L-DOPA

Med this is typically first line for PD

effectiveness wears off over time; potential for impulsive behavior, sleep disturbances, and addictive behaviors

Cons of L-DOPA use

inhibits breakdown of L-DOPA (so typically given in combination with L-DOPA)

how does carbidopa work?

MAO-B Inhibitors

Treatment for Early PD when trying to avoid the use of L-DOPA and when the effects of L-DOPA wear off

prevent breakdown of DA, allowing it to hang around system longer

How do MAO-B inhibitors work?

same as L-DOPA/carbidopa (Increase in DA = impulsive behaviors, sleep disturbances, involuntary movements)

negative side effects of MAO-B inhibitors

Deep Brain Stimulation

treatments available for moderate to advances PD

disrupts abnormal signals in attempt to create normal movement

How does DBS stimulation work for PD?

10 years

QoL and Mobility prognosis when using DBS for PD

Thalamus

DBS to this part of the brain is most effective in improving tremors with PD

globus pallidus

other areas of DBS for PD to improve general movement, which can create undesirable cognitive effects

symptomatically (specific to the symptom)

How are the non-motor symptoms treated in those with PD?

no significant effect

Effect of PD on lifespan

true

True or False? All clinical manifestations of PD will worsen.

tremors

Better prognosis of PD is indicated by the initial emergence of what symptom?

postural instability, rigidity, hypokinesia

Worse prognosis of PD is indicated by the initial emergence of what symptoms?

tremor

which initial symptom of PD is more common

Hoehn and Yahr Scale

a widely used system to describe the progression of Parkinson's disease symptoms, ranging from unilateral involvement to severe disability, with stages 1-5

unilateral involvement only

Stage 1 PD according to the Hoehn and Yahr Scale

unilateral and axial involvement

Stage 1.5 PD according to the Hoehn and Yahr Scale

bilateral symptoms, no balance issues

Stage 2 PD according to the Hoehn and Yahr Scale

Mild bilateral disease with recovery on pull test

Stage 2.5 PD according to the Hoehn and Yahr Scale

Mild to moderate disease, physically independent

Stage 3 PD according to the Hoehn and Yahr Scale

severe disability, still able to walk or stand unassisted

Stage 4 PD according to the Hoehn and Yahr Scale

wheelchair-bound or bedridden unless assisted

Stage 5 PD according to the Hoehn and Yahr Scale

50-60

around what age is generalized idiopathic PD typically developed

flexibility exercises

What PT intervention has low quality of evidence concerning its use with PD?

telerehabilitation

What PT intervention has moderate quality of evidence concerning its use with PD?

aerobic exercise, community-based exercise, task-specific training

What 3 PT interventions have high quality of evidence concerning its use with PD, and were emphasized in the lecture?

excessive

Huntington's Disease is characterized by excessive or decreased movement?

familial

is huntington's disease sporadic or familial?

psychological, cognitive, physical

3 main areas of disorders present with HD

loss of neurons in the indirect pathway in the BG

motor symptoms of HD occur as a result of what loss?

depression, anxiety

Degeneration in the nucleus accumbens results in what clinical symptoms of PD?

personality changes, dementia

Degeneration in the general cortical area results in what clinical symptoms of PD?

difficulty swallowing

Degeneration in the brainstem results in what clinical symptoms of PD?

chorea

uncontrollable, jerky movements of arms, legs, and facial muscles

cognitive impairments

what impairments can typically be detected prior to motor symptoms with HD?

25%

% of individuals with HD that attempt suicide

Genetic testing, imaging

Diagnostic options for HD

CAG repeat

genetic testing of HD would reveal what?

39 or more (although 36 is also significant)

how many CAG repeats usually manifest HD?

atrophy of striatum (up to 10 years prior)

what will CT and MRI show when an individual has HD?

none

treatments to stop or reverse the progression of HD

tetrabenazine, deutetrabenazine

treatments for chorea or excessive movements caused by HD

interferes with CNS ability to use dopamine

how do tetrabenazine and deutetrabenazine work?

increases suicidal ideations

negative consequence of tetrabenazine

antipsychotics, counseling

other txment options for HD

15-20 years

life expectancy for those with HD

younger

if someone is _______________ (younger or older) when they have onset of symptoms, they will experience a more severe form of HD.

family members

age of onset and death from HD is usually associated with what?

bed/wheelchair mostly

mobility in the late stage of HD

aerobic exercise, strengthening programs, IMT/LVRT

early stage interventions for HD

transfer training, assistive device training

middle stage interventions for HD

rollator

what AD is typically easier for patients with HD to use?

family training, stretching programs

end stage PT interventions for HD

increased. muscle tone

what is dystonia?

sustained/abnormal posturing, slow/repeated twisting motions, hyperactivity, patterned movements, tremors potentially

clinical symptoms of dystonia

12

common age of onset for primary or genetic dystonia

30-50 years

common age of onset for focal dystonia

1 body segment

focal dystonia impacted area

adjacent body parts

segmental dystonia impacted area

2 or more noncontinuous body parts

multifocal dystonia impacted area

Trunk + 2 or more body parts

generalized dystonia impacted area

entire side of the body

Hemidystonia impacted area

static dystonia

dystonia that stays the same

progressive dystonia

dystonia that gets worse

variable

dystonia that comes and goes

persistent

dystonia that hangs around for a long time

action specific

dystonia that only occurs for a specific actvity

foot, limbs, cervical

very common muscles regions affects by dystonia

clinical diagnosis including:

1. dystonic postures/movements

2. alleviation of movements if affected body part is stimulated

3. "mirror dystonia"

4. "overflow dystonia"

diagnosis of dystonia involves: