2. Motor impairments in PD

Flashcards on motor impairments in Parkinson's Disease, their effects, and cueing techniques.

What is Parkinson's disease (PD)?

• Degeneration of the CNS

• Α-syneucleopathy + neurodegeneration (dopamine)

• Main area is in the basal ganglia

What are motor impacts in PD?

unable to perform automated tasks without directing attention to them

What is the aetiology of PD?

Genetic predisposition after environmental toxis affect them

List some non-motor impairments associated with Parkinson's Disease.

Reduced sense of smell, bladder and bowel impairments (especially constipation), sleep disturbance, fatigue, anxiety, depression, reduced mood, pain and sensory symptoms, cardiovascular autonomic impairment, postural hypotension.

List further non-motor impairments associated with Parkinson's Disease.

Cognitive impairment, slowness of thinking, decreased attention, planning, flexibility, decreased verbal fluency, dementia, hallucinations, respiratory impairment, upper airways obstruction.

List the motor impairments associated with Parkinson's Disease.

Tremor, rigidity, bradykinesia, hypokinesia, freezing, postural instability, reduced dexterity, reduced muscle strength/power, speech and swallowing difficulties.

Describe the types of tremor seen in Parkinson's Disease.

Resting (pill-rolling) 4-6 Hz; Action or postural tremor 6-15 Hz

Define rigidity in the context of Parkinson's Disease.

Increased stiffness throughout range, independent of speed of passive movement, present in both agonists and antagonists.

Define bradykinesia and hypokinesia in relation to Parkinson's Disease.

Decreased speed of movement and decreased amplitude of movement; most common motor impairments in PD, occur bilaterally but may be asymmetrical. Bradykinesia tends to respond better to medication than hypokinesia and worsens with repetition. More pronounced in complex movements.

What is freezing of gait (FOG)?

Difficulty initiating or continuing a movement, can occur during any motor task - most commonly during gait. Freezing is the feeling that the feet are transiently glued to the floor while trying to initiate walking, making a turn, or when walking through narrow spaces or in crowded places, sometimes accompanied with trembling of the legs and small shuffling steps.

When and where does freezing commonly manifests?

During any motor task, attempting to initiate a movement, during turning when walking, when performing a concurrent task, when anxious, in cluttered/busy environments and narrow doorways/small spaces.

Define Postural Instability in the context of Parkinson's Disease.

Inability to control the COM over the BOS or a changing BOS. Everyone with PD will develop some degree of balance impairment. Can be a primary impairment, and other impairments can contribute.

What are some differential diagnoses of PD?

• PSP (progressive supranuclear palsy)

  • Younger, progression of falls, dementia, eyeball dysfunction

• MSA (multiple system atrophy)

  • Autonomic dysfunction, upper motor neuron signs

• CBD (corticobasal degeneration)

What are some medications for PD?

• Dopamine replacement: levodopa/carbidopa

• Reduce the breakdown of dopamine: dopamine agonist, MAO-B inhibitors, COMT inhibitors

What motor complications arise due to prolonged use of levodopa medication?

Dyskinesia, dystonia, Wearing ‘off’

According to the 2-year longitudinal study, what activities showed worsening difficulty in PD patients?

Getting out of bed, getting out of a chair, walking indoors and outdoors, using public transport. Disability progression associated with greater disease severity, FOG, increased fear of falling, more anxiety and depression.

How does Bradykinesia/hypokinesia impact gait in mild to moderate PD?

Speed is reduced due to difficulty regulating stride length, cadence is increased to compensate for shortened stride length.

What is the immediate effect of cues on gait in mild to moderate PD?

Speed and stride length can be normalised with visual or attentional cues and retained for 2 hours.

What is the immediate effect of dual tasking on gait in mild to moderate PD?

Addition of cognitive dual tasks decreases speed and stride length, which is evident on covert monitoring.

What is the immediate effect of instructions on gait under dual task conditions in mild to moderate PD, and how long do they retain?

Speed and stride length can be normalised with visual or attentional cues and retained for 2 hours

What are the immediate effects of combined cues and instructions on gait?

Feasible and immediately effective in increasing speed and stride length in single and dual tasks in people with PD without cognitive impairment and in people with PD with mild cognitive impairment.

What are the clinical implications of the immediate effect of cues on gait?

Visual and attentional cues have an immediate effect of improving gait. These immediate effects are short term and not retained when concurrent tasks are performed. Specific instructions +/- cues can be used to manipulate attention to immediately enhance stride length, and therefore walking velocity, even under dual task conditions, in people with mild to moderate PD.

What is the immediate effect of cues on freezing of gait (FOG)?

Cues (e.g., metronome, floor marker) can immediately improve freezing of gait.

How does auditory cuing affect FOG while turning?

Auditory cueing at every stride caused freezing during turning to disappear in all except one of the freezers. Improvement disappeared once cue removed.

What are the clinical implications of the immediate effects of cues on FOG?

Visual and attentional cues can have an immediate effect of reducing freezing of gait. These immediate effects are short term and not retained when the cue is removed.

How does cueing help with movements in PD patients?

Cueing provides a non-automatic drive, bringing attention to movement amplitude and timing, immediate effects