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Questions and Answers
What is a primary cause of secondary parkinsonism related to vascular issues?
What is a primary cause of secondary parkinsonism related to vascular issues?
Which of the following is NOT mentioned as a cause of secondary parkinsonism?
Which of the following is NOT mentioned as a cause of secondary parkinsonism?
What type of toxicity is associated with secondary parkinsonism?
What type of toxicity is associated with secondary parkinsonism?
Which of the following structures is primarily affected in secondary parkinsonism?
Which of the following structures is primarily affected in secondary parkinsonism?
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Which type of trauma contributes to secondary parkinsonism?
Which type of trauma contributes to secondary parkinsonism?
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What type of assessment focuses on the speed, control, and composition of movement?
What type of assessment focuses on the speed, control, and composition of movement?
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Which test involves standing up from a chair and walking a distance?
Which test involves standing up from a chair and walking a distance?
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What movement does the timed up and go test NOT include?
What movement does the timed up and go test NOT include?
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Which of the following best describes diadochokinetic movements?
Which of the following best describes diadochokinetic movements?
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In functional tests, what primary aspect of movement is evaluated?
In functional tests, what primary aspect of movement is evaluated?
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What characterizes the slowness of voluntary motor activity?
What characterizes the slowness of voluntary motor activity?
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Which of the following is an observable effect of decreased or lost facial expression?
Which of the following is an observable effect of decreased or lost facial expression?
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What does decreased or lost blinking typically indicate?
What does decreased or lost blinking typically indicate?
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Which scenario best illustrates the loss of automatic actions?
Which scenario best illustrates the loss of automatic actions?
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What can result from the loss of associative movements?
What can result from the loss of associative movements?
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What could indicate a decline in ambulation ability for a patient?
What could indicate a decline in ambulation ability for a patient?
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Which factor should be avoided to help manage disease progression effectively?
Which factor should be avoided to help manage disease progression effectively?
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When is the recommended time to conduct an assessment?
When is the recommended time to conduct an assessment?
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What may be a consequence of medication effects in disease management?
What may be a consequence of medication effects in disease management?
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Which of the following statements about static tremors is accurate?
Which of the following statements about static tremors is accurate?
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What is the primary impact of rigidity on the patient's axial body part?
What is the primary impact of rigidity on the patient's axial body part?
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Which statement best describes the relationship between rigidity and balance in patients?
Which statement best describes the relationship between rigidity and balance in patients?
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How does the patient's difficulty with repositioning the body manifest in daily activities?
How does the patient's difficulty with repositioning the body manifest in daily activities?
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In terms of treatment focus, what should be prioritized for the patient with rigidity affecting trunk movement?
In terms of treatment focus, what should be prioritized for the patient with rigidity affecting trunk movement?
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What underlying condition could be inferred from the described issues with body alignment and movement?
What underlying condition could be inferred from the described issues with body alignment and movement?
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What is the maximum time allowed for a normal subject to complete the hand fisting and opening test?
What is the maximum time allowed for a normal subject to complete the hand fisting and opening test?
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During the 5 times repetition test from sit to stand, what is the maximum allotted time for completion?
During the 5 times repetition test from sit to stand, what is the maximum allotted time for completion?
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What physical action is performed when asked to execute pronation and supination from a seated position?
What physical action is performed when asked to execute pronation and supination from a seated position?
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In the context of the tests described, which of the following best describes the condition of performance for sitting to standing?
In the context of the tests described, which of the following best describes the condition of performance for sitting to standing?
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What is the primary objective when performing the fisting and opening of the hand?
What is the primary objective when performing the fisting and opening of the hand?
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Study Notes
Parkinson's Disease
- Parkinson's disease is a neurodegenerative disorder primarily affecting the basal ganglia.
- It most often affects individuals over 60 years old.
- Extrapyramidal system is a key component; includes centers and tracts that control activity in the spinal cord,excluding the pyramidal tract.
- It also encompasses diverse systems that extend throughout the central nervous system, with multiple final descending tracts.
- Essential components of the extrapyramidal system include: areas 6 and 8 & 4, basal ganglia, thalamus, subthalamus, red nucleus, substantia nigra, brain stem reticular nuclei, and other nuclei, and descending tracts.
- Basal ganglia, a group of grey matter nuclei in the cerebral hemispheres (caudate nucleus, putamen, globus pallidus), plays a crucial role in regulating the extrapyramidal system.
- The putamen and head of the caudate nucleus form the corpus striatum, while the putamen and internal portion of the globus pallidus form the lentiform nucleus.
- Basal ganglia and their connections are essential to the extrapyramidal system.
- Extrapyramidal tracts are final pathways influencing activities; they originate in the brainstem and terminate in the spinal cord via interneurons.
- Key tracts include rubrospinal, tectospinal, vestibulospinal (lateral and medial), and reticulospinal (pontine and medullary).
Function of the Extrapyramidal System
- Regulates postural muscle tone.
- Facilitates voluntary movement initiation.
- Controls emotional and involuntary movements.
- Regulates and scales background posture during movements and learned motor skills.
- Influences cortical activity via connections with basal ganglia.
- Influences activity of the central nervous system (CNS) through descending pathways.
Basal Ganglia and Cortical Activation
- Dopamine is a neurotransmitter crucial for smooth, purposeful movement, transmitting signals between the substantia nigra and corpus striatum.
- Basal ganglia influence cortical motor activity through two circuits:
- Direct pathway: striatum inhibits globus pallidus, activated by D1 dopamine receptors, to increase thalamic activation.
- Indirect pathway: striatum facilitates globus pallidus, inhibited by D2 dopamine receptors, to decrease thalamic activation.
Extrapyramidal Tracts
- Acts primarily on interneurons (mainly gamma motor neurons).
- Facilitates extensor muscles, and has some inhibitory effect on flexors.
- Maintains posture and proximal control.
Disorders of the Extrapyramidal System
- Parkinson's disease is the most common extrapyramidal disorder in adults.
- It involves degeneration of the substantia nigra and subsequent dopaminergic stimulation of the nigrostriatal tract.
- This imbalance between dopamine and acetylcholine transmitters may constitute the hallmark of Parkinson's disease.
Causes of Parkinson's Disease
- Primary Parkinson's: idiopathic degeneration of substantia nigra (SN).
- Secondary Parkinsonism (Parkinsonian disease): affects the basal ganglia due to vascular ischemia, encephalitis, trauma, toxins (e.g., manganese), drugs, or neoplasms.
Manifestations of Parkinson's Disease
- Characterized by four cardinal features: tremors, bradykinesia, rigidity, and postural instability.
- Tremors: static or resting tremors, more prominent at rest, but can interfere with movement.
- Bradykinesia: slowness of both voluntary and involuntary movements, including facial expressions.
- Rigidity: increased muscle tone, leading to resistance in passive movements.
- Postural instability: impaired balance and postural control may lead to falls.
- Additional symptoms can include speech problems, swallowing difficulties, cognitive impairments, such as depression, and the "on-off" phenomenon.
Cognitive Manifestations
- Depression: a direct consequence of the disease's pathology (decreased dopamine) and a reactive response to motor problems.
- Bradyphrenia: slowness of thought. Narcolepsy: daytime sleepiness
- Memory problems: reduced memory functions can lead to dementia
- On and off phenomenon: fluctuations in motor function related to drug use.
Assessment Scales
- The Modified Hoehn and Yahr scale, and the Montreal Cognitive Assessment (MoCA) are used to assess the stage and cognitive function in patients with Parkinson's disease.
Assessment of Parkinson's Patients
- Accurate standardized scales, such as the Functional Independence Measure (FIM), are crucial for assessing and tracking progress.
- Assessments should consider medication effects, time of day, any age-related issues, and other aspects, such as vision and hearing.
Speech and Cranial Nerve Assessment
- Characteristic features: monotonous speech, diminished emotional range, and reduced speech volume.
- Difficulties with eye movements, and other cranial nerve functions may be present.
- Loss of glabellar reflex and potential swallowing difficulties may also occur.
Sensory Assessment
- In Parkinson's, there's typically no direct sensory impairment.
- Difficulty in organizing sensory input for postural control is possible.
Motor Function Assessment
- Rigidity, slowness, loss of motor control, static tremors, and posture are often characteristic.
- Specific assessments like the timed up and go test, as well as diadochokinetic tests are relevant tools for evaluation.
Respiratory Assessment
- Rigidity decreases the lung's expansion and may lead to decreased respiratory function, contributing to fatigue, reduced lung capacity, and deconditioning.
ADL (Activities of Daily Living) Assessment
- Patient's independence in daily tasks is important, so assessment needs to be accurate and standardized, using the Functional Independence Measure (FIM).
- Factors including medication timing and age-related factors should be considered and accounted for.
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Description
Explore the essential aspects of Parkinson's disease, a neurodegenerative disorder that primarily affects individuals over 60. This quiz dives into the role of the basal ganglia and extrapyramidal system in regulating motor activity. Test your understanding of its components and the impact on nervous system functions.
