Podcast
Questions and Answers
Which of the following is MOST directly affected by the degeneration of cells in the substantia nigra in Parkinson's disease?
Which of the following is MOST directly affected by the degeneration of cells in the substantia nigra in Parkinson's disease?
- Cognitive processing speed
- Sensory perception
- Regulation of blood pressure
- Muscle coordination and movement (correct)
A client with Parkinson's disease exhibits a shuffling gait and difficulty initiating movements. Which primary symptom of Parkinson's is the client experiencing?
A client with Parkinson's disease exhibits a shuffling gait and difficulty initiating movements. Which primary symptom of Parkinson's is the client experiencing?
- Tremors
- Poor balance
- Bradykinesia (correct)
- Rigidity
Which of the following best describes the nature of tremors associated with Parkinson's disease?
Which of the following best describes the nature of tremors associated with Parkinson's disease?
- Intention tremors that occur during voluntary movements
- Kinetic tremors that occur with specific actions, such as writing
- Postural tremors that occur when maintaining a position against gravity
- Resting tremors that typically occur when the body is still (correct)
What is the MOST likely explanation for the presence of muscle pain and stiffness (rigidity) in a person with Parkinson's disease?
What is the MOST likely explanation for the presence of muscle pain and stiffness (rigidity) in a person with Parkinson's disease?
Which of the following secondary symptoms is associated with autonomic dysfunction in Parkinson's disease?
Which of the following secondary symptoms is associated with autonomic dysfunction in Parkinson's disease?
A massage therapist observes uniform resistance in both flexor and extensor muscles during passive range of motion assessment of a client with Parkinson's. This finding is BEST described as:
A massage therapist observes uniform resistance in both flexor and extensor muscles during passive range of motion assessment of a client with Parkinson's. This finding is BEST described as:
What is the PRIMARY reason for avoiding prolonged vigorous or painful massage techniques when treating a client with Parkinson's disease?
What is the PRIMARY reason for avoiding prolonged vigorous or painful massage techniques when treating a client with Parkinson's disease?
Which of the following modifications to massage techniques is MOST important when working with a client with Parkinson's disease who has altered sensation?
Which of the following modifications to massage techniques is MOST important when working with a client with Parkinson's disease who has altered sensation?
A client with Parkinson's disease experiences orthostatic hypotension. What is the MOST appropriate modification to positioning during the massage session?
A client with Parkinson's disease experiences orthostatic hypotension. What is the MOST appropriate modification to positioning during the massage session?
What is the MOST appropriate action for a massage therapist to take if a client with Parkinson's disease begins to experience tremors during a massage session?
What is the MOST appropriate action for a massage therapist to take if a client with Parkinson's disease begins to experience tremors during a massage session?
What is the PRIMARY goal of addressing postural changes, such as a kyphotic posture, in a client with Parkinson's disease?
What is the PRIMARY goal of addressing postural changes, such as a kyphotic posture, in a client with Parkinson's disease?
Which of the following home care recommendations is MOST appropriate for a client with Parkinson's disease to maintain functional ability?
Which of the following home care recommendations is MOST appropriate for a client with Parkinson's disease to maintain functional ability?
Based on the information provided, what is the underlying cause of muscular movement weakness and erratic motions in Parkinson's disease?
Based on the information provided, what is the underlying cause of muscular movement weakness and erratic motions in Parkinson's disease?
A client with Parkinson's disease is taking levodopa. What is the MAIN purpose of this medication?
A client with Parkinson's disease is taking levodopa. What is the MAIN purpose of this medication?
What is the MOST likely reason a client with Parkinson's experiences difficulty swallowing (dysphagia)?
What is the MOST likely reason a client with Parkinson's experiences difficulty swallowing (dysphagia)?
A client is diagnosed with Parkinson's. What key difference should a therapist expect when performing PROM(passive range of motion) compared to a healthy individual?
A client is diagnosed with Parkinson's. What key difference should a therapist expect when performing PROM(passive range of motion) compared to a healthy individual?
If postural hypotension is a primary concern for your client with Parkinson's, which hydrotherapy approach is MOST appropriate?
If postural hypotension is a primary concern for your client with Parkinson's, which hydrotherapy approach is MOST appropriate?
Diaphragmatic breathing exercises are included in the homecare of a client with Parkinson's diseases primarily for what reason?
Diaphragmatic breathing exercises are included in the homecare of a client with Parkinson's diseases primarily for what reason?
Which massage technique would be LEAST appropriate to use on a client with Parkinson's disease due to potential adverse effects?
Which massage technique would be LEAST appropriate to use on a client with Parkinson's disease due to potential adverse effects?
If a client with Parkinson's Disease displays cogwheel rigidity during a massage session, what is the MOST effective strategy for adapting the treatment?
If a client with Parkinson's Disease displays cogwheel rigidity during a massage session, what is the MOST effective strategy for adapting the treatment?
What aspect of a patient's health history would make you MOST cautious when applying hydrotherapy to a client with Parkinson's?
What aspect of a patient's health history would make you MOST cautious when applying hydrotherapy to a client with Parkinson's?
Which assessment is the MOST appropriate for gauging muscle stiffness in a client with Parkinson's who is taking medication to manage their symptoms?
Which assessment is the MOST appropriate for gauging muscle stiffness in a client with Parkinson's who is taking medication to manage their symptoms?
What specific instruction should a massage therapist give to a client with Parkinson's prior to transitioning from lying face-up to a seated position?
What specific instruction should a massage therapist give to a client with Parkinson's prior to transitioning from lying face-up to a seated position?
Which of the following signs is MOST likely to be observed in a patient with advanced Parkinson's Disease?
Which of the following signs is MOST likely to be observed in a patient with advanced Parkinson's Disease?
If a client with Parkinson's has excessive salivation, which intervention is MOST appropriate during massage?
If a client with Parkinson's has excessive salivation, which intervention is MOST appropriate during massage?
Which communication strategy is MOST helpful when interacting with a client who has Parkinson's and speaks softly?
Which communication strategy is MOST helpful when interacting with a client who has Parkinson's and speaks softly?
A client with Parkinson's reports recent increased constipation. Which massage technique is MOST likely to provide relief?
A client with Parkinson's reports recent increased constipation. Which massage technique is MOST likely to provide relief?
Which treatment would you LEAST likely incorporate during massage if the client with Parkinson's has a tremor that intensifies with anxiety?
Which treatment would you LEAST likely incorporate during massage if the client with Parkinson's has a tremor that intensifies with anxiety?
A client with Parkinson's disease presents with a forward head posture. Which muscle group should you primarily target to help correct this imbalance?
A client with Parkinson's disease presents with a forward head posture. Which muscle group should you primarily target to help correct this imbalance?
When providing massage to a client with Parkinson's disease, what adjustment should be made to the treatment environment?
When providing massage to a client with Parkinson's disease, what adjustment should be made to the treatment environment?
A client with Parkinson's disease mentions that they have been experiencing increased fatigue. Which modification to the massage session is MOST appropriate?
A client with Parkinson's disease mentions that they have been experiencing increased fatigue. Which modification to the massage session is MOST appropriate?
What aspect of Parkinson's Disease is primarily addressed by encouraging 'whole body integration' during a massage therapy session?
What aspect of Parkinson's Disease is primarily addressed by encouraging 'whole body integration' during a massage therapy session?
During a session, the therapist notices their client with Parkinson's has reduced bladder control. Which is the MOST effective and respectful?
During a session, the therapist notices their client with Parkinson's has reduced bladder control. Which is the MOST effective and respectful?
Besides Parkinson's Disease, what other condition would cogwheel rigidity likely be present?
Besides Parkinson's Disease, what other condition would cogwheel rigidity likely be present?
What is the primary mechanism by which regular and moderate exercise is believed to improve motor control in individuals with Parkinson's?
What is the primary mechanism by which regular and moderate exercise is believed to improve motor control in individuals with Parkinson's?
What homecare would you recommend for a client with Parkinson's to assist with thoracic motion?
What homecare would you recommend for a client with Parkinson's to assist with thoracic motion?
What medication is administered in conjunction with Levodopa to inhibit breakdown and increase effectiveness?
What medication is administered in conjunction with Levodopa to inhibit breakdown and increase effectiveness?
What is the main reason to teach someone with Parkinson's retraction / protraction exercises?
What is the main reason to teach someone with Parkinson's retraction / protraction exercises?
A client with Parkinson's has rigid muscles. With consent, which intervention would be MOST appropriate?
A client with Parkinson's has rigid muscles. With consent, which intervention would be MOST appropriate?
Flashcards
Parkinson's Disease
Parkinson's Disease
Progressive, neurodegenerative disorder involving diminishing basal ganglia function causing slowed movements, tremor, rigidity, and other symptoms.
Substantia Nigra
Substantia Nigra
The control of muscular movements by releasing dopamine.
Bradykinesia
Bradykinesia
Impairment of voluntary motor control, slowness or freezing, difficulty initating movements, and festinating gait
Rigidity
Rigidity
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Postural changes
Postural changes
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Medications for PD
Medications for PD
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AROM & Parkinson's
AROM & Parkinson's
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PROM & Parkinson's
PROM & Parkinson's
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Bradykinesia test
Bradykinesia test
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Treatment Goals
Treatment Goals
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Study Notes
- Parkinson's disease is a progressive, neurodegenerative disorder
- It involves diminishing basal ganglia function
- Parkinson's disease causes slowed movements, tremor, rigidity, and a wide variety of other symptoms
- "Neurodegenerative" refers to the degeneration of neurons, the basis for all brain activity
Etiology
- The cause of Parkinson's is unknown
- Destruction of brain cells in the substantia nigra occurs
Substantia Nigra
- It controls muscular movements by releasing dopamine (neurotransmitter)
- Dopamine decreases as we age
- In Parkinson's, dopamine supply decreases due to necrosis
- Muscular movements become weaker and more erratic, affecting walking, writing, reaching, and basic movements
Primary Symptoms
- Bradykinesia involves impairment of voluntary motor control, slowness, or freezing
- It can present in standing up, walking, and sitting down
- There can be difficulty initiating movements (especially walking) and experiencing "freezing episodes" when startled
- Festinating gait or shuffling gait occurs
- Tremors often occur in hands, fingers, forearms, foot, mouth, or chin and typically occur at rest
- Rigidity is muscle stiffness that produces muscle pain with movement
- Poor balance results from loss of reflexes that help posture, often leading to falls
Secondary Symptoms
- Postural changes like kyphotic, head forward posture can occur
- Breathing difficulties
- Fatigue
- Constipation
- Difficulty swallowing
- Choking, coughing, or drooling, speech difficulties can occur
- Excessive salivation
- Loss of bowel/bladder control
- Anxiety, depression, isolation are possible symptoms
- Slow response to questions
- Soft whispery voice - unable to project
Diagnosis & Treatment
- There is no specific test for Parkinson's
- A systematic neurological exam includes testing reflexes and observing muscle strength, coordination, balance, and other details of movement
- Tests rule out other nerve dysfunction, narrowing of the spinal canal, which other treatments are needed
- Commonly used medications include Levodopa (sinemet) & entacapone (comtan) to improves the effectiveness of levodopa
- Dopamine agonists (mirapex) stimulate the body's natural production of dopamine
Parkinson's and ROM
- Usual ROM and strength testing protocol is attempted
- AF ROM reveals a decrease in ROM if rigidity is present
- PROM reveals uniform resistance in the flexor and extensor groups acting on affected joints, known as Leadpipe
- Cogwheel rigidity (intermittent resistance) may be revealed during PROM
- RROM will not be useful if rigidity is present
Special Tests
- Sensory testing varies depending on the client's sensory impairment
- Tests include light touch, deep pressure, pain/temperature perception, two-point discrimination, and proprioception
- Specific orthopedic tests depending on the complaint may be used
- Bradykinesia test: positive test is movement becomes slower & more difficult
Contraindications
- Prolonged vigorous or painful techniques should be avoided to prevent stimulating the SNS
- Areas sensitive to touch are avoided
- Pressure and hydro are modified in areas of altered sensation
- Positioning, techniques, and hydro are modified if hypertension is present
- Hypotension is a threat due to autonomic dysfunction, monitor during position changes
- Avoid holding down tremors
Treatment Goals
- Maintain proper alignment
- Decrease SNS firing
- Decrease edema if present
- Maintain tissue health
- Decrease pain
- Address postural changes and muscle imbalances
- Limit contractures
- Reduce constipation
- Address diaphragm muscles
- Maintain thoracic mobility
- Encourage whole body integration
Home Care
- Encourage relaxation with diaphragmatic breathing
- Regular, moderate exercise can improve motor control
- Encourage continuation with ADLs
- Maintain functional ability by moving joints through simple ROM and engaging in balance activity, such as sidelying retraction/protraction and trunk rotation exercises
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