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what's the name of the motor circuit that modulates cortical output necessary for normal movement?
basal ganglia
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signals from ___are processed thru the basal ganglia-thalamocortical motor circuit, and how are these signals returned to the same area?
- the cerebral cortex
- via a feedback pathway
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in PD, decreased ___ causes increased ___ from basal ganglia, which ___
- striatal dopamine (the neurons that produce the dopamine needed for normal movement are no longer there)
- inhibitory output
- suppresses movement
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size change in mvmnt w PD?
- it becomes smaller
- handwriting will shrink over years, but cog changes prevent the pt from knowing this, even when looking at his handwriting from that and prior years
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what neurons transmit dopamine from the brain stem to the basal gangli?
nigrostriatal neurons
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dopamine is needed for normal activation o fthe cortex
if there's an inadequate amount this'll limit__ and __
initiation and speed of movement
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basal ganglia facilitate cortically initiated movement by serving these 2 functions:
- 1) maintain motor plans in readiness (referred to as set)
- 2) provide for timing so one subroutine of a movement sequence is released in preparation for the next subroutine to begin
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earliest symptoms of PD - the premotor phase
- these are pretty non-specific -
- fatigue
- depression
- constipation
- decreased sends of smell
- sleep problems
- daytime slepiness
- REM behavior disorder
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initial motor sings of PD
- subtle decrease in dexterity
- difficulty w specific tasks - turning in bed, rising from a chair -- tasks that start from non-movement
- lack of coordinatin w activities like golf or dressing
- aching or tightness in calf or shoulder
- one-sided decreased arm swing in amb w ipsilat foot scraping floor
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4 cardinal signs of DP
- T tremor
- R rigidity
- A akinesia & bradykinesia
- P postural instability
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microphagia
small handwriting - a characteristic problem in PD
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hypomimia
masked faces - decreased facial animation - a characteristic problem in PD
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characteristic problems in PD (not the early symptoms or TRAP, but other symptoms)
- micrographia
- hypomimia
- hypophonia (soft speech)
- ANS dysfunction
- depression
- cognition decline
- sleep disorder
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resting tremor of 1 hand is often the first symptom of PD. what is this? when is it most active?
- slow & coars
- maximal at rest, lessening during movement, absent during sleep
- amplitude increased by emotional tension or fatigue
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when is a resting tremor less prominant in PD?
when the disease has progressed (then you get more cog issues)
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order in which parts get affected by resting tremor?
- hands, arms, legs - these are the most affected, and in that order
- also affects jaw, tongue, forehead, eyelids
- not the voice
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titubation def
- 1. the act of staggering or reeling.
- 2. a tremor of the head and sometimes trunk, commonly seen in cerebellar disease.
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Rigidity develops w/o tremor in many pts. When a rigid joint is passively moved suddenly,what happens?
- rhythmic jerks due to variations in intensity of the rigidity
- gives a ratchet-like effect
- a pulsing on/off of agonist & antag muscles / simultaneous regidity in ag/antag
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freezing/akinesia is what?
- temp invol inability to move
- "goad and the halter" - being shoved & pushed back
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triggers for frezing
- thresholds, doorways
- pt may have festination leading up to freezing
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treatments for freezing
- provide an external cue to move (a visual goal)
- distraction (sing, create another task, like asking a pt who can't get out of a chair to pick up an object over yonder)
- don't fight it or push the pt!
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bradykinesia
akinesia
hypokinesia defs
- slowness of movement
- absense of mvmnt
- decreased mvmnt amplitude
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4 typical features of PD posture for trunk, cervical spine, hips knees elbows, shoulders
- flexion of trunk
- cervical hyperextension
- flexion of hips, knees, elbows
- shoulders abd & IR
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how are PD pts with perturbation
they have a difficult time adjusting their response level to the perturbation
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how do reflexes affect postural instability?
the increased amplitude of destabilising medium latency reflexes throw off stability
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tell me about trunk stiffness
there's increased trunk stiffness in all planes of movement, and this contributes to postural instability
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what protective pattern is delayed in PD pts?
protective UE patterns (reaching out to block a fall)
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5 item that add to postural instability in PD pts
- reduced amplitude & slower development of APA's
- difficulty adjusting response level to perturbation
- increased amplitude of destabilizing medium latency reflexes
- delayed protective UE pattern
- increased trunk stiffness in all planes of mvmnt
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for a PD pt, what gets fractured more - hip or wrist, and why?
- hip, bc they don't have the response in a fall of shooting out the wrist in time
- in response to perturbation that ADDUCT their arms
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5 ANS dysfunctions seen in PD pts
- GI motility
- bladder dysfunction
- sialorrhea (excessive salivation)
- excessive heand and neck sweating
- orthostatic hypotension
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