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what's the name of the motor circuit that modulates cortical output necessary for normal movement?
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
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
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
what neurons transmit dopamine from the brain stem to the basal gangli?
dopamine is needed for normal activation o fthe cortex
if there's an inadequate amount this'll limit__ and __
initiation and speed of movement
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
earliest symptoms of PD - the premotor phase
- these are pretty non-specific -
- decreased sends of smell
- sleep problems
- daytime slepiness
- REM behavior disorder
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
4 cardinal signs of DP
- T tremor
- R rigidity
- A akinesia & bradykinesia
- P postural instability
small handwriting - a characteristic problem in PD
masked faces - decreased facial animation - a characteristic problem in PD
characteristic problems in PD (not the early symptoms or TRAP, but other symptoms)
- hypophonia (soft speech)
- ANS dysfunction
- cognition decline
- sleep disorder
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
when is a resting tremor less prominant in PD?
when the disease has progressed (then you get more cog issues)
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
- 1. the act of staggering or reeling.
- 2. a tremor of the head and sometimes trunk, commonly seen in cerebellar disease.
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
freezing/akinesia is what?
- temp invol inability to move
- "goad and the halter" - being shoved & pushed back
triggers for frezing
- thresholds, doorways
- pt may have festination leading up to freezing
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!
- slowness of movement
- absense of mvmnt
- decreased mvmnt amplitude
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
how are PD pts with perturbation
they have a difficult time adjusting their response level to the perturbation
how do reflexes affect postural instability?
the increased amplitude of destabilising medium latency reflexes throw off stability
tell me about trunk stiffness
there's increased trunk stiffness in all planes of movement, and this contributes to postural instability
what protective pattern is delayed in PD pts?
protective UE patterns (reaching out to block a fall)
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
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
5 ANS dysfunctions seen in PD pts
- GI motility
- bladder dysfunction
- sialorrhea (excessive salivation)
- excessive heand and neck sweating
- orthostatic hypotension