Physiotherapeutic theory for neurological rehabili
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Summary phys.theory: Upper limb in Parkinson's disease
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Physiotherapeutic theory for neurological rehabili
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the PD upper limb lesson given by prof. M. Gilat from the subject of physiotherapeutic theory. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as possible. It is therefore a mix...
Physiotherapeutic theory for neurological rehabili
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Phys. Theory: Parkinson: upper limb function
IMPACT OF UPPER LIMB DYSFUNCTIONS
Diminished arm-hand function affects:
- Self-care, e.g. dressing,…
- Daily-life activities, e.g. household activities
- Recreational activities, e.g. sports met veel UL functions
- Social and personal life
- Embarrassment, e.g. eating in company
- Use of modern technologies, e.g. smartphones, tablets
- Professional activities, e.g. computer use
Niet allemaal al op pensioen
Soms moeten ze wel vroeger op pensioen gaan
Example:
- UL
Moeilijkheden fijne motoriek
o Zeer regide hand
o Micrographia
Kan ook 1 van 1e symptomen zijn die opvallen
Tremor
o Meestal in rust
o Hier ook tijdens act
- Writing
Tremor and difficulty with the writing movement, it gets smaller and will drift
Making loops between 2 lines -> freezing episodes, making small letters = issue
Klein schrijven kan freezing veroorzaken
1. KEY UNDERLYING ISSUES
Symptom interference (bradykinesia)
- Bradykinesia= traag bewegen
- Fine-tuning of control of force (precision grip)
- Ability to move the fingers selectively
- Finger coordination
- Micrographia or dysgraphia (= strange drifts in all directions)
Dysgrafia= disfuncties in het schrijven
- Motor sequence performance - diminishing of movement
Performance= ook onderdeel UPDRS
- Freezing during small amplitude sequences
Bradykinesia = in large movements
Freezing = in small movements
- Action tremor
1.1. BE AWARE OF STRIATAL HAND DEFORMITY
Striatal
- Deformiteit hand veroorzaakt door disfunctie striatum, leasies in putamen of caudate
Intrinsic hand muscle pathology
- usually most affected side and more prevalent in young onset & early PD
Described by MCP flexion and extension at PIP and DIP
23/100 had SHD and 10/100 had stiffnes of the intrinsic hand muscles
Rigidity and dystonia?
- why is the stiffnes their? rigidity could be a factor, also a deviation of the 5th finger
dystonia also causes stiffnes
combination of both = deformity
Echte oorsprong is niet gekend
Distonia
o Malfunctie balase gangalia circuit dat leidt tot deformiteit
- exercises need to make the hands loose and to prevent the stiffnes
- Really, really important!!
Deformiteiten gerelateerd aan PD
Nala Melis Pagina 1
, Phys. Theory: Parkinson: upper limb function
Abductie pink
Joints in striatal hand deformity: typically painless
PIP joint hyperextension: unbalance between intrinsic and extrinsic muscles
1.2. Verschil reuma of striatal hand deformity
Bij reuma
- Pijn aan gewrichten
- Ontsteking
ASSESSMENT OF UL FUNCTION IN PD
Recommended assessment methods
- MDS-UPDRS, upper limb items
- Questionnaires (MAM-16, DEXTQ-24)
- Tests using coin rotation or flipping
- Pegboard tests
- Systematic screening of writing
- Funnel task for upper limb freezing
- Mobile phone task
1. MDS-UPDRS PART III, UPPER LIMB IETS
Item 3.3. Rigidity – right and left arm
Item 3.4. Finger tapping
Item 3.5. Hand movements
Item 3.6. Pronation – supination of the hands
Item 3.15. Postural tremor of the hands
Item 3.16. Kinetic tremor of the hands
Item 3.17. Amplitude of the rest tremor – right and left arm
Item 3.18. Amount of rest tremor
+ MDS-UPDRS part II item 8. Handwriting vraag hierover
2. MANUAL ABILITY MEASURE – MAM-16
Nala Melis Pagina 2
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