Summary phys.theory: Upper limb in Parkinson's disease

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

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, 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


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