4.4- "Other" Neuro Disorders 1 Flashcards
What neuro disease is a demyelination of the central nervous system (brain and SC)?
Multiple Sclerosis
MS is an autoimmune response with possible ____ or _____ triggers. Myelin is attacked destroying _____. This produces ________.
viral or environmental triggers
Oligodendrocytes
patches of demyelination with plaques
What population/demographics will you see with MS?
Typical onset 20-40 yo, women affected 2-3x more than men, northern climates/Caucasians of northern European descent
What are the 4 types of MS?
Describe them.
Which one is the most common?
- Relapsing- remitting (85%)- attacks lasting days or months followed by full or partial recovery
- Secondary-progressive- initial pattern of relapse/remission changing into a progressive pattern
- Primary-progressive- steady decline from onset
- Progressive-relapsing- progressive with clear exacerbations
There are 11 signs or symptoms of MS.
- W___
- F___
- L___
- S___
- G___
- P___
- O___
- I___
- N___
- S____
- D___
- Weakness
- Fatigue (worsened by heat)
- Lack of coordination (ataxia)
- Spasticity
- Gait disturbances
- Pain- burning, often neuropathic and not in a normal distribution
- Optic neuritis (unilateral painful loss of vision), double vision
- Impaired sensation (parathesias & dysesthesia)
- Nystagmus
- Slurred Speech
- Disruption of memory/emotion
What is the prognosis of someone with MS?
Relatively permanent deficits/variable, most live near normal life span
There are 3 medical treatments for MS.
- Medication to _____(Interferon)
- _____ during acute exacerbations (Dextamethazone, Prednisone)
- Meds to treat _____ (varies)
- Medication to lessen relapses
- Steroids during acute exacerbations
- Meds to treat symptoms
Therapy Treatment for MS
- Weakness due to ______
- A________
- B_______
- S______
- A______
- Weakness due to lesions and inactivity/deconditioning
- Aerobic conditioning
- Balance training
- Spasticity
- Ataxia
MS patients suffer from weakness. 4 PT treatments for weakness are…
- Strengthening- low to mod intensity with higher reps
- Limit fatigue and avoid overheating
- Rotational movements (PNF)- decrease tone
- Aquatics- cool water, not a warm pool
What must be done before aerobic conditioning with an MS patient?
What kind of environment should you exercise an MS patient in?
What is contraindicated with an MS patient?
testing must be done before started to rule out autonomic cardiovascular dysfunctions
Cool environment to keep core temp down
Exercise to fatigue is contraindicated (use BORG scale)
MS Spasticity needs a _______ before exercise, ______, and ______ to decrease tone.
MS Ataxia should be ____ progressing utilizing developmental sequence.
slow static stretch before exercise- teach pt and family how to do
PNF techniques
Lower trunk rotation to decrease tone
prone progression utilizing developmental sequence
What neuro disease is an acute inflammation and demyelination of peripheral motor and sensory pathways slows/blocks transmission?
Guillain Barre Syndrome
Guillain Barre Syndrome is probably autoimmune attacking the _______.
It affects all ages (including children) with no gender preference.
Schwann cells
Signs and Symptoms of Guillain Barre
- M______
- S_____
- Possible _______ involvement affecting chewing, swallowing, speaking and facial expressions
- P_____
- Possible ____ and ____ involvement
- Motor paralysis
- Sensation- parathesia and hypesthesia
- Possible cranial nerve involvement
- Pain
- Possible cardiac & respiratory involvement
Guillain Barre Syndrome motor paralysis may be only ____, may include _______. It can be a lower motor neuron injury- ____ paralysis that is ____ and occurs _____ to _____.
may be only limbs, may include trunk and diaphragm
lower motor neuron- flaccid paralysis that is bilateral and occurs distal to proximal
What is the prognosis with Guillain Barre Syndrome?
What is the medical treatment?
Gradual recovery with 75% having complete recovery (Schwann cells will regenerate); 3% mortality
Plasmapheresis
Treatment therapy for Guillain Barre comes in three phases. The acute phase involves preventing _____, closely watching ____, and ______.
preventing contractures and skin breakdowns, closely watching respiratory status, and pain
- ROM needs to be gentle if muscle is deinervated- easily damaged
- postural drainage PRN
- stretch trunk and chest wall
The plateau phase of Guillain Barre is to increase tolerance to _____, _____, and ______ (can use heat if intact sensation).
increase tolerance to upright, pressure relief, and stretching
The recovery phase of Guillain Barre occurs in reverse order as loss (proximal to distal). A tilt table can be used to acclimate to ____ and _____. Strengthening (non-fatiguing) means increasing loads only after _____ and focusing on ____ rather than _____.
to upright and weightbearing
increase loads only after doing well after a week and focus on function rather than individual muscle groups
What neuro disease is a progressive motor neuron disease?
ALS
ALS is a destruction of _____ in what areas?
The cause is unknown and ___% is sporadic. 5-10% is _____.
anterior horn cells in SC, brain stem, and cerebral cortex (results in both upper and lower motor neuron findings depending on area first affected by disease)
90% sporadic, 5-10% inherited
ALS affects what population/demographics?
What is the prognosis of an ALS patient?
Usually over 50 yo, males over females 2 to 1, almost all are Caucasian
Average life span after Dx 3 years, death from respiratory failure
ALS Signs and Symptoms
- Lower motor neuron: _____, ____, ____
- Upper motor neuron: _____ with voluntary weakness, _____, ____
- _____ dysfunction (50%): problems with ____, ____, ____, ____
- S_____ and B______
- Lower motor: asymmetric weakness distal > proximal, extensors > flexors, progresses to atrophy and wasting
- Upper motor: spasticity with voluntary weakness, hyperreflexive, clonus
- Executive dysfunction: problems with attention, language comprehension, planning, reasoning
- Swallowing and breathing
ALS Medical Treatment is _____ which is the only drug approved by the FDA,
slightly slows progression.
What is the therapy treatment for ALS?
Rilutec
Stretching and approp therex to slow loss of strength at beginning, modalities for pain associated with contractures, assistive devices, bracing, energy conservation
What neuro disorder is a degeneration of the Striatum and Cerebral cortex leading to excessive output from the motor areas of the cortex?
Huntington’s Disease
Huntington’s is a ______ disorder that onsets at 40-50 yo, affecting males and females equally.
progressive hereditary disorder
Signs and Symptoms of Huntington’s
- C______ (involuntary jerky, rapid movements)
- R___ and b___ as disease progresses
- D____, d___, m____, OCD tendencies, s___ disorders
- Chorea
- Rigidity and bradykinesia
- Dementia, depression, mood swings, OCD, sleep disorders
What is the prognosis of Huntington’s Disease?
What is the therapy treatment?
Progressive resulting in death about 15 years after first signs due to choking or heart failure
no evidence that therapy slows progression, but can address functional deficits such as ROM, tight trunk musculature, adaptive devices/gait
What is the medical treatment for Huntington’s?
- medication such as ____ that block ____
- ______ for mood swings
- Botox for _______
- medication such as anticonvulsants that block dopamine
- antipsychotics for mood swings
- Botox for spastic muscle groups
