4.5- "Other" Neuro Disorders 2

Question 1

What is a Basal Ganglion disorder due to death of Dopamine producing cells in the Substantia Nigra and acetylcholine producing cells in the Pedunculopontine nucleus (80% of cells die before any deficits are observed)?

Answer 1

Parkinson’s Disease

Question 2

What disorder effects activation of voluntary movement and automatic/reflexive movement?

Answer 2

Parkinson’s Disease

Question 3

Parkinson’s origin is unknown, may include _______.

More years of education = _____ risk; smoking and exercise = ____ risk

Answer 3

toxic exposure

greater risk

less risk

Question 4

What disorder typically onsets 50-65 yo and increasing frequency with age;
men > women?

Answer 4

Parkinson’s Disease

Question 5

Signs and Symptoms of Parkinson’s

1. Rigidity- _____ and _____
2. Difficulty coming from ____ to ___
3. _____ (___) gait- take very short steps so pt compensates by speeding cadence, may result in running into something or falling

Answer 5

1. trunk & extremities
2. sitting to standing
3. Festinating (shuffling)

Question 6

Signs and Symptoms of Parkinson’s

4. Postural instability
5. Resting “_____” tremors- gets worse with tension and exertion
6. “____” during movement, including gait cycle
7. ____ and parathesis

Answer 6

5. pill-rolling
6. Freezing
7. pain

Question 7

Signs and Symptoms of Parkinson’s

8. _____ complications/low breath support- ____ speech
9. ______ dysfunction causing _____
10. _____ impairments
11. ___ of thought processes with decreased ability to ___ & ___

Answer 7

8. respiratory- soft monotone speech
9. autonomic dysfunction causing orthostatic hypotension
10. visuoperceptive
11. slowing of thought processes w/ decreased ability to attend & concentrate

Question 8

Parkinson’s Rigidity

• first sign = _________
• ____ rigidity= jerky response to passive movement
• ____ rigidity= slow and sustained resistance to passive movement

Answer 8

loss of arm swing in gait

cogwheel

lead-pipe

Question 9

Festinating (shuffling) gait

-flexed posture with ______

Answer 9

little to no arm swing

Question 10

Postural instability

• flexed posture w/ ↑ ____ causing COG to be pulled forward- pt compensates by _____
• can’t respond to expected & unexpected postural disturbances- causes ____

Answer 10

kyphosis

leaning back

falls

Question 11

Visuoperceptive impairment (difficulty moving past visual blocks such as walker, doorway, therapist), or walking on a different surface
- difficulty separating self movement from \_\_\_\_\_

Answer 11

movement of environment

Question 12

Slowing of through processes w/ ↓ ability to attend and concentrate

• 50% develop ____ due to neurochemical changes
• ____ and ____ due to chemical changes

Answer 12

dementia

depression and apathy

Question 13

What is the prognosis for someone with Parkinson’s Disease?

What is the medical treatment?

Answer 13

progressive, average life span after Dx 13 years

Drug therapy w/ L-dopa (Sinemet)- tends to lose effectiveness over time

Surgical intervention to destroy part of the thalamus or the globus pallidus or implant stimulator

Question 14

Therapy for Parkinson’s focuses on

1.
2.
3.

Answer 14

1. Gait
2. Posture
3. Aerobic conditioning

Question 15

Parkinson’s Gait

• ____ cues- step over markers, walk towards a mirror, mentally rehearse long strides
• ____ cues- rhythmic cues can speed up cadence & stride length

Answer 15

visual cues

verbal cues

Question 16

Parkinson’s Gait

• break down task so pt can think about ____
• practice ____, ____, ____, ____
• mark a spot ahead as a goal
• if using device, promote ___ rather than ____

Answer 16

the parts

practice side stepping, walking backwards, braiding, marching

promote ext rather than flexion

Question 17

Parkinson’s Posture

• Increase ______
• Stretch ______ and _____
• Rotational therex for ____ and ____
• Postural stability exercises

Answer 17

• increase extension
• stretch anterior chest and gastroc
• rotational therex for trunk and limbs (might do better sitting vs. supine)

Question 18

Parkinson’s Aerobic Conditioning

• decreases ____ and maintains _____ system

Answer 18

• decreases fatigue and maintains respiratory system

Question 19

What disorder is a reduced reciprocal inhibition due to decreased descending inhibition; when in hand, often misdiagnosed as CTS or tennis elbow?

Answer 19

Dystonia

Question 20

Dystonia is idiopathic: 66% of cases are ____, remaining cases are due to _______.

Focal dystonia found in musicians may be result of abnormal or repetitive mechanics.

Answer 20

66% are genetic, remaining cases are due to scarring in small areas of the cortex

Question 21

What population/demographics are diagnosed with dystonia?

Answer 21

idiopathic dystonia onset 8 yo

focal dystonia onset 30-50 yo

male equal to female

Question 22

Signs and Symptoms of Dystonia

• involuntary sustained muscle contraction causing abnormal ___ or ____ limited to one part of the body
• often limited to a particular activity
• can also be more generalized affecting multiple muscle groups/body segments

Answer 22

postures or twisting repetitive movements

Question 23

Prognosis of Dystonia- earlier onset=greater likelihood it ____

Answer 23

will progress

Question 24

Medical treatment of Dystonia= medication that affects acetylcholine or ____ levels, surgery on ____, or Botox into affected muscles in severe cases

Answer 24

dopamine

surgery on thalamus

Question 25

Therapy Treatment of Dystonia - limit _____ - avoid _____ - sensory retraining, biofeedback, mental rehearsal of target movement

Answer 25

- limit abnormal movements | - avoid heavy gripping of the offending object/instrument

Question 26

What disease affects synaptic transmission at the neuromuscular junction by producing antibodies to the nicotinic receptors on the muscle cell?

Answer 26

Myasthenia Gravis

Question 27

Myasthenia Gravis is ____ and affects women ages 20-30 and men ages 60-70.

Answer 27

autoimmune

Question 28

Signs and Symptoms of Myasthenia Gravis 1. ↑ ____ with repetitive muscle use 2. muscles that ____ frequently will be more affected- eye lids, eyes, facial expression, swallowing, proximal limb movement, respiration 3. Worse in the ____ than ____

Answer 28

1. weakness 2. contract 3. worse in the afternoon than morning

Question 29

What is the prognosis of Myasthenia Gravis? What is the therapy treatment?

Answer 29

stable with treatment gentle strengthening stretching aerobic activity w/o working client to significant fatigue

Question 30

Medical treatment of Myasthenia Gravis - drugs that ___ breakdown of acetylcholine - removal of the _____ - ______ drugs - plasmapheresis

Answer 30

inhibit thymus gland immunosuppressive

Question 31

What disease is a viral infection attacking anterior horn cells leading to muscular paralysis? Found in 20-40% of survivors.

Answer 31

Post-Polio Syndrome (PPS)

Question 32

_____ - giant motor units were made as pt originally recovered; as pt ages, motor units are lost- loss is compounded in this situation b/c they are larger than normal but fewer in number than typical person

Answer 32

PPS (Etiology)

Question 33

Signs and Symptoms of PPS 1. ____- overuse and deconditioning can contribute 2. ____- sweating, HA 3. ____- occurs in previously involved and new muscles

Answer 33

1. fatigue 2. autonomic distress 3. new weakness

Question 34

Signs and Symptoms of PPS 4. Pain can occur __ days after activity 5. ____-due to sympathetic involvement 6. ↑ ____- often have compensated to past deficits, but w/ new changes the compensations may no longer work

Answer 34

4. 1-2 5. cold intolerance 6. increased fall risk

Question 35

PPS- new weakness- occurs in previously involved & new muscles - asymmetric, ___>___, slowly progressive - responds well to ___ & ___ activity

Answer 35

- proximal > distal | - rest and pacing activities

Question 36

What is the prognosis of PPS? What is the medical treatment? What is the therapy treatment?

Answer 36

slowly progressive meds not effective lifestyle changes & exercise

Question 37

``` Therapy Treatment of PPS Lifestyle changes 1. ↓ ___& ___ stress 2. Protect ___ 3. Modify ______ 4. _____ aids 5. Weight loss & _____ ```

Answer 37

1. decrease physical and emotional stress 2. protect joints (esp if decreased strength of surrounding muscle) 3. modify work/home environment 4. mobility aids 5. energy conservation

Question 38

Therapy Treatment of PPS Exercise 1. ____, but avoid pushing past fatigue & pain a. ____- do not exceed 70-75% Max HR or 13 on BORG scale b. _____

Answer 38

1. strengthen a. conditioning b. aquatics