Adult Neuro Flashcards

1
Q

Outline walking aid prescription for an individual with Parkinson’s

A

Walking Aid Use Restricting Normal Walking Patterns:
- When prescribing a walking aid, consider that the aid itself can alter the patient’s walking pattern.
- Example: a standard walker might lead to shorter steps or a narrower base of support.
- The chosen walking aid should not exacerbate these issues but should ideally support the patient in maintaining a more natural gait pattern as much as possible.

Motor-Planning Problems Complicating Aid Use:
- Some individuals may struggle with properly using a walking aid due to these motor-planning difficulties.
- When selecting a walking aid, it’s crucial to choose one that is intuitive and easy to use, as complex or challenging aids may further complicate mobility for these patients.

Reducing Falling Episodes:
- The choice of aid should provide stability, support, and a means to regain balance in case of stumbling or freezing.
- For example, rollators or canes with a wide base can offer enhanced stability.

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2
Q

Outline 3 strategies that can be taught to a patient with Parkinson’s to minimize freezing

A

Visual Cueing:
- Lines or patterns on the floor (parallel lines or a checkerboard pattern) in areas were freezing commonly occurs (doorways or narrow corridors).
- When approaches a visually marked area, focus their attention on stepping over or between the lines or squares.
- helps redirect their attention and facilitates movement initiation.

Auditory cueing:
- using rhythmic sounds to provide an auditory rhythm for walking
- I synchronize their steps with the auditory cues
- Music with a steady beat or, a portable metronome device or, counting steps aloud

“Big” Movements:
- Before attempting to walk, instruct the patient to consciously make big, exaggerated steps, lifting their feet high off the ground and taking longer strides.
- Once the patient is in motion, they can gradually transition to their normal gait pattern.

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3
Q

What treatment techniques can be used to treat rigidity in Parkinson’s?

A

Slow Rhythmical Trunk Rotations: Improves trunk mobility and reduces rigidity. Patients engage in controlled, deliberate movements to counteract stiffness.

Muscle Length Maintenance: passive or active stretching exercises to help patients maintain or improve their range of motion and reduce muscle stiffness. Physiotherapists should educate patients on how to perform these exercises at home independently.

Incorporating relaxation techniques, such as deep breathing and progressive muscle relaxation, help patients manage muscle tension and reduce the perception of rigidity.

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4
Q

Explain the importance and benefits of a home program for patients with Parkinson’s

A

Simple mobilizing techniques

Diaphragmatic breathing exercises
- Improved Respiratory Function: prevent respiratory infections and pneumonia
- Stress Reduction and relaxation

Pt should be made to understand the importance of continuing exercises at home
- Educating patients about the significance of home exercises empowers them to take control of their health.

Cost-Effective:
Home exercises are a cost-effective way to manage PD, particularly when compared to the expense of regular therapy sessions.

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5
Q

Describe three exercises that can be used to counteract the simian posture typical to Parkinson’s disease.

A
  • Repetitive exercises that facilitate a total extensor response e.g. cobra yoga pose
  • Shoulder horizontal abduction in prone at a cadence of 50-58.
  • Hang from an overhead bar for short periods.
  • Advise patient to lie in prone at night.
  • Visual input from a mirror to correct posture.
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6
Q

Discuss the principles of physiotherapy management for a patient with Parkinson’s disease who scores a grade 5 on the Yahr scale.

A
  • Maintain vital functions
  • Prevent pressure sores
  • Prevent contractures
  • Support carers/nurses
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7
Q

Explain why people with Parkinson’s struggle to stand up

A

Parkinson’s disease often leads to bradykinesia, which hinders the speed and efficiency of spontaneous and automatic movements needed to stand up from a chair due to delayed or weakened brain signals to the muscles.
Additionally, the stiffness and rigidity of muscles in Parkinson’s make it difficult to flex joints and use muscles effectively, essential for rising from a chair.
Furthermore, postural instability and balance problems in Parkinson’s affect the ability to maintain an upright position during the transition from sitting to standing, increasing the risk of falls due to a lack of coordination in these automatic movements.

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8
Q

Discuss the principles of physiotherapy management for a patient with Parkinson’s disease who scores a grade 3/4 on the Yahr scale.

A
  • Maintain or improve activities, especially:
  • Transfers: between a wheelchair and other surfaces, such as a bed or a chair.
  • Balance: reduce the risk of falls
  • Manual activities: reaching for objects, dressing etc.
  • Gait: gait pattern, step length, and walking speed.
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9
Q

Explain the physiotherapy management of a patient with Guillain-Barré syndrome during the acute phase of the disease

A
  • Respiratory care (ACBT, PD, Manual tech, Sxn..)
  • Musculoskeletal: Joint protection (e.g. AFO), Maintenance of joint movement (e.g. AP’s/PA’s – should know when to choose between the two) and soft tissue length
  • Skin: positioning & circulatory exercises
  • Circulation: Prevent DVT & Postural hypotension
  • Psychological support: family and patient
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10
Q

What are the signs and symptoms of postural hypotension in a patient with GBS?

A

Dizziness or lightheadedness: W
Fainting (syncope):
Blurred vision:
Nausea:
Weakness or fatigue:
Rapid heartbeat (tachycardia): In response to low blood pressure, the heart may beat faster to compensate.
Paleness or pallor:

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11
Q

Why does postural hypotension occur more frequently in GBS?

A

GBS often results in damage to the myelin sheath and nerve fibers in peripheral nerves. This damage can affect the transmission of signals from the brain to the autonomic nervous system, leading to impaired communication and coordination in response to postural changes.

In a healthy individual, when you stand up, the autonomic nervous system helps to constrict blood vessels and increase heart rate to maintain blood pressure and prevent a drop in oxygen supply to the brain. In GBS, the autonomic nervous system may be less effective at these compensatory mechanisms.

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12
Q

Discuss precautions that should be taken into consideration when treating a patient with Guillain Barré Syndrome.

A

Don’t Overstretch
Beware of Postural Hypotension (GBS can affect the autonomic nervous system, potentially leading to postural hypotension)
Don’t Exercise to the Point of Fatigue (Paradoxical weakening)
Autonomic Dysreflexia
Beware of Decreased Sensation
DVT (Deep Vein Thrombosis)

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13
Q

Outline Uhthoff’s phenomenon/syndrome

A

o Transient worsening of neurological function that can occur in multiple sclerosis patients due to increases in core body temperature
o An increase in body temperature can aggravate the decrease in conduction of nerve impulses
o Heat increases hydrolysis of acetylcholine, resulting in a reduced capacity for motor unit recruitment, ultimately causing muscle weakness and increased fatigue.
o This sensitivity can result from external sources like hot weather or internal factors such as exercise.

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14
Q

Explain the reasons for fatigue in a patient with MS

A

 Excessive fatigue after an activity
* Due to overuse of muscles because of reduced conduction velocity in the CNS and this decreased muscle strength
 Main reasons for fatigue:
* Working against spastic muscles: The effort required to overcome the resistance of spastic muscles during movement can be physically demanding
* Decreased nerve conduction due to decreased internodal distance
* Heat – hydrolysis of acetylcholine
* Weakness and poor endurance due to immobility/deconditioning etc

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15
Q

What bladder and bowel problems do people with MS have

A

o Stress and urge incontinence: upper motor neurons are damaged, leading to a loss of control and coordination of all muscles, including the ones responsible for bladder function. As these muscles become weaker and less coordinated, stress incontinence (leakage during activities that increase intra-abdominal pressure) and urge incontinence (sudden and uncontrollable urges to urinate) may occur.
o Urinary retention: leads to urinary tract infections which can trigger flexor spasms

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16
Q

Outline the general treatment principles of a patient with motor neuron disease (excluding orofacial management)

A
  • Depends on the disease stage; Management should be in line with patient’s expectations/wishes
  • Prophylactic physio for respiratory function
  • Positioning to maximise ventilation/perfusion
  • Clear secretions
  • Maintain ROM and muscle length
  • Minimise joint damage
  • Medical: Riluzole – to decrease glutamate activity
17
Q

Contractures are a common complication of upper motor neuron lesions.
Write short notes on the aetiology, prevention and management of contractures

A

Contractures are abnormal, permanent shortening of muscles and tendons that result in reduced joint mobility. They are a common complication of upper motor neuron lesions

Prevention of Contractures:
Range of Motion Exercises: Regularly moving and stretching affected joints and muscles through passive or active range of motion exercises can help prevent contractures.
Positioning: Proper positioning of the affected limbs and joints is essential. Maintaining a neutral or extended position can help minimize the risk of contractures.
Orthoses and Splints: Custom-made orthotic devices or splints can help maintain joint alignment and prevent contractures.

18
Q

Mr Anji was diagnosed with Motor Neuron Disease (MND) and now receives physiotherapy treatment. He presents with progressive bulbar palsy as a result of this MND. Discuss two oro-facial problems which he may present with as a result of the progressive bulbar palsy.

A
  • Swallowing
    o Results of difficulty swallowing:
     Drooling
     Aspiration
     Difficulty ingesting food – poor nutritional state – may need to use a nasogastric tube
    o N.B. Retrain normal swallowing as soon as possible
    o Requirements for normal swallowing:
     Jaw and lip closure
     Elevation of the posterior third of the tongue
     Elevation of the borders of the tongue
     The stimulus of something to swallow
     The sitting position
     Control of breathing in relation to swallowing
     Normal gag reflex
  • Facial expression:
    o Raising eyebrow
    o Closing eye
    o Retracting the lip
  • Ventilation
  • Motor aspects of speech production
  • Tearing due to lax lower eye lid
  • Drooling
19
Q

Discuss three primary goals of physiotherapy management for a patient with pseudo bulbar palsy in the terminal stage of motor neuron disease

A
  • Pseudobulbar Palsy – UMN
    Pseudobulbar palsy is characterized by dysarthria, dysphagia, facial and tongue weakness, and emotional lability

Terminal stage:
* Position changing
* Respiratory care
* Pressure care
* Back care for carers
* Advice on feeding positions and diet
* Counselling to patient and carer

20
Q

Motor Neuron Disease - common problems

A
  • Muscle weakness
    o Progressive loss of motor neurons
    o Can do strengthening as the issue is with innervation, not muscle
  • Increased/reduced tone
    o Spasticity: UMN
    o Flaccidity: LMN
  • Muscle shortening
    o Due to muscle weakness and disuse
    o Position dependent therefore frequent changes NB
  • Mobility problems
    o Widespread weakness
  • Respiratory & bulbar function
    o Reduced cough strength (respiratory muscle weakness): huffing
    o Dysphagia: difficulty swallowing - aspiration
  • Pain – from cramps, soft tissue damage and fasciculations
  • Usually there is no bladder and bowel involvement