Degenerative Diseases

Question 1

List 2 characteristics of the early disease stage.

Answer 1

1. Minimal Impairments or functional limitations

2. No disabilities

Question 2

List 4 rehabilitation priorities for the early stage of disease.

Answer 2

1. Prevention (fitness and energy conservation)
2. Delaying the onset of movement disorders
3. Remediation: education/psychological support
4. Compensatory: Movement strategies, equipment, home modifications

Question 3

List 4 resources the PT can suggest to a patient in the early disease stage. Why is it important to recommend these resources?

Answer 3

1. Referral to speciality clinic
2. Register for clinical trial
3. Encourage contact and membership in state/national societies
4. Support groups

Why?: Empowers the patient to seek out information and support outside of PT.

Question 4

List 2 characteristics of the middle disease stage.

Answer 4

1. Increasing number and severity of impairments and functional limitations.
2. Some disabilities

Question 5

List 3 rehabilitation priorities for the middle stage of disease.

Answer 5

1. Prevention (fitness, energy conservation, and neuroprotection)
2. Remediation: Dystonia management and ROM
3. Compensatory: Bracing, splinting, care giver training, and AD prescription

Question 6

List 2 characteristics of the late disease stage.

Answer 6

1. Severe impairments

2. Complete disability

Question 7

List 3 rehabilitation priorities for the late stage of disease.

Answer 7

1. Compensatory: care giver training
2. Preventative: skin and pulmonary management, contracture prevention
3. Restorative: Palliative care

Question 8

What is the pathophysiology of multiple sclerosis? (2)

Answer 8

1. Inflammatory process causing patchy plaques on the myelin sheaths in CNS.
2. Reduces the speed and effectiveness of nerve transmission

Question 9

List the 4 criteria that make up the clinical diagnosis for MS.

Answer 9

1. Two or more central nervous system pathologies.
2. Two distinct episodes of nervous system dysfunction.
3. Diagnosed between 15-50 years of age with a majority diagnosed in their 30’s
4. Confirmed by CT scan or MRI

Question 10

List 4 factors that contribute to a FAVORABLE prognosis of MS.

Answer 10

1. Female
2. Onset of sxs before 35-40 years of age
3. No disability for 5 years
4. Initial signs and sxs: optic neuritis and sensory dysfunction

Question 11

List 1 factor that contributes to a UNFAVORABLE prognosis of MS.

Answer 11

1. Initial signs and sxs: Cerebellar and motor dysfunction

Question 12

________ is the most common pattern of MS where ____ % of cases remain benign.

Answer 12

Relapsing and Remitting

20%

Question 13

List 3 characteristics of relapsing and remitting MS.

Answer 13

1. Sudden onset of symptoms
2. Symptoms last days or weeks
3. Complete or partial disappearance of symptoms

Question 14

List 2 characteristics of primary progressive MS.

Answer 14

1. Continuous and gradual worsening of symptoms

2. No delineated exacerbations or periods of remission

Question 15

List 2 characteristics of secondary progressive MS.

Answer 15

1. Starts as Exacerbating and Remitting

2. Becomes progressive

Question 16

_____ is the most common symptom of MS, affecting _____ % of people.

Answer 16

Fatigue

70-95%

Question 17

Fatigue, relative to MS, occurs as a result of inefficient ______.

Answer 17

Nerve conduction

Question 18

List 4 PT management interventions used to manage fatigue in patients with MS.

Answer 18

1. Energy conservation
2. Schedule activity during higher energy times
3. Aerobic Exercise
4. Teach exertion perception concepts

Question 19

Why do patients with MS have decreased heat tolerance?

Answer 19

Increased heat increases the inflammatory process of the disease which could exacerbate symptoms

Question 20

List 2 PT management interventions used to manage decreased heat tolerance in patients with MS.

Answer 20

1. Education regarding: hydration, clothing management and cooling vests
2. Aquatic therapy

Question 21

List 3 interventions used to treat weakness in patients with MS.

Answer 21

1. Prevent disuse atrophy of un-effected muscles
2. Overcome spastic antagonists
3. Increase strength of afffected muscle groups

Question 22

Aerobic exercise is associated with higher levels of _______ integrity and _____ concentration in patients with MS.

Answer 22

Higher levels of white matter integrity

BDNF

Question 23

Huntington’s disease is characterized by neuronal loss in the _____ and ______.

Answer 23

Caudate nucleus

Putamen

Question 24

What is used to confirm a diagnosis of Huntington’s disease?

Answer 24

Genetic testing

Question 25

Symptoms of Huntington’s disease appear at ages _____ with a median survival rate of _____ years after symptom onset.

Answer 25

30-50 years of age 15-25 years = median survival rate after onset of sxs

Question 26

List 2 behavioral and 2 cognitive impairments associated with Huntington’s disease.

Answer 26

Behavioral impairments: Depression and irritability Cognitive impairments: Slow processing and decrease attention

Question 27

List 7 movement disorders characteristic of Huntington’s disease.

Answer 27

1. Difficulty modulating gait and bed mobility 2. Difficulty turning 3. Chorea of the hands, limbs and trunk (increases then decreases) 4. Dystonia 5. Hypokinesia 6. Bradykinesia 7. Hemiballismus

Question 28

List 4 treatment considerations used to treat Huntington’s disease.

Answer 28

1. Cognitive and sensory strategies as per PD 2. Balance retraining in early stages 3. ROM of spastic agonists 4. Strengthening of antagonists

Question 29

True or False: There is no evidence related to exercise having an impact on Huntington’s disease progression.

Answer 29

TRUE

Question 30

ALS is caused by the degeneration and death of both ______ in the ____ of the brain, the _____ and the _____.

Answer 30

Death of both motor neurons (upper and lower) In the motor cortex Brain stem Spinal cord

Question 31

List 2 things that are used to confirm a diagnosis of ALS.

Answer 31

1. Clinical: UMN and LMN signs | 2. MRI

Question 32

ALS has a ___ year survival rate with a median/mean survival rate of ____ years.

Answer 32

5-10 years | Mean: 2-4 years

Question 33

List 3 characteristics of a FAVORABLE ALS prognosis.

Answer 33

1. Age at onset under 40 2. Limb onset better than bulbar 3. Absence of dyspnea at onset

Question 34

List 3 characteristics to describe the course of ALS.

Answer 34

1. Initially manifests as weakness (sporadic and progressive) 2. Bulbar impairments (swallowing and speaking affected) 3. Cognitive sxs (fronto-temporal dementia)

Question 35

List 3 respiratory impairments that affect patients with ALS.

Answer 35

1. Initial Impairments present as fatigue and compensated for by activity limitation 2. 50% FVC –orthopnea, dyspnea at rest and ineffective cough 3. 25% FVC acidosis, coma, death

Question 36

List 3 treatment considerations used to treat patients with ALS.

Answer 36

1. Strength and Endurance Exercise in early stage 2. Supporting weak muscles - wrist and cervical spine extensors 3. Airway Clearance-Mechanical Insufflation-Exsufflation

Question 37

______ and ______ are common pathologies among patients with ALS.

Answer 37

Shoulder Hand Syndrome | Adhesive Capsulitis

Question 38

Aerobic exercise is associated with improved ____ measures in humans with ALS.

Answer 38

QOL

Question 39

_____ in every ____ people over 65 have Alzheimer’s disease.

Answer 39

1 in 9 | 11,000 in every 100,000

Question 40

How is a diagnosis of Alzheimer’s disease determined?

Answer 40

Cognitive decline and ruling out other causes

Question 41

The presence of _____ and _____ in the brain are characteristic of Alzheimer’s disease.

Answer 41

Amyloid plaques | Neurofibrillary tangles

Question 42

The amyloid core becomes surrounded by _____, _____, and other _______, representing ______ areas.

Answer 42

Fragmented axons Altered glial cells Cellular debris Represent nonfunctional areas

Question 43

Neurofibrillary tangles develop in the ______ cells, leading to _____ and _____.

Answer 43

Pyramidal cells Atrophy Necrosis

Question 44

The first structure to show pathological cognitive behavioral changes in ALS patients is the ______.

Answer 44

Cerebral cortex

Question 45

List 2 early signs of cognitive behavioral changes in patients with ALS.

Answer 45

1. Loss of ability to learn new information (declarative memory) 2. Spatial disorientation

Question 46

List 3 late signs of cognitive behavioral changes in patients with ALS.

Answer 46

1. Global memory loss 2. Loss of comprehension 3. Frontal lobe disinhibition

Question 47

The cognitive behavioral impairments associated with ALS are similar to those seen with ______.

Answer 47

Chronic traumatic encephalopathy (CTE)

Question 48

It is possible for even severely demented patients to acquire and retain ___________ memories.

Answer 48

Motor type procedural memories

Question 49

List 3 movement disorders that may be seen in patients with MS.

Answer 49

1. Akinsea 2. Dystonia 3. Rigidity

Question 50

The movement disorders seen in patients with ALS are similar to those seen in ______ and ______ Disease.

Answer 50

Parkinson’s | Huntington’s

Question 51

Exercise interventions improve _____ and decrease ____ and ______ in patients with Alzheimer’s and dementia.

Answer 51

Improve ADL function | Decrease fall risk and disease progression