Degenerative Diseases Flashcards
List 2 characteristics of the early disease stage.
- Minimal Impairments or functional limitations
2. No disabilities
List 4 rehabilitation priorities for the early stage of disease.
- Prevention (fitness and energy conservation)
- Delaying the onset of movement disorders
- Remediation: education/psychological support
- Compensatory: Movement strategies, equipment, home modifications
List 4 resources the PT can suggest to a patient in the early disease stage. Why is it important to recommend these resources?
- Referral to speciality clinic
- Register for clinical trial
- Encourage contact and membership in state/national societies
- Support groups
Why?: Empowers the patient to seek out information and support outside of PT.
List 2 characteristics of the middle disease stage.
- Increasing number and severity of impairments and functional limitations.
- Some disabilities
List 3 rehabilitation priorities for the middle stage of disease.
- Prevention (fitness, energy conservation, and neuroprotection)
- Remediation: Dystonia management and ROM
- Compensatory: Bracing, splinting, care giver training, and AD prescription
List 2 characteristics of the late disease stage.
- Severe impairments
2. Complete disability
List 3 rehabilitation priorities for the late stage of disease.
- Compensatory: care giver training
- Preventative: skin and pulmonary management, contracture prevention
- Restorative: Palliative care
What is the pathophysiology of multiple sclerosis? (2)
- Inflammatory process causing patchy plaques on the myelin sheaths in CNS.
- Reduces the speed and effectiveness of nerve transmission
List the 4 criteria that make up the clinical diagnosis for MS.
- Two or more central nervous system pathologies.
- Two distinct episodes of nervous system dysfunction.
- Diagnosed between 15-50 years of age with a majority diagnosed in their 30’s
- Confirmed by CT scan or MRI
List 4 factors that contribute to a FAVORABLE prognosis of MS.
- Female
- Onset of sxs before 35-40 years of age
- No disability for 5 years
- Initial signs and sxs: optic neuritis and sensory dysfunction
List 1 factor that contributes to a UNFAVORABLE prognosis of MS.
- Initial signs and sxs: Cerebellar and motor dysfunction
________ is the most common pattern of MS where ____ % of cases remain benign.
Relapsing and Remitting
20%
List 3 characteristics of relapsing and remitting MS.
- Sudden onset of symptoms
- Symptoms last days or weeks
- Complete or partial disappearance of symptoms
List 2 characteristics of primary progressive MS.
- Continuous and gradual worsening of symptoms
2. No delineated exacerbations or periods of remission
List 2 characteristics of secondary progressive MS.
- Starts as Exacerbating and Remitting
2. Becomes progressive
_____ is the most common symptom of MS, affecting _____ % of people.
Fatigue
70-95%
Fatigue, relative to MS, occurs as a result of inefficient ______.
Nerve conduction
List 4 PT management interventions used to manage fatigue in patients with MS.
- Energy conservation
- Schedule activity during higher energy times
- Aerobic Exercise
- Teach exertion perception concepts
Why do patients with MS have decreased heat tolerance?
Increased heat increases the inflammatory process of the disease which could exacerbate symptoms
List 2 PT management interventions used to manage decreased heat tolerance in patients with MS.
- Education regarding: hydration, clothing management and cooling vests
- Aquatic therapy
List 3 interventions used to treat weakness in patients with MS.
- Prevent disuse atrophy of un-effected muscles
- Overcome spastic antagonists
- Increase strength of afffected muscle groups
Aerobic exercise is associated with higher levels of _______ integrity and _____ concentration in patients with MS.
Higher levels of white matter integrity
BDNF
Huntington’s disease is characterized by neuronal loss in the _____ and ______.
Caudate nucleus
Putamen
What is used to confirm a diagnosis of Huntington’s disease?
Genetic testing
Symptoms of Huntington’s disease appear at ages _____ with a median survival rate of _____ years after symptom onset.
30-50 years of age
15-25 years = median survival rate after onset of sxs
List 2 behavioral and 2 cognitive impairments associated with Huntington’s disease.
Behavioral impairments: Depression and irritability
Cognitive impairments: Slow processing and decrease attention
List 7 movement disorders characteristic of Huntington’s disease.
- Difficulty modulating gait and bed mobility
- Difficulty turning
- Chorea of the hands, limbs and trunk (increases then decreases)
- Dystonia
- Hypokinesia
- Bradykinesia
- Hemiballismus
List 4 treatment considerations used to treat Huntington’s disease.
- Cognitive and sensory strategies as per PD
- Balance retraining in early stages
- ROM of spastic agonists
- Strengthening of antagonists
True or False: There is no evidence related to exercise having an impact on Huntington’s disease progression.
TRUE
ALS is caused by the degeneration and death of both ______ in the ____ of the brain, the _____ and the _____.
Death of both motor neurons (upper and lower)
In the motor cortex
Brain stem
Spinal cord
List 2 things that are used to confirm a diagnosis of ALS.
- Clinical: UMN and LMN signs
2. MRI
ALS has a ___ year survival rate with a median/mean survival rate of ____ years.
5-10 years
Mean: 2-4 years
List 3 characteristics of a FAVORABLE ALS prognosis.
- Age at onset under 40
- Limb onset better than bulbar
- Absence of dyspnea at onset
List 3 characteristics to describe the course of ALS.
- Initially manifests as weakness (sporadic and progressive)
- Bulbar impairments (swallowing and speaking affected)
- Cognitive sxs (fronto-temporal dementia)
List 3 respiratory impairments that affect patients with ALS.
- Initial Impairments present as fatigue and compensated for by activity limitation
- 50% FVC –orthopnea, dyspnea at rest and ineffective cough
- 25% FVC acidosis, coma, death
List 3 treatment considerations used to treat patients with ALS.
- Strength and Endurance Exercise in early stage
- Supporting weak muscles - wrist and cervical spine extensors
- Airway Clearance-Mechanical Insufflation-Exsufflation
______ and ______ are common pathologies among patients with ALS.
Shoulder Hand Syndrome
Adhesive Capsulitis
Aerobic exercise is associated with improved ____ measures in humans with ALS.
QOL
_____ in every ____ people over 65 have Alzheimer’s disease.
1 in 9
11,000 in every 100,000
How is a diagnosis of Alzheimer’s disease determined?
Cognitive decline and ruling out other causes
The presence of _____ and _____ in the brain are characteristic of Alzheimer’s disease.
Amyloid plaques
Neurofibrillary tangles
The amyloid core becomes surrounded by _____, _____, and other _______, representing ______ areas.
Fragmented axons
Altered glial cells
Cellular debris
Represent nonfunctional areas
Neurofibrillary tangles develop in the ______ cells, leading to _____ and _____.
Pyramidal cells
Atrophy
Necrosis
The first structure to show pathological cognitive behavioral changes in ALS patients is the ______.
Cerebral cortex
List 2 early signs of cognitive behavioral changes in patients with ALS.
- Loss of ability to learn new information (declarative memory)
- Spatial disorientation
List 3 late signs of cognitive behavioral changes in patients with ALS.
- Global memory loss
- Loss of comprehension
- Frontal lobe disinhibition
The cognitive behavioral impairments associated with ALS are similar to those seen with ______.
Chronic traumatic encephalopathy (CTE)
It is possible for even severely dementedpatients to acquire and retain ___________ memories.
Motor type procedural memories
List 3 movement disorders that may be seen in patients with MS.
- Akinsea
- Dystonia
- Rigidity
The movement disorders seen in patients with ALS are similar to those seen in ______ and ______ Disease.
Parkinson’s
Huntington’s
Exercise interventions improve _____ and decrease ____ and ______ in patients with Alzheimer’s and dementia.
Improve ADL function
Decrease fall risk and disease progression
