Degenerative Neurologic Disorders Flashcards

1
Q

Be able to describe, as if speaking to a client, what is causing the symptoms of Multiple Sclerosis

A

Mayo Clinic: In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged.

Pedretti (pgs. 936-937): MS is a progressive, inflammatory neurologic disease that damages the myelin sheath of the central nervous system (CNS). The myelin sheath is the covering over our nerve fibers.

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2
Q

Be able to describe, as if speaking to a client, what is causing the symptoms of Parkinson’s Disease

A

There is a part of your brain called the substantia nigra and it plays an important role in collaborating with your body to help you move. This part of your brain undergoes significant deterioration as your disease progresses. Lewy bodies, or an accumulation of protein, form in your neurons and can disrupt the signals the nerves are trying to send. The reduction in dopaminergic neurons, or cells that communicate within this portion of your brain, causes a decrease of activity within another area of your brain called the basal ganglia, which is responsible for initiating movement. This process causes a reduction in “spontaneous” movement, which translates to your difficulty to walk or initiate movement, your tremors, and your slowness of movement.

Pedretti (pgs. 940-941): PD is a slowly progressive, degenerative movement disorder, characterized by dysfunction in voluntary & involuntary movements. It is due to the degeneration, or breakdown, of different structures in the brain. One of these brain structures is called the substantia nigra; within the substantia nigra are dopamine neurons – when there is a reduction of these dopamine neurons, there is a decrease in activity within the basal ganglia and an overall reduction in “spontaneous movement.” The basal ganglia is another brain structure associated with movements (repetitive & sub-conscious) along with motor commands, so it makes sense that some of the symptoms of this disease are difficulty initiating movement & slowness in maintaining movement. Not only is there a reduction in dopamine neurons, but Lewy bodies are also found in the brain, within the substantia nigra (abnormal collections of proteins that are found inside the nerve cells)

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3
Q

Be able to describe, as if speaking to a client, what is causing the symptoms of Alzheimer’s Disease

A

Many of the neurons in your brain die or lose the ability to communicate with other neurons. This is due to the accumulation of plaques, which are clumps of proteins that interfere with neuron communication, and tangles, which disrupt the nutrient transport system within your brain and lead to neuron death.

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4
Q

Be able to describe, as if speaking to a client, what is causing the symptoms of Amyotrophic Lateral Sclerosis (ALS)

A

While the exact cause of ALS is unknown, we do know that the motor neurons, or neurons that tell your muscles to move, are becoming destroyed in your spinal cord, brainstem, and motor cortex. All of these are areas of the brain that are related to voluntary or involuntary movement.

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5
Q

Be able to describe, as if speaking to a client, what is causing the symptoms of Huntington’s Disease

A

Degeneration of the areas of the brain that control voluntary and involuntary movement as well as cognitive and emotional functions

Pedretti (pgs. 932-933): HD is degenerative brain disorder that is characterized by progressive deterioration in both voluntary & involuntary movement. There is a structure in the brain called the corpus striatum (the caudate nucleus & the putamen comprise this structure) and it is involved with motor control – when this area deteriorates, chorea (rapid, involuntary, irregular movements) occurs. Degeneration of this brain structure results in decreased production of the neurotransmitter GABA. Emotional & cognitive impairments also occur; progressive loss of tissue actually occurs in these brain areas: frontal cortex, globus pallidus, & thalamus.

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6
Q

What is the typical age(s) of onset for MS?

A

Age at onset ranges from 15 to 60 yr, typically 20 to 40 yr; women are affected somewhat more often.

Pedretti (pg. 936): between ages of 20-45 years; some studies have found persons younger than 20 displaying MS symptoms

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7
Q

What is the typical age(s) of onset for Parkinson’s Disease?

A

55+

Prevalence increases with age; 55+ (1.4%); diagnosis most often made after the age of 60; prevalence of PD in men ages 55-74 is higher, but after the age of 74, women show slightly higher prevalence

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8
Q

What is the typical age(s) of onset for Alzheimer’s Disease?

A

65+ (13%)
85+ (40-50%)

30-40 early onset (uncommon)

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9
Q

What is the typical age(s) of onset for ALS?

A

between ages of 40-70 (avg. age 55)

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10
Q

What is the typical age(s) of onset for Huntington’s Disease?

A

age: 40

Pedretti (pg. 933): person usually experiences an onset of symptoms in his/her 30’s or 40’s, but there have been reported cases in teenage years and younger

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11
Q

Cognitive changes play a role in all of these neurological conditions, except which one?

A

ALS

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12
Q

What are the typical symptoms seen in the early stages of MS?

A
  • Paresthesias
  • Diplopia
  • Visual loss in one eye
  • Fatigue
  • Emotional lability
  • Sensory loss in extremities
  • Worsening of symptoms when temperature is elevated
  • Cognitive deficits in 30-70%
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13
Q

What are the typical symptoms seen in the advanced stages of MS?

A
  • Varying degrees of paralysis (total lower extremity paralysis to involvement of upper extremities)
  • Dysarthria, dysphagia
  • Severe visual impairment
  • Ataxia
  • Spasticity
  • Nystagmus
  • Neurogenic bladder
  • Impaired cognition
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14
Q

What are some OT assessment strategies for MS?

A
  • Occupational profile
  • Interviews, observation
  • Home eval
  • Instruments to assess occupational performance across SLAPWIRE
  • Special attention to: motor/praxis, sensory-perceptual, emotional reg, cognitive, and communication
  • The Modified Fatigue Scale
  • Fatigue Questionnaire
  • Perceptual processing and cognitive status should be reassessed periodically (helps decide how much supervision client needs)
  • Evaluation of cultural, social, & physical environment (generally hits “sandwich generation”)
  • Assessing performance patterns
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15
Q

What are some typical interventions for MS?

A

Could include…

  • Educate caregivers and client about disease and supports
  • Problem-solving compensatory strategies
  • Time & energy management
  • Role delegation
  • Using adaptive equipment to compensate for motor, sensory, endurance, cognitive, & visual deficits
  • Exercise program
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16
Q

What are the typical symptoms seen in the early stages (Stages I-II) of Parkinson’s?

A

I: Unilateral resting tremor, micrographia (tiny handwriting), poor endurance, fatigue

→ No impairment in functional abilities, but fatigue can affect performance

II: Bilateral motor disturbances, mild rigidity reported, difficulties with simultaneous tasks, difficulties with executive function, stooped posture but can ambulate independently

→ Client should think about pros & cons of remaining employed

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17
Q

What are some OT assessment strategies for the early stages (Stages I-II) of Parkinson’s?

A
  • Occupational profile to establish goals/priorities
  • Home evaluation
  • Ergonomic assessment
  • Evaluate energy levels as client performs ADLs/IADLs

II:

  • Assess ADLs and IADls (Activity analysis)
  • Driving assessment
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18
Q

What are some typical interventions for the early stages (Stages I-II) Parkinson’s?

A
  • Educate client/ family on course of disease & community resources
  • Work simplification for work/home
  • Taking rest breaks
  • Time management
  • Utensils w/ built-up handles

II:

  • Energy conservation for ADLs
  • Daily flexibility exercises (trunk rotation)
  • Alternatives for community mobility
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19
Q

What are the typical symptoms seen in the middle stages (Stages III-IV) of Parkinson’s?

A

III: Balance problems with delayed reactions, difficulties in skilled sequential tasks

→ Safety concerns while standing (showering, meal prep) & walking

IV: Fine motor control severely compromised, oral motor deficits

→ Significant deficits in completing ADLs (esp. dressing, feeding, hygiene)

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20
Q

What are some OT assessment strategies for the middle stages (Stages III-IV) of Parkinson’s?

A

III:

  • Home evaluation
  • Activity analysis

IV:

  • Feeding assessment (safety while eating)
  • Focus on assessing ADLs
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21
Q

What are some typical interventions for the middle stages (Stages III-IV) of Parkinson’s?

A

III:

  • Home mods (raised toilet seat, chairs w/ arms, remove throw rugs)
  • Visual cues & supports for sequential tasks
  • Rhythmic auditory stimulation, dancing to improve gait
  • Community mobility/resources

IV:

  • ADL adaptations, modifications
  • Changes in food textures
  • Oral-motor exercises
22
Q

What are the typical symptoms seen in the late stage (Stage V) of Parkinson’s?

A

V: Client severely compromised motorically, dependent with ADLs

→ Typically confined to w/c or bed, depends on others for most self-care activities

23
Q

What are some OT assessment strategies for the late stage (Stage V) of Parkinson’s?

A

V:

  • Environment analysis
  • Talk to caregivers about concerns
24
Q

What are some typical interventions for the late stage (Stage V) of Parkinson’s?

A

V:

  • Use of environmental controls to allow access to environment (ex: switches)
  • Positioning
  • Support for caregivers
25
Q

What are the typical symptoms seen in the early stage (Stage I: Very mild cognitive decline) of Alzheimer’s?

A
  • Feels loss of control, less spontaneous; may become more anxious & hostile if confronted with losses
  • Mild problems with memory and less initiative; difficulty in word choice, attention, comprehension; repetition; superficial conversations; mild probs with gnosis or praxis
  • Seems socially & physically intact except to intimates; decline in job performance
26
Q

What are the typical symptoms seen in the middle stage (Stage II: Mild to moderate decline/Stage III: Moderate to moderately severe decline, some difficulties involving physical status) of Alzheimer’s?

A

II: - Denial, anxious, hostile; withdrawal; possible paranoia;

  • Moderate memory loss with gaps in personal history and current events; decreased concentration; losing objects; difficulty problem-solving, learning new tasks; visuospatial deficits;
  • Inc. need for supervision; decreased sociability; mod. impairment in ADL/IADL; unemployed

III: - Reduced affect; sleep disturbances; hostile behavior; paranoia; delusions, agitation, violence possible;

  • Progressive memory loss of well-known material - some past history retained but unaware of recent events; disorientation to time and place; severe deficits in communication; apraxia & agnosia;
  • Slowed response; impaired visual and functional spatial orientation
  • Unable to perform most IADLs; assistance needed in ADLs; beginning signs of incontinence; wandering
27
Q

What are the typical symptoms seen in the late stage of Alzheimer’s?

A

IV: - Memory impairment severe; may forget family member’s names but still recognizes them; confused in familiar surroundings

  • Gait & balance disturbances; difficulty negotiating env. barriers; slow-moving
  • Communicating is difficult, often grunts or says single word; psychomotor skills deteriorate until unable to walk, eat; completely incontinent; usually client goes to nursing home
28
Q

What are some OT assessment strategies for the early stage (Stage I: Very mild cognitive decline) of Alzheimer’s?

A
  • Asking caregivers & staff informants to complete rating scales that assess occupational performance/ functional ability (ex: Functional Behavior Profile, Activity profile)
  • Interview staff, family members
  • Brief screening strategies for mental status (ex:Mini mental status (MMSE), clock drawing), depression, & anxiety
29
Q

What are some OT assessment strategies for the middle stage (Stage II: Mild to moderate decline/Stage III: Moderate to moderately severe decline, some difficulties involving physical status) of Alzheimer’s?

A

II & III: Scales to measure ADL/IADLs in relation to cognitive performance:

  • Kitchen Task Assessment
  • Executive Function Performance Test
  • Allen Cognitive Level
  • Cognitive Performance Test
  • Disability Assessment for Dementia
  • Independent Living Scales
30
Q

What are some OT assessment strategies for the late stage (stage IV) of Alzheimer’s?

A

IV: - Observation

  • Staff/family interviews
  • Assess safety while walking
  • Environmental assessment
31
Q

What are some interventions for the early stage (Stage I: very mild cognitive decline) of Alzheimer’s?

A
  • Empathize; help client identify challenging areas; encourage healthy habits
  • Help client & caregiver establish daily routine
  • Educate about disease & support groups
  • Identify needs/goals of caregiver
  • Identify appropriate environments, adapt for activities as needed
  • Use auditory, visual, & kinesthetic input when teaching a new task
32
Q

What are some interventions for the middle stage (Stage II: Mild to moderate decline/Stage III: Moderate to moderately severe decline, some difficulties involving physical status) of Alzheimer’s?

A

II: - Help caregiver maintain routines, environmental support, level of cueing
- Educate on outside resources (day care, public transport, etc.)
- Analyze & adapt meaningful productive activities
- Simplify instructions/
tasks
- Maintain socialization opportunities
- Use reality orientation activities & photo albums as reminder of the past
- Encourage stretching, walking, & other balance activities

III: - Educating/Training caregiver in managing problematic behaviors (ABCs) and in providing verbal cues & physical assistance

  • Maintain as much involvement in meaningful activity as possible
  • Maintain consistent routines!!!
  • Environmental management, ensuring it is safe
  • Environmental adaptations (ex: alarms, cabinet latches, identification bracelet, removing sharp devices)
33
Q

What are some interventions for the late stage (Stage I: very mild cognitive decline) of Alzheimer’s?

A

IV: - Encourage caregiver to use respite program

  • Encourage continued socialization by family
  • Instruct family or staff on need for simple communication, cues, and instructions
  • Use dysphagia techniques to promote swallowing, prevent choking, and encourage eating
  • Instruct family in transfer techniques
  • Positioning in bed & w/c
  • Provide sensory controlled stimulation
  • AROM, AAROM, PROM
34
Q

What are the typical symptoms seen in the early stages (Stages I-III Independent) of ALS?

A

I: - Mild weakness

  • Clumsiness, but still ambulatory
  • Independent in ADLs

II: - Moderate, selective weakness
- Slightly decreased indep. in ADLs (difficulty raising arms, climbing stairs, buttoning)

III:- Severe, selective weakness in ankles, wrists, & hands

  • Moderately decreased indep. in ADLs
  • Easy fatigue with long-distance walks
  • Slight increased respiratory effort
35
Q

What are some OT assessment strategies for the early stages (Stages I-III Independent) of ALS?

A

I: - Occupational profile

  • Interview with client
  • ROM, MMT (?)

II: - Activity Analysis: assess self-care, work, & leisure skills
- Perform baseline dysphagia eval (re-evaluate thru dz)

III: - W/C assessment (power may be best)
- Reassess for AE

36
Q

What are some typical interventions for the early stages (Stages I-III Independent) of ALS?

A

I: - Energy conservation

  • Educate about prognosis and resources
  • Begin ROM program (stretch, tai chi, yoga)
  • Strengthening program (careful with fatigue)

II: - Adapt tasks (button hook, reacher, built-up utensils, shower seat, grab bar)

  • Consider orthotic support
  • Continue stretching
  • Cautious strengthening of mm. above 3+

III: - Help client prioritize activities, simplify tasks

  • Adapt use of communicative devices (ex: typing aid)
  • Discuss need for home mods (ex: ramp, bed on 1st floor)
  • Deep-breathing exercises, chest stretching
  • Psychological support continued
37
Q

What are the typical symptoms seen in the middle stages (Stages IV-V Partially Independent) of ALS?

A

IV: - Hanging-arm syndrome w/ shoulder pain & edema in hand

  • W/C dependent
  • Severe LE weakness (can have spasticity)
  • Can perform some ADLs but fatigues easily

V: - Severe LE weakness, mod to severe UE weakness

  • W/C dependent
  • Increasingly dependent in ADLs
  • Risk for skin breakdown
38
Q

What are some OT assessment strategies for the middle stages (Stages IV-V Partially Independent) of ALS?

A

IV: - Evaluate need for arm or overhead slings, mobile arm supports (eating, typing, pg. turning)
- Evaluate need for AT (aug comm, voice-activated controls)

V: - Evaluate need for mechanical lift, electric hospital bed, specific environmental controls

39
Q

What are some typical interventions for the middle stages (Stages IV-V Partially Independent) of ALS?

A

IV: - Prescribe a power W/C

  • Pain & spasm management (heat, massage, antiedema measures, AAROM or PROM, isometric contraction)
  • Help client prioritize tasks, consider negotiating roles with significant others
  • Assist with ability to participate in closure activities (writing letters, making tapes, write life history, update will)

V: - Train caregivers in assisting with self-care, transfers, positioning, use of mechanical lift, skin inspection techniques, electric hospital bed, antipressure device

  • Adapt & select essential controls for phone, TV, stereo
  • Adapt WC for respiratory unit
40
Q

What are the typical symptoms seen in the late stages (Stage VI Dependent) of ALS?

A

VI: - Dependent, with all positioning in bed or W/C

  • Completely dependent in all ADLs
  • Extreme fatigue
  • Possibly ventilator dependent
41
Q

What are some OT assessment strategies for the late stages (Stage VI Dependent) of ALS?

A

VI: - Evaluate for dysphagia/need for tube feeding

- Evaluate aug comm methods

42
Q

What are some typical interventions for the late stages (Stage VI Dependent) of ALS?

A

VI: - Recommend appropriate diet, possibly suction machine to prevent aspiration

  • Aug comm devices
  • Continue PROM
  • Sensory stim with massage and skin care
43
Q

What are some typical symptoms seen in the early stage of Huntington’s?

A
  • Alterations in behavior (irritability, depression)
  • Changes in cognitive function (forgetful, difficulty concentrating)
  • Choreiform hand movements (often mask by manipulating small objects with hands)
  • Difficulty with work
44
Q

What are some OT assessment strategies for the early stage of Huntington’s?

A
  • Worksite Eval
  • Activity analysis
  • Evaluate need for AT
45
Q

What are some typical interventions for the early stage of Huntington’s?

A
  • Address cognitive components of memory and concentration (checklists)
  • Create routines
  • Task anaylsis to break down tasks to manageable steps
  • AT
  • Family education; -Reduce extraneous stimuli
  • Maintain social interactions
  • Modifications to diminish the effect of chorea and fine motor incoordination
46
Q

What are some typical symptoms seen in the middle stage of Huntington’s?

A
  • Cognitive and emotional abilities continue to deteriorate
  • Usually, dismissal from work
  • Mental calculations, sequencing, and memory worsens
  • Depression worsens, potential for suicide (frequently in psyc hospital)
  • Chorea more severe (entire body, face)
  • Staggering gait, poor balance
  • Bradykinesia, akinesia
  • Distorted handwriting
  • Distorted occular pursuits
  • Dysphagia, slight dysarthria
47
Q

What are some OT assessment strategies for the middle stage of Huntington’s?

A
  • Walker/ wheelchair eval

- Home eval

48
Q

What are some typical interventions for the middle stage of Huntington’s?

A
  • Establish and maintain meaningful habits & routines
  • Person will probably resign from job; engagement in purposeful activities should be encouraged - Encourage family involvement
  • Home mods
  • Walker/wheelchair
  • Compensatory strategies for memory deterioration
  • Energy conservation
  • Implement higher calorie diet – 5 meals/day
  • Positioning during feeding
49
Q

What are some typical symptoms seen in the late stage of Huntington’s?

A
  • Hypertonicity, rigidity replace chorea
  • Severe reduction in voluntary movements
  • Severe difficulty with eye movement
  • Dysarthria
  • Needs sig. assistance in walking, talking, & ADLs
50
Q

What are some OT assessment strategies for the late stage of Huntington’s?

A
  • Evaluate for dysphagia
  • Home eval
  • ROM (splinting)
51
Q

What are some typical interventions for the late stage of Huntington’s?

A
  • Splinting to prevent contractures
  • ADL’s and feeding provided by others
  • Environmental controls to allow control of and access to environment; touch pad for TV, etc;
  • Encourage routines to decrease emotional outbursts