Diagnoses Flashcards
1
Q
What is autism?
A
Neurodevelopmental condition that includes social communication and interaction deficits as well as repetitive patterns of behavior and interests.
2
Q
What is social emotional reciprocity?
A
Social emotional reciprocity is one type of social interaction deficit. Challenges can include difficulties with sharing, participating in the back and forth of conversational exchange, and joint attention.
Joint attention is when two individuals use gestures or eye gaze to share focus on the same object or event.
3
Q
What are social communication differences?
A
Social communication differences commonly include echolalia, one example of unconventional verbal behavior in which the individual repeats words and phrases heard from digital sources or people in their lives. In autism, echolalia may or may not have communicative meaning.
4
Q
What is intellectual disability?
A
ID is characterized by deficits in intellectual functions that can vary in severity. These include reasoning, problem-solving, planning, abstract thinking, judgement, academic learning, and learning from experience.
These deficits lead to impairments in adaptive functioning that can impact personal, social, academic, and/or occupational functioning.
5
Q
What is global developmental delay?
A
when an individual fails to meet expected developmental milestones in several areas of intellectual functioning
6
Q
Describe mild intellectual disability.
A
Slowed development, modest difficulty in school
Higher level executive functioning
May sustain jobs
Individuals can often live independently with minimal support.
7
Q
Describe moderate intellectual disability.
A
Can be independent in self-care
Difficulty interpreting social cues
Academic skills are significantly lower than peers
Communication is less complex
Extensive teaching and cuing supports are needed.
Environmental and visual cuing systems can help with communication, memory, and sequencing.
8
Q
Describe severe intellectual disability.
A
Limited attainment of conceptual skills and cannot read or manipulate numbers
Communication is focused on the present
Understands simple speech and gestures
Speaks with limited vocab and grammar
Requires full time supervision
Significant support for all ADLs
9
Q
Describe profound intellectual disability.
A
Dependent in ADLs
Nonverbal and non-symbolic communication and social interaction
May follow 1-2 step actions
Often co-ocuring with physical and sensory conditions
Caregiving support for all ADLs
10
Q
What impact does ID have on sensory and motor functions?
A
Sensory functions, such as vision and hearing, are often compromised for people with intellectual disabilities.
Locomotor skills, postural balance, and object manipulation are often slower for individuals with an intellectual disability.
11
Q
What is ADHD?
A
People with ADHD typically exhibit behaviors that are classified into two main categories: (1) poor sustained attention and (2) hyperactivity-impulsivity.
12
Q
A comprehensive OT intervention for ADHD focuses on…
A
sensorineural, cognitive, motor, and psychosocial functions, and combined with the awareness of lifestyle considerations in medication management can provide a dynamic perspective to clients, their families, and their various treatment, educational, or vocational resources
13
Q
What are neurodevelopmental disorders?
A
A group of conditions with onset in the developmental period
14
Q
What is language disorder?
A
Reduced vocabulary, limited sentence structure, impairments in discourse
15
Q
What is speech sound disorder?
A
Difficulty with speech sound production causing limits in effective communication.
16
Q
What is social (pragmatic) communication disorder?
A
Difficulties in the social use of verbal and nonverbal communication resulting in functional limitations.
17
Q
What is childhood-onset fluency disorder (stuttering)?
A
Disturbances in fluency and time patterning of speech (repetitions, prolongations, broken words, blocking)
18
Q
What is developmental coordination disorder?
A
characterized by deficits in the acquisition and execution of coordinated motor skills and is manifested by clumsiness and slowness or inaccuracy of performance of motor skills that cause interference with ADLs.
19
Q
What is stereotypic movement disorder?
A
diagnosed when an individual has repetitive, seemingly driven, and apparently purposeless motor behaviors (hand flapping, body rocking, head banging, self-biting, hitting)
20
Q
What are tics?
A
sudden, rapid, recurrent, nonrhythmic, motor movements or vocalizations
21
Q
What is tourette’s disorder?
A
motor and vocal tics persisting for more than 1 year
22
Q
What is pica?
A
The label for behavior involved in eating nonfood.
Examples: dirt, coins, articles of clothing, etc.
Often occurs in context of a developmental disability.
23
Q
What is rumination disorder?
A
Occasionally adults are diagnosed—typically in those with ID.
Diagnostic criteria: repeated regurgitation over at least 1 month.
The only specifier is whether the condition is in remission; must be distinguished from medical conditions that might explain the symptoms (such as anorexia or bulimia).
May result in failure to thrive, anemia, and other medical conditions that may affect the infant’s developmental progress
24
Q
What is anorexia nervosa?
A
Often associated w/ disturbances of body image–perception that one is distressingly large despite obvious thinness.
Disorder in which persons refuse to maintain a minimally normal weight, intensely fear gaining weight, and significantly misinterpret their body and its shape.
25
What enuresis?
Inability or unwillingness to control urination.
26
What is encopresis?
Term is used to describe withholding feces and ignoring the need to defecate.
After ignoring the need, they eventually lose the ability to recognize the impulse.
27
What is a depressive disorder?
As a group, these are characterized by “sad, empty, or irritable mood.”
Symptoms in this cluster of disorders include somatic and cognitive changes which typically affect an individual’s ability to function.
Depressed mood is characteristic of all these disorders.
Distinctions: severity, duration of episodes, degree of chronicity, and presumed etiology
28
What is major depressive disorder?
Major depressive episodes characterize both the bipolar and depressive disorders.
For a diagnosis of, the individual must show 5 symptoms that include depressed mood or anhedonia and four other manifestations of depression. May include:
- Weight loss.
- Insomnia or hypersomnia almost every day.
- Fatigue or lack of energy.
- Feelings of guilt or worthlessness.
- Difficulty concentrating.
- Repeated suicidal ideation.
The symptoms must cause distress and dysfunction. They must be distinguished from grief following a loss and must occur almost daily for 2 weeks.
29
What is dysthymia (persistent depressive disorder)?
Is more chronic but typically less severe than major depressive disorder.
Diagnostic criteria: appetite changes, poor sleep, fatigue, low self-esteem, difficulty concentrating, and feelings of hopelessness.
30
What is premenstrual dysphoric disorder?
5 or more symptoms before and during menses: emotional lability (emotions all over the place), irritability, depressed mood, anxiety, decreased interest in activities, poor concentration, lethargy, changes in appetite and sleep, feelings of being overwhelmed or out of control, and physical symptoms.
Condition must interfere with individual’s daily function.
31
What is seasonal affective disorder?
Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year.
32
What is disruptive mood dysregulation?
Refers to presence of symptoms (persistent irritability and frequent episodes of extreme behavioral dysfunction/dyscontrol) for children up to 12 years of age
33
What are symptoms of anxiety?
Emotional: feeling uneasy, overwhelmed, helpless and out of control.
Physiological: cardiovascular, GI, respiratory, urinary, genital, autonomic, muscular
Cognitive: confusion, poor memory, loss of perspective, obsessive thoughts, poor problem solving.
Behavioral: looks preoccupied, immobile, overactive, restless, excess, or decreased consumption of substances/foods, rituals to alleviate anxiety.
34
What is selective mutism?
Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings.
The majority of these children have a genetic predisposition to anxiety.
35
What is a panic attack?
4 or more symptoms in 10 minutes
- cardiac symptoms
- trembling
- shortness of breath
- feeling of suffocation
- chest pain
- sensations of choking
- nausea
- dizziness
- derealization
- paresthesia
- chills
- hot flashes
- fear of losing control
36
What is OCD?
Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
37
What are obsessions?
Obsessions: uncontrollable, reoccurring thoughts or mental images that cause anxiety.
38
What are compulsions?
Compulsions: uncontrollable, reoccurring behaviors in response to an obsessive thought.
39
What is the diagnostic criteria for body dysmorphic disorder?
Preoccupation with one or more perceived defects/flaws in physical appearance
During course, individual has performed repetitive behaviors (mirror checking, skin picking, excessive grooming) or mental acts (comparing appearance to that of others) in response to appearance concerns.
40
What is body dysmorphia?
Consists of preoccupation with the idea that one’s body is too small or insufficiently lean or muscular.
Majority tends to diet, exercise, and/or lift weights excessively, sometimes causing bodily damage.
41
What is bipolar I disorder?
Represents the classic manic-depressive disorder (affective psychosis)
42
What is bipolar II disorder?
Requires at least one episode of major depression and at least one hypomanic episode.
43
What is cyclothymic disorder?
Diagnosis given to adults who experience at least 2 years of hypomanic and depressive periods without fulfilling the criteria for mania, hypomania, or major depression.
44
What is mania?
Mania is a mood state characterized by period of at least one week where an elevated, expansive, or unusually irritable mood exists.
45
What is a manic episode?
A distinct period during which there is an abnormally, persistently, elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for at least 1 week
46
What are hypomanic episodes?
Associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
47
Persecutory delusions
belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group
48
Referential delusions
belief that certain gestures, comments, environmental cues, and so forth are directed at oneself.
49
Grandiose delusions
when an individual believes that he or she has exceptional abilities, wealth, or fame
50
Erotomanic delusions
when an individual believes falsely that another person is in love with him or her
51
Nihilistic delusions
involve the conviction that a major catastrophe will occur
52
Somatic delusions
focus on preoccupations regarding health and organ function
53
What are hallucinations?
Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders.
54
What are delusions?
Fixed beliefs that are not amenable to change considering conflicting evidence.
55
Avolition
A decrease in motivated self-initiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities.
56
Alogia
Diminished speech output
57
Anhedonia
Decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced
58
Asociality
The apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions
59
What is schizophrenia?
To meet the criteria for schizophrenia, an individual must exhibit at least two of the following symptoms for at least 1 month:
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms.
At least one of the two symptoms must be delusions, hallucinations, or disorganized speech.
In addition, there must be a marked decline in functioning.
60
Psychotic schizophrenia
hallucinations, delusions
61
Disorganized schizophrenia
disorganized speech, disorganized or bizarre behavior, inappropriate affect
62
Negative schizophrenia
alogia, flat affect, avolition, anhedonia, attentional impairment
63
Affective schizophrenia
manic, depressive
64
What are schizoaffective disorders?
Schizoaffective disorder is characterized by a combination of psychotic and mood symptoms. For someone to receive a diagnosis of schizoaffective disorder, criteria must be met for a mood episode as well as criteria for schizophrenia.
65
What is the diagnostic criteria for reactive attachment disorder?
Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregiver manifested by child rarely seeking comfort when distressed or rarely responding to comfort when distressed
The disturbance is evident before age 5 years
The child has a developmental age of at least 9 months
66
What is disinhibited social engagement disorder?
A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
- Reduced/absent reticence in approaching or interacting with unfamiliar adults
- Overly familiar verbal or physical behavior (not within culturally or age appropriate bounds)
- Diminished or absent checking back with adult after venturing away, even in unfamiliar settings
- Willingness to go off with an unfamiliar adult with minimal or no hesitation
67
What is the diagnostic criteria for PTSD?
Adults, adolescents, and children older than 6
Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more way
68
What is the diagnostic criteria for acute stress disorder?
Exposure to actual or threatened death, serious injury, or sexual violation in 1 or more way
Presence of 9 or more symptoms from the 5 categories below
- Intrusion symptoms
- Negative mood
- Dissociative symptoms
- Avoidance symptoms
- Arousal symptoms
69
Dissociative disorders are characterized by…
an involuntary escape from reality or a disconnection between thoughts, identity, consciousness and memory.
70
What is dissociative amnesia?
Main symptom is difficulty remembering important information about one’s self
This amnesia may be localized (i.e., an event or period of time), selective (i.e., a specific aspect of an event), or generalized (i.e., identity and life history).
71
What is depersonalization disorder?
Involves ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie
72
What is dissociative identity disorder?
Formerly known as multiple personality disorder
Alternating between multiple identities
Often these identities may have unique names, characteristics, mannerisms and voices
Characterized by a) the presence of two or more distinct personality states or an experience of possession and b) recurrent episodes of amnesia
73
What is a somatic disorder?
A mental disorder with persistent and clinically somatic complaints
This is coupled with excessive thoughts, feelings and rash behaviors about the symptoms
Ranges from mild to severe
Somatic means body
74
What is conversion disorder (hysteria)?
a condition in which a person experiences physical and sensory problems, such as paralysis, numbness, blindness, deafness or seizures, with no underlying neurologic pathology
75
What is factitious disorder?
Factitious disorder is a condition in which a patient intentionally falsifies medical or psychiatric symptoms. Symptoms can be self-induced or fabricated.
76
What is muscle dysmorphia?
Also referred to as Bigorexia, muscle dysmorphia is a subtype of BDD. It is characterized by the preoccupation with the idea that one’s body is not sufficiently lean and muscular
77
What is hoarding?
People with hoarding disorder have persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items. Attempts to part with possessions create considerable distress and lead to decisions to save them. The resulting clutter disrupts the ability to use living spaces.
78
What is trichotillomania?
also known as trich, is when someone cannot resist the urge to pull out their hair. They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes. Trich is more common in teenagers and young adults.
79
What is excoriation?
characterized by the conscious repetitive picking of skin that leads to skin lesions and significant distress or functional impairment.
80
What is a disruptive behavior disorder?
These disorders are all characterized by problems in self-control of emotions and behaviors.
81
How is ODD diagnosed?
Individuals with disorder often justify their behavior as a response to unreasonable demands or circumstances.
Disturbance in behavior is associated with distress in the individual or others in immediate social context (family, peer group, work colleagues) or it impacts negatively on social, educational, occupational, or other important areas of functioning.
82
What is the diagnostic criteria for conduct disorder?
Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by at least 3 of the following 15 criteria in the past 12 months from any of the categories listed, with at least 1 present in the past 6 months:
- Aggression to people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
83
Neurocognitive Disorders (NCD)
Neurocognitive disability resulting from an underlying neurological cause
Delirium
- Short term disorientation or psychosis
- Can be brought on by high fever and UTI
Hypoactive (stunned), Hyperactive (agitated) or Mixed
One or more declines in:
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual motor
- Social cognition
Modest decline that requires compensatory strategies and accommodations
- May or may not turn into Major NCD
Intervention:
Assure appropriate diagnosis
Psychoeducation of patient and family is key in association with medical management.
Manage behavior and cognitive decline
- Routines, adaptations, reactions of others
Promoting ADLS
Caregiver support
Pharmacology
84
Frontotemporal Disease
Formally called pick disease
Behavioral Variant
- Loss of sympathy, apathy or inertia
- Compulsive/ritual behavior
- Extreme behavioral changes
- Decline in social cognition and executive ability
Language Variant
- Decline in language
* Speech production
* Word finding
* Object naming
* Grammar
* Comprehension
Both retain learning, memory and perceptual motor skills
85
Lewy body disease
Abnormal deposits of alpha-synuclein protein called Lewy bodies
- Blocks dopamine and acetylcholine
Changes in attention, emotions, movement and sleep
Hallucinations
Learning difficulty, memory later
Misdiagnosed as Alzheimer’s or Parkinson’s
86
Vascular dementia
Due to decreased vascular supply
87
Illness anxiety disorder
Fear of getting a disorder
Insist on X-Ray, MRI, Blood work
Previous illness or family illness
Hypochondriasis- over attention but can be swayed
88
Conversion disorder
Also called Functional Neurological Symptom Disorder or Psychogenic Disorder
Tremors, tick, dystonic movements
“cause and effect”
- begins shaking when husband gets mad and thinks she has parkinson’s
89
Rumination
Rarest eating disorder
Like a bird
Regurgitation and reswallow
Not able to control
very rare, no real numbers
90
Avoidant/restrictive food intake disorder
May be due to sensory issues
May severely limit the type of food
Not weight driven
- Sensory, emotional, unpleasant experience, belief
Start as perfectly normal diets
91
Substance use disorder
Irreversible brain circuit changes
Behavioral relapse
Strong cravings
Intoxications: temporary state of high- with problematic behavior
Withdrawal: symptoms immediately following the stoppage of a substance that impact function
92
Substance induced disorders
Disorders that are typically reversible if the substance is stopped
Severe but temporary
Symptoms disappear after a month or so
They include:
- Intoxication
- Withdrawal
- Psychotic disorders
- Depressive disorders
- Sleep disorders
- Sexual disorders
- Anxiety disorders
- Medication Induced Disorders
93
Chronic fatigue syndrome
Extreme fatigue lasting for at least 6 months and can’t be explained by any other medical cause
Symptoms:
- Post-exertional malaise
- Unrefreshing sleep
- Brain fog
- Muscle and joint pain
- Headache and light sensitivity
- Chills
- Stomach pain, bloating, nausea
- Sinus problems, swollen glands, tender lymph nodes, sore throat
94
Fibromyalgia
Often triggered by physical or emotional stress
If you have lupus or rheumatoid arthritis (RA), you are more likely to develop fibromyalgia.
Symptoms:
- Fatigue, cognitive and memory problems, headaches, diziness, trouble sleeping
- Vision problems
- Tender points
- Nausea
- Urinary problems, dysmenorrhea in women
- Restless leg syndrome
- Joint pain and stiffness
- Skin problems
- Muscle pain
- Jaw pain
95
Carpal tunnel
Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.
Causes numbness and tingling
96
Tendonitis
Micro tear from lifting off the bone
Types:
- Epicondylitis
- Lateral: tennis
- Medial: golfers
97
DeQuervain’s Tenosynovitis
Affects abductor pollicis longus and extensor pollicis brevis
98
Intersections Syndrome
Abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi radialis longus and the extensor carpi radialis brevis
99
Trigger finger
Affects the pulleys of the finger
- Annular (A 1-5)
- Cruciate (C 1-3)
100
Dupuytrens’ disease
Non cancerous tumor that grows around tendons and causes contractures
30º contracture at MP joint
Any contracture at PIP joint
Flat hand test
Z plasty to prevent straight line scar the pulls into flexion
101
Bursitis
Potential space filled with fluid
Found in areas where bone approaches another surface
102
Ganglion cysts
A fluid filled sac that grows out of the tissues surrounding a joint or tendon.
Ganglion cysts are common in the soft tissue along the back of the wrist
Can be associated with rheumatoid arthritis or osteoarthritis
Usually right on the carpal bones
103
Osteoporosis
Decreased bone density
Silent disease until there is a fracture
Loss of balance between production and uptake
Kyphosis
Dowager’s hump
- not fixable by a therapist
Frequently a comorbidity or RSD/CRPS, spinal cord injuries, or astronauts
104
Osteopenia
Reversible weakening of the bone
- fracture without trauma (standing while washing dishes and hip suddenly just breaks)
“Pre” osteoporosis
- pathological fracture
105
Volkman’s ischemia
Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling, called compartment syndrome.
106
Rheumatoid arthritis
System, RH factor
- severe joint inflammation, changes in the synovial lining
* pannus: corrosive agent that breaks down cartilage in bone
- more than just joints
- autoimmune
- leading cause of disability worldwide
- any age (JRA), adults 40-70
- all races and ethnic groups
- hereditary component
Moves from acute to chronic
- active vs inactive (flares)
107
Gout
Due to hyperuricemia (uric acid) in blood and tissues
Presents as a painful form of arthritis
Frequently affects the large joint of the big tow, although any joint can be affected
Acute gouty arthritis is sudden onset of joint pain caused by an inflammatory reaction to precipitated uric acid deposits in a joint
Occurs predominantly in men
Tends to run in families
Red, swollen joint
108
Complex regional pain syndrome
Used to be called reflexive sympathetic dystrophy (RSD)
Cardinal signs: pain outside the norm associated with that injury, swelling outside the norm associated for that injury, temperature change, stiffness or motor changes
Complete overreaction of the system to an injury
Can occur anywhere in the body, but most commonly in the arm after a distal radial fracture
Many different symptoms associated with it
Narcotics don’t affect the pain
Extremely hypersensitive to ice
6-12 weeks in, an x-ray will show osteoporotic changes in the affected limb
109
Myasthenia gravis
Weakness and exhaustion of skeletal muscles (droopy eye)
Autoimmune
110
Amyotrophic lateral sclerosis (ALS)
Degeneration of the nerve, spinal cord, and muscle
111
Low back pain
One of the most common musculoskeletal complaints with 80% of people experience it.
People that are inactive are at higher risk for back injury.
Typically have tight hamstrings, causing posterior tilt
Limited ROM when 4+ vertebrae are fused
Causes:
- muscle pain/strain
* often linked to tight hamstrings
* pelvic position
* posture
* it hurts “here,” true back pain
* ergonomic intervention
- lumbar radiculopathy (pinched nerve)
* bone, cartilage, degenerative disease of spine, bone spur, disc
- herniated or ruptured disc
- degenerative disc
112
Acquired brain injury
Nondegenerative
Noncongenital
Non disease caused
External Force
Trauma that causes one of the following:
- Loss of consciousness
- Posttraumatic amnesia
- Disorientation
- Confusion
- Neurological signs
* MRI, paralysis, seizure
113
Seizures
Sudden uncontrolled electrical disturbance in the brain resulting in convulsions
1. Time it
2. Protect head
3. Make sure they’re in a safe place
4. Roll on side (recovery position) AFTER seizure is over
5. Assess vitals
don’t restrain them
don’t put anything in their mouth
114
Dysautonomia
Failure of the sympathetic and parasympathetic system
115
Concussion
Brain collides with skull which can cause bruising, torn tissues, and swelling
Second impact syndrome: suffering a second concussion before the first one is healed
116
Hematoma
Extradural
- usually associated with skull fracture
- young patients (20-40)
- between dura and skull
Subdural
- usually associated with TBI
- between dura and brain
Intracerebral
- usually associated with TBI, especially penetrating and shearing injury
- inside brain tissue
- usually causes permanent damage
- shaken baby syndrome
117
Levels of SCI
Neurological level: what muscles can still function
Functional level: what can client still do?
Osteological level: where the damage is
118
Central cord SCI
Incomplete - center of spinal cord usually damaged from tumor
Weak upper, stronger lower
Varying degrees of bowel and bladder
Burning hand syndrome
- with some central cord clients (usually there is a fx or dislocation present)
- the patient complains of severe burning in hands and/or feet
119
Anterior cord syndrome
Loss of voluntary motor, pain, and temperature perception below injury
Retains posterior column function (proprioception, light touch, pressure, position, and vibration)
Injury to anterior cord
120
Posterior cord syndrome
Happens with hyperextension injuries with fx or tumor
Proprioception, vibration sense, 2 point discrimination, and light touch are lost below lesion
Most function is preserved
Compression by tumor or infarction of posterior spinal artery
121
Conus medullaris syndrome
Lesion to sacral cord (T12)
- compression of fx of T12 - kicked in butt
Flaccid legs
Flaccid anal sphincter
- atonic bowel
122
Cauda equina syndrome
Compression of nerve roots below L1, usually by fx or disc herniation
LE motor deficit
Variable bladder, bowel, and sexual dysfunction
Variable sensory loss
123
Multiple sclerosis
Demyelization disorder - progression of 30 years
Myelin of the CNS is broken down (PNS is not involved)
Onset 20-30 years, more in women, all races
May be triggered by pregnancy, trauma, or infection
Relapsing and remitting - acute attack with full or near full recovery
Primary progressive - steady progression, only minor recovery (somewhat rare)
Secondary progressive - starts as relapsing, 2/3 of patient shave this type, eventually begins to progress with less recovery.
Progressive relapsing - rare
124
Parkinson’s Disease
May demonstrate akinesia hyperkinesia, or bradykinesia
Difference between syndrome and disease
- we know what causes syndrome
Effect of basal ganglia
Cause is idiopathic
Hits around 50-62 years old, men more than women
Loss of dopamine
Resting and intention tremors, rigidity, stooped posture, foot shuffle, freezing
Depression is common (50%)
Dementia (30%)
Treatment: Levadopa, therapy, surgery, deep stimulators
125
Stages of Parkinson’s
Stage 1
- Slight tremors on one side of the body
- symptoms are often mild and include changes in walking, posture, and facial expressions
Stage 2
- symptoms worsen and affect both sides of the body
- changes in walking and moving make daily tasks more difficult
Stage 3
- loss of balance and slowness of movement make falls more common
- symptoms significantly impair ADLs
Stage 4
- symptoms are severe and limit the ability to live alone
- walkers or other aides are used daily to help support limited mobility
Stage 5
- confined to wheelchair or bed
- a 24 hour caregiver is required
- many experience hallucinations and other non-motor symptoms
126
ALS stages
Early
- muscle weakness, fasciculation, and atrophy often limited to one region of the body
- fatigue, poor balance, slurred words, tripping, weak grip
Middle
- symptoms from early stage are more widespread and affect more than one region of the body
- muscles become paralyzed and fasciculations continue
- muscle contractures, weakness in breathing and swallowing causing difficulty eating, drinking, and breathing
Late
- most voluntary muscles are paralyzed and breathing muscles are very weak
- very limited mobility, poor respiration causing fatigue, and increased susceptibility to pneumonia
- loss of speech and limited eating/drinking via mouth
127
Huntington’s Disease
Also called Huntington Chorea
Hereditary and degenerative
Onset around 30-50 years (often had kids before they know they have it)
Occurs in all races
Abnormal movement with progressive dementia
128
Guillian-Barre Syndrome
Polyneuritis (a bunch of inflammed nerves)
Idiopathic
Acute inflammatory condition
Acute motor paralysis
- they often think they’re having a stroke
Occurs worldwide, in children and adults, of all races
Often precipitated by a mild viral or bacterial infection
2-3% die, usually from respiratory distress
5-10% have permanent disability
Different degrees
Many make a full recovery
129
Types of abnormal movement
Hypokinesia - decreased movement
Akinesia - absence of movement, related to extrapyramidal system
Bradykinesia - slowness of movement
- difficulty initiating movement
- difficulty with smoothness
- difficulty with synchronizing movement
- client may “freeze”
130
Bell’s Palsy
Idiopathic inflammation of the 7th cranial nerve (facial nerve)
Sudden onset paralysis of 7th cranial nerve distribution
- gets all of it; if only part then it’s not bell’s
Effects children to adults, more common in diabetics
131
Diabetes mellitus
The result of insufficient or inadequate use of insulin (produced in Islets of Lanerhans, pancreas)
Can lead to high deposits of waste (ketones) in the blood and over metabolism and proteins (diabetic ketoacidosis), which destroys tissue
Type I
- Usually diagnosed before 30
- Formally called insulin dependent (IDDM)
- Complete lack of insulin (most difficult to regulate and treat)
- Cause is unknown
* Autoimmune-triggering event (infection, toxin)
* Genetic
Type II
- On the increase in US (especially in Children)
* Can often be managed with diet, activity
- Formally called non-insulin dependent (NIDDM)
- Obesity and inactivity, genetics, advanced age and race (AI, AA, His, C)
Gestational Diabetes (GDM)
- Occurs during pregnancy
* Increase risk of type I
- Symptoms for all types
* Malfunction in the bodies ability to make or use insulin
* Polyuria, glucose in urine, excessive thirst, weight loss, excessive eating, hard to heal, blurred vision, eventually weakness and fatigue
* Type I-fast sudden onset
* Type II- slow onset, often don’t have symptoms
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Congestive heart failure
Progressive Condition
- Hearts ability to pump blood effectively to tissues, due to ventricle function decreases
Etiology
- Infections
- Diabetes
- Thyroid
- Obesity
- Lifestyle
Symptoms
- Dyspnea (difficulty breathing)
* Worse when lying down (orthopnea)
- Edema in extremities
- Chest pain
- Swelling of legs, hands, and feet
- Sudden weight gain
- Sudden fatigue or weakness
- Dizziness
Management
- Medications
- Blood thinners
- Lifestyle changes
- Exercise within parameters
- Heart transplant
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Myocardial Infarction
Blood flow to the heart muscle is reduced or blocked
- Heart muscle dies (necrosis)
- Cardiac arrest
Most often caused by
- Atherosclerosis
- Drug use
- Coronary artery dissection
* Spontaneous or violent
- Electrical disturbance in the body
50% die within an hour of onset
Diagnosis: EGG
Intervention:
- Aspirin
- Nitroglycerin -stops pain not blood loss
- Stop cause
> Surgical
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Types of ABI
Concussion - mild TBI caused by an impact to the head or whiplash
Contusion - blood under skin due to trauma causing a bruise
Coup countrecoup - contusion present at both the site of impact and the exact opposite end of the impact
Diffuse axonal injury - similar to concussion, though the brain is shake much more violently
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Decerebrate and decorticate postures
