Exam 4 (Lectures 10-12) Flashcards
1
Q
What is multiple sclerosis (MS)?
A
An inflammatory disease of the central nervous system (CNS).
2
Q
Sclerosis
A
formation of scar tissue
3
Q
What happens in MS?
A
The myelin sheaths in multiple areas of the brain and spine are damaged, which results in demyelination.
4
Q
4 causes of MS?
A
Immunologic
Genetic
Environmental
Infections
5
Q
Worldwide prevalence of MS
A
> 2.3 million people worldwide
6
Q
Prevalence of MS in U.S.
A
400,000 MS cases in U.S.
7
Q
Within 10 years of diagnosis
A
> 50% with MS are disabled
8
Q
MS is more common in people of this descent
A
Northern European descent
9
Q
Lifetime cost of MS
A
> $1 million/person
10
Q
Etiology of MS
A
is unknown
11
Q
What type of disease is MS?
A
Autoimmune
12
Q
Pathophysiology of MS
A
Autoreactive T Cells enter the CNS and secrete lymphokines or cytokines, which recruits cells to participate in demyelination.
13
Q
Oligadentrites and myelin sheaths are destroyed in
A
MS
14
Q
Nerve impulses are disrupted in MS due to
A
plaque formation
15
Q
Plaque forms in MS due to
A
Demyelination
16
Q
Common symptoms of multiples sclerosis (13)
A
- Fatigue
- Numbness
- Walking, balance, and coordination problems
- Bladder dysfunction
- Bowel dysfunction
- Vision problems
- Dizziness and vertigo
- Sexual dysfunction
- Spasticity
- Pain
- Cognitive impairment
- Depression
- Emotional changes
17
Q
Less common symptoms of MS (8)
A
- Speech disorders
- Swallowing problems
- Headache
- Hearing loss
- Seizures
- Tremors
- Breathing problems
- Itching
18
Q
MS is more common in this region
A
North U.S. and Canada
19
Q
What is fatigue?
A
Overwhelming tiredness
20
Q
What is secondary fatigue?
A
Fatigue due to deconditioning, depression, or medication
21
Q
MS relapses/flare-ups are caused by
A
acute inflammation damaging myelin
22
Q
MS relapses cause
A
New or worsening symptoms
23
Q
After remission of MS
A
some people feel symptoms, some do not.
24
Q
Symptoms of MS relapses
A
may vary in intensity and may affect morbididty
25
The most common form of MS cases
Relapse-remitting MS
26
85% of MS cases are
relapse-remitting MS
27
Relapse-remitting MS
Relapse followed by remission as inflammation process gradually comes to an end.
28
Diagnosis of MS (5)
1. Medical history and neurological exam
2. MRI
3. Evoked response testing
4. Cerebrospinal fluid analysis
5. Blood test
29
Do many people with MS have symptoms?
No, many people with MS are asymptomatic.
30
This doesn't rule out MS
A normal MRI
31
This test shows lesions due to MS
Evoked response training
32
Cerebrospinal fluid analysis
detection of immune system markers
33
Blood tests do not rule of MS, but
they may rule out other immune diseases.
34
4 types of MS
Clinically Isolated Syndrome (CIS)
Relapsing-remitting MS (RRMS)
Primary Progressive MS (PPMS)
Secondary Progressive MS (SPMS)
35
Clinically Isolated Syndrome
First episode of neurological symptoms
Caused by inflammation and demyelination
Must last at least 2 hours
36
From a diagnostic standpoint, this is not MS.
Clinically Isolated Syndrome
37
Some people with Clinically Isolated Syndrome
may not develop MS
38
Lesions seen on a brain MRI indicate
A high likelihood for another episode and a high likelihood for developing RRMS.
39
Clearly defined attack of worsening condtion
Relapsing-Remitting MS
40
RRMS has periods
with or without progression
41
Characterized by partial or complete recovery periods or remissions
RRMS
42
15% of persons with MS
Primary Progressive MS
43
PPMS
worsening neurologic function from onset
44
Has no early relapses or remissions
PPMS
45
Can PPMS have occasional relapses later and periods with or without progression?
Yes.
46
Most people with RRMS transition into this course
Secondary Progressive MS (SPMS)
47
Secondary Progressive Multiple Sclerosis
Follows RRMS
Occasional relapses are possible
Periods with or without progression
48
Treatment for MS
Medication and Rehabilitation
49
Goals of medication for MS
Manage symptoms
Treat exacerbations
Slow disease progression
50
Goal of rehabilitation for MS
To improve functioning for people with MS
51
Greek for walking
Amkyra
52
When should a physician be consulted for exercise with MS patients?
Prior to testing and training
53
Considerations for exercise testing and training with MS patients
Cognitive impairment
Medications for spasticity may cause fatigue
Balance and gait difficulties
Ataxia
Assistive devices
Thermoregulation (fans, fluid replacement, temperature, humidity, pre-cooling)
54
Diagnostic value of exercise testing in MS patients
```
Coronary Artery Disease
Autonomic dysfunction (results in lower peak heart rate)
```
55
Functional value of exercise testing in MS patients
Safety and exercise training effectiveness
| Exercise prescription
56
GXT recommendations for MS patients
Leg-cycling is often best
Treadmill walking can be used in mild cases
General termination criteria apply
Mild increase in workload
57
For MS patients, the mild increase in workload should look like
```
Light warm-up
10-25 W/stage for leg-cyling
8-12 W/stage for arm cycling
2 min. stages
ramping protocols
```
58
People with MS have lower
```
Muscular strength and muscular endurance
Motor unit firing rates
Muscle activation
Cardiorespiratory fitness
Respiratory muscle function
Muscle oxidative capacity
Walking speed
Habitual physical activity
```
59
For MS patients, exercise _________
improves the factors that are lower in people with MS and provides additional health benefits.
May also lower fatigue.
60
Does exercise cause exacerbations in MS patients?
No
61
In cardiovasuclar training for MS patients, progression
should be individualized, fatigue should be avoided, and periods of disease exacerbation should be avoided.
62
Cadiovascular training in MS patients should involve
Cycling
Walking
Swimming/aquatic exercise
Other
63
Intensity for cardiovascular training in MS patients
40-70% VO2 reserve
Monitor with RPE
(Published formulas for VO2 estimation may not work)
64
Strength training in MS patients should be
performed on days with no other training in order to avoid fatigue
65
Individualized strength training in MS patients
60-80% 1 RM (8-15 RM)
| Lower resistance if needed
66
MS patients should avoid free weights if
they have balance problems
67
Flexibility training is
important for MS patients
68
MS patients should train in flexibility
daily
69
MS patients tend to engage in this type of flexibility training
Static stretching (Passive and Active)
70
What is cerebral palsy?
A group of disorders of movement and posture causing disability
71
Is cerebral palsy progressive?
No, but it may worsen.
72
The most common cause of motor disability in children.
Cerebral palsy
73
Due to disturbances in fetal or infant brain
Cerebral palsy
74
Types of cerebral palsy
Spastic
Athetoid
Ataxic
Mixed forms
75
Prevalence of CP
500,000 - 764,000 people in the U.S.
76
8 year old children with CP
3.3 per 1,000
| 1 in 303
77
Cerebral palsy is more common among
Boys
Black non-hispanic children
Those living in low income neighborhoods
78
Incidence rate of cerebral palsy
1.5-2.5 per 1,000 live births
79
Total direct cost of cerebral palsy
$2.2 billion per year
80
Average lifetime cost of cerebral palsy
$11.5 billion for people born with CP in 2000
| $921,000 per person
81
Cerebral palsy is caused by
injury to the brain
82
75% of CP cases are caused by
Pre-natal brain injury
83
Brain damage causing cerebral palsy can occur during
Pre-natal
During birth
Post-natal
84
Cerebral Palsy is characterized by
impairment in voluntary motor control
85
Brain damage in different areas
affect people in different ways (symptoms vary between people.)
86
Risk factors for cerebral palsy
Pre-mature births and low-weight births
Multiple births
Prolonged hypoxia during birth
87
The risk of developing cerebral palsy during pre-mature births and low weight births can be increased by
Smoking
Alcohol abuse
Poor management of maternal conditions
88
70-80% of CP cases
Spastic cerebral palsy
89
Characterized by hypertonia, spasticity, contractures, and stiff muscles
Named by the limbs affected
Spastic cerebral palsy
90
10-20% of CP patients
Athetoid cerebral palsy
91
Characterized by uncontrolled and slow movements in hands, feet, arms, or legs, and in some cases, the muscles of the face and tongue, causing grimacing or drooling; increase stress; speech problems
Athetoid cerebral palsy
92
5-10% of CP patients
Ataxic cerebral palsy
93
Usually due to cerebellum damage; hypotonia; tremor; motor control affected; balance problems; unstable and wide gait
Ataxic cerebral palsy
94
A combination of symptoms from the other 3 types of CP
Mixed forms of cerebral palsy
95
Most common combination of mixed form cerebral palsy
Spastic + athetoid cerebral palsy
96
Symptoms of spastic cerebral palsy may affect
one or both sides
97
Symptoms of spastic cerebral palsy
Tight and weak muscles
Abnormal gait
Paralysis
98
Symptoms of other CP types
Abnormal movements (jerking, tremors, writhing)
Unsteady gait
Loss of coordination
Floppy muscles
99
Additional symptoms of cerebral palsy (12)
1. Cognitive or learning disabilities
2. Speech problems
3. Hearing or vision problems
4. Seizures
5. Pain
6. Difficulty sucking or feeding in infants
7. Problems with chewing and swallowing in older children and adults
8. Vomiting or constipation
9. Increased drooling
10. Slower than normal growth
11. Breathing difficulties
12. Urinary incontinence
100
Components of the primary disabling condition; not prevention
Associated clinical condition
101
Health problems independent of the primary condition
Comorbid clinical condition
102
Physical or psychosocial problems resulting from the primary disabling condition; preventable
Secondary clinical condition
103
Associated conditions with CP (8)
1. Bowel/bladder problems
2. Cognitive impairment
3. Musculoskeletal problems
4. Oral motor dysfunction
5. Respiratory problems
6. Seizures/epilepsy
7. Sensory impairments
8. Vision problems
104
Secondary conditions of CP (9)
1. Cardiovascular conditions
2. Deconditioning
3. Fatigue
4. Mobility problems
5. Communication disorders
6. Depression
7. Obesity
8. Pain
9. Pressure sores
105
Diagnosis for CP
Physical exam
EEG (for seizure disorders)
Hearing and vision testing
Imaging of the brain (CT scan; MRI)
106
Physical exam for CP
```
Maternal and infant medical history
Motor skill testing
Reflexes
Muscle tone/spasticity
Posture, balance, gait
Ruling out other conditions
```
107
Is there a cure for cerebral palsy?
No
108
Goal of treatment for cerebral palsy
Management to improve independence
109
Medication for CP manages
spasticity, dystonia, seizures
110
Ways of treating CP patiens (8)
1. Medication
2. Positioning and walking aids
3. Braces, splints
4. Hearing aids
5. Glasses
6. Rehabilitation
7. Orthopedic surgery
8. Electrical stimulation
111
Lifespan of CP patients
Similar to general population, if no significant co-morbidities are present
112
Exercise training improves
associated conditions and secondary conditions
113
Endurance exercise for CP patients
Improves VO2peak, leg strength, gross motor functiong, decreases sub-maximal VO2
114
Resistance exercise in CP patients
Improves muscle strength, walking ability; does not cause spasticity
115
Flexibility exercise in CP patients
Prevents contractures, Increases ROM
116
What exercise combinations are effective for CP patients
resistance and endurance
117
Exercise programs that are effective with CP patients
Community and home based programs
118
Cardiovascular fitness for CP patients
GXT with mild increases
Consider heterogeneity of responses
Upper body exercise is common
119
Muscular strength and endurance exercise for CP patients
Exercise machines preferred
120
Flexibility recommendations for CP patients
similar to non-disabled populations
121
What is the fitness standard for CP patients
Low fitness is expected in CP patients
122
Exercise prescription for CP patients
General principles apply
FITT for people with CP not known
Modifications based on function, mobility, associated and secondary conditions
123
Cardiovascular training recommendations for CP patients
Non-weight bearing recommended
Start at low intensities (40-50% VO2R)
Consider interval training
124
Why is non-weight bearing training recommended in CP patients?
Avoids muscle and joint pain
125
Things to remember with the intensity of cardiovascular training in CP patients
Formulas that estimate VO2 cannot be used with CP patients
| Evaluated potential for fatigue
126
Muscular Fitness Training for cerebral palsy
1. Use machines, cuffed weights, elastic bands, hydrotherapy
2. Exercises for weak muscle groups opposing hypertonic muscles.
3. Neuromuscular eletrical stimulation and whole body vibration
4. Slow speed of contraction
5. Ensure safety
127
What is the purpose of exercising weak muscles groups opposing hypertonic muscles
Improves strength of agonists
| Normalizes tone of antagonists
128
Neuromuscular electrical stimulation and whole body vibration
improve strength
| No adverse effects on spasticity
129
Why should contraction speed be slowed in CP patients?
Avoids the stretch reflex activity of opposing muscles
130
Flexibility training in CP patients
Active and passive stretching may be used
Hypertonic muscles should be stretched slowly
Tai chi and yoga improve flexibility
131
Hypertonicity in CP patients
may change during growth
132
Functional potential in CP patients
can be drastically changed with medical intervention
133
The primitve reflexes of CP patients may be controlled with
good positioning
134
These simple modifications may improve positioning with CP patients
cuffed weights
| velcro staps
135
What type of injury are persons with CP susceptible to?
Overuse injury
136
Down Syndrome
A chromosomal condition
| Presence of part or all of an extra copy of the 21st chromosome
137
Down Syndrome was named by
Dr. John Langdon Down in 1866
138
Physical signs of down syndrome
```
Short height and leg length
Flat face with an upward slant to the eye
Short neck
Small ears
Small mouth
Tiny white spots on iris of the eye
Small hands and feet
A single crease across the palm of the hand
Small pinky fingers
Low muscle tone
Loose ligamenets
```
139
Causes of down syndrome
Trisomy 21
Translocation
Mosaic trisomy 21
140
95% of down syndrome cases
Trisomy 21
141
Trisomy 21
caused by meiotic nondisjunction
142
Meiotic nondisjunction
Gamete has extra copy of chromosome 21 (most commonly maternal gamete)
Embryo has 47 chromosomes (3 copies of chromosome 21)
143
4% of down syndrome cases
Translocation
144
Gamete with long arm of chromosome 21 attached to another chromosome (usually 14)
Translocation
145
Fertilization results in karotype with 46 chromosomes
(2 copies of chromosome 21)
(1 copy of chromosome 14)
(1 copy of chromosome 14/21)
Translocation
146
1% of down syndrome cases
Mosaicism
147
Some cells are normal, some have trisomy 21
(Trisomy 21 in blood cells, but not skin)
(Trisomy 21 in brain cells; not all brain cells)
Mosaicism
148
In mosaicism, physiological and cognitive impairment
may be less
149
Is down syndrome inherited?
Not in most cases, it is a mistake in cell division
150
Which type of down syndrome can be inherited?
Translocation
151
The amount of newborns with translocation who have down syndrome
1/2 of newborns
152
Chances of passing translocation down syndrome
Father - 3%
| Mother - 10-15%
153
Prevalence of down syndrome in 2008
250,700 persons in U.S.
| 8.27/10,000 persons
154
Prevalence of down syndrome at birth
11.8-14.5 per 10,000 live births
| Large increase
155
Prevalence of down syndrome among U.S. children and adolescents
12 per 10,000 persons
| Lower among black than white youth
156
Official government wording for intellectual disability in 2004
Mental retardation
157
Medical costs of down syndrome
12-14 times higher for down syndrome children than children without down syndrome
Higher with congenital heart defects
158
Families of children with down syndrome
have a 1.8 time higher risk of experiencing financial problems than families of other CSHCN.
159
Health costs of down syndrome in Australia
4.2 times higher than general population for 0-4 year olds
| Costs decline with older age
160
Risk factors of down syndrome
Increases with maternal age
age 20: 1 in 2000
Age 45: 1 in 20
Risk increases if parent is a carrier of translocation
161
Can down syndrome be prevented?
No, but healthy pregnancies are the best deterrent
162
Prenatal screening to detect down syndrome
Ultrasound
Blood tests
Amniocentesis - late in pregnancy
163
Healthy pregnancies
Multi-vitamin with folic acid
No smoking
No drinking alcohol
164
Associated conditions with Down Syndrome (13)
1. Congenital heart defects
2. Hematologic abnormalities
3. Endocrine abnormalities
4. Gastrointestinal malformations
5. Orthopedic problems
6. Neurological conditions
7. Sensory impairments
8. Skin conditions
9. Dental problems
10. Epilepsy
11. Psychiatric disorders
12. Alzheimer's Disease
13. Cognitive limitations
165
Secondary conditions of down syndrome (5)
1. Dyslipidemia
2. Obesity
3. Lack of friend
4. Depression
5. Deconditioning
166
Life expectancy of down syndrome patients
Has increased to 50's and 60's
167
Death rates of Down Syndrome patients
accelerate after 40
| higher among African American DS patients
168
Mortality risk factors in mid-life intellectual disability and Down Syndrome
Older age
Functional abilities, motor skills, non-ambulation
Behavioral issues, IQ, limited communication
Parental death, self-help
Down Syndrome
169
Causes of mortality in DS
```
Leukemia
Respiratory illness
Congenital abnormalities
Cardiovascular diseases
Dementia
Cancers
```
170
Is there a treatment for Down Syndrome
No, but persons with Down Syndrome are evaluated and treated for medical complications
171
Early intervention for Down Syndrome
involves sensory, motor, and cognitive function
172
Factors affecting movement in Down Syndrome
```
Cerebellum abnormalities
Joint laxity
Muscle hypotonia (decreased skeletal muscle tone; floppiness)
Lower strength
Faster biological aging
```
173
Persons with Down Syndrome gross motor skill development
is delayed
174
Movement performance in Down Syndrome
is reduced and more varied
175
Persons with Down Syndrome have difficulty
with coordination
176
Reaction time in Down Syndrome
is slower and more variable
177
Persons with Down Syndrome experience co-contraction
during single joint movements
178
Down Syndrome patients have a preference for this type of movement
Slow movement
179
People with Down Syndrome favor
safety and accuracy in their movements
180
People with Down Syndrome have a delayed onset
of independent walking (usually by age 2)
181
DS has slow walking
Due to shorter legs and to optimize energetic costs
182
Less stability in DS
due to cerebellum abnormalities, joint laxity, hypotonia reduced strength
183
Stepping behaviors in DS
tend to be faster, shorter and wider steps
| greater step width variations
184
DS gait has
higher energetic costs
185
The preferred walking speed of DS patients
saves energy by optimizing energy cost per unit of distance
186
DS patients have low aerobic fitness
due to low activity and low heart rate max
187
DS patients have a higher___ at 3.6 mph than non DS
VO2 (approximately 19.82 ml/kg/min at 3.6 mph)
188
Physical activity in Down Syndrome patients
Is likely lower than general population
| Likely declinces with age
189
In DS patients, is max or sub-max testing preferred?
Max testing is preferred over sub-max
190
How to test strength in DS patients
1 or 10 or 12 RM
191
Cardiovascular training with DS
3-5x/week
Group activity preferred
40-85% VO2R or heart rate reserve
192
Intensity with DS
should progressively increase
193
HRmax formula for DS
HRmax = 210 - 0.56 (age) - 31
194
Muscular and Flexibility training in DS
As for people without DS
| consider safety
