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EP 4133: Exercise Programming for Clinical Populations > Exam 4 (Lectures 10-12) > Flashcards

Exam 4 (Lectures 10-12) Flashcards

1
Q

What is multiple sclerosis (MS)?

A

An inflammatory disease of the central nervous system (CNS).

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2
Q

Sclerosis

A

formation of scar tissue

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3
Q

What happens in MS?

A

The myelin sheaths in multiple areas of the brain and spine are damaged, which results in demyelination.

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4
Q

4 causes of MS?

A

Immunologic
Genetic
Environmental
Infections

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5
Q

Worldwide prevalence of MS

A

> 2.3 million people worldwide

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6
Q

Prevalence of MS in U.S.

A

400,000 MS cases in U.S.

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7
Q

Within 10 years of diagnosis

A

> 50% with MS are disabled

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8
Q

MS is more common in people of this descent

A

Northern European descent

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9
Q

Lifetime cost of MS

A

> $1 million/person

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10
Q

Etiology of MS

A

is unknown

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11
Q

What type of disease is MS?

A

Autoimmune

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12
Q

Pathophysiology of MS

A

Autoreactive T Cells enter the CNS and secrete lymphokines or cytokines, which recruits cells to participate in demyelination.

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13
Q

Oligadentrites and myelin sheaths are destroyed in

A

MS

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14
Q

Nerve impulses are disrupted in MS due to

A

plaque formation

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15
Q

Plaque forms in MS due to

A

Demyelination

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16
Q

Common symptoms of multiples sclerosis (13)

A
  1. Fatigue
  2. Numbness
  3. Walking, balance, and coordination problems
  4. Bladder dysfunction
  5. Bowel dysfunction
  6. Vision problems
  7. Dizziness and vertigo
  8. Sexual dysfunction
  9. Spasticity
  10. Pain
  11. Cognitive impairment
  12. Depression
  13. Emotional changes
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17
Q

Less common symptoms of MS (8)

A
  1. Speech disorders
  2. Swallowing problems
  3. Headache
  4. Hearing loss
  5. Seizures
  6. Tremors
  7. Breathing problems
  8. Itching
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18
Q

MS is more common in this region

A

North U.S. and Canada

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19
Q

What is fatigue?

A

Overwhelming tiredness

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20
Q

What is secondary fatigue?

A

Fatigue due to deconditioning, depression, or medication

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21
Q

MS relapses/flare-ups are caused by

A

acute inflammation damaging myelin

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22
Q

MS relapses cause

A

New or worsening symptoms

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23
Q

After remission of MS

A

some people feel symptoms, some do not.

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24
Q

Symptoms of MS relapses

A

may vary in intensity and may affect morbididty

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25
Q

The most common form of MS cases

A

Relapse-remitting MS

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26
Q

85% of MS cases are

A

relapse-remitting MS

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27
Q

Relapse-remitting MS

A

Relapse followed by remission as inflammation process gradually comes to an end.

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28
Q

Diagnosis of MS (5)

A
  1. Medical history and neurological exam
  2. MRI
  3. Evoked response testing
  4. Cerebrospinal fluid analysis
  5. Blood test
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29
Q

Do many people with MS have symptoms?

A

No, many people with MS are asymptomatic.

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30
Q

This doesn’t rule out MS

A

A normal MRI

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31
Q

This test shows lesions due to MS

A

Evoked response training

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32
Q

Cerebrospinal fluid analysis

A

detection of immune system markers

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33
Q

Blood tests do not rule of MS, but

A

they may rule out other immune diseases.

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34
Q

4 types of MS

A

Clinically Isolated Syndrome (CIS)
Relapsing-remitting MS (RRMS)
Primary Progressive MS (PPMS)
Secondary Progressive MS (SPMS)

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35
Q

Clinically Isolated Syndrome

A

First episode of neurological symptoms
Caused by inflammation and demyelination
Must last at least 2 hours

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36
Q

From a diagnostic standpoint, this is not MS.

A

Clinically Isolated Syndrome

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37
Q

Some people with Clinically Isolated Syndrome

A

may not develop MS

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38
Q

Lesions seen on a brain MRI indicate

A

A high likelihood for another episode and a high likelihood for developing RRMS.

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39
Q

Clearly defined attack of worsening condtion

A

Relapsing-Remitting MS

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40
Q

RRMS has periods

A

with or without progression

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41
Q

Characterized by partial or complete recovery periods or remissions

A

RRMS

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42
Q

15% of persons with MS

A

Primary Progressive MS

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43
Q

PPMS

A

worsening neurologic function from onset

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44
Q

Has no early relapses or remissions

A

PPMS

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45
Q

Can PPMS have occasional relapses later and periods with or without progression?

A

Yes.

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46
Q

Most people with RRMS transition into this course

A

Secondary Progressive MS (SPMS)

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47
Q

Secondary Progressive Multiple Sclerosis

A

Follows RRMS
Occasional relapses are possible
Periods with or without progression

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48
Q

Treatment for MS

A

Medication and Rehabilitation

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49
Q

Goals of medication for MS

A

Manage symptoms
Treat exacerbations
Slow disease progression

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50
Q

Goal of rehabilitation for MS

A

To improve functioning for people with MS

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51
Q

Greek for walking

A

Amkyra

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52
Q

When should a physician be consulted for exercise with MS patients?

A

Prior to testing and training

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53
Q

Considerations for exercise testing and training with MS patients

A

Cognitive impairment
Medications for spasticity may cause fatigue
Balance and gait difficulties
Ataxia
Assistive devices
Thermoregulation (fans, fluid replacement, temperature, humidity, pre-cooling)

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54
Q

Diagnostic value of exercise testing in MS patients

A 
Coronary Artery Disease
Autonomic dysfunction (results in lower peak heart rate)
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55
Q

Functional value of exercise testing in MS patients

A

Safety and exercise training effectiveness

Exercise prescription

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56
Q

GXT recommendations for MS patients

A

Leg-cycling is often best
Treadmill walking can be used in mild cases
General termination criteria apply
Mild increase in workload

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57
Q

For MS patients, the mild increase in workload should look like

A 
Light warm-up
10-25 W/stage for leg-cyling
8-12 W/stage for arm cycling
2 min. stages
ramping protocols
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58
Q

People with MS have lower

A 
Muscular strength and muscular endurance
Motor unit firing rates
Muscle activation
Cardiorespiratory fitness
Respiratory muscle function
Muscle oxidative capacity
Walking speed
Habitual physical activity
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59
Q

For MS patients, exercise _________

A

improves the factors that are lower in people with MS and provides additional health benefits.
May also lower fatigue.

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60
Q

Does exercise cause exacerbations in MS patients?

A

No

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61
Q

In cardiovasuclar training for MS patients, progression

A

should be individualized, fatigue should be avoided, and periods of disease exacerbation should be avoided.

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62
Q

Cadiovascular training in MS patients should involve

A

Cycling
Walking
Swimming/aquatic exercise
Other

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63
Q

Intensity for cardiovascular training in MS patients

A

40-70% VO2 reserve
Monitor with RPE
(Published formulas for VO2 estimation may not work)

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64
Q

Strength training in MS patients should be

A

performed on days with no other training in order to avoid fatigue

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65
Q

Individualized strength training in MS patients

A

60-80% 1 RM (8-15 RM)

Lower resistance if needed

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66
Q

MS patients should avoid free weights if

A

they have balance problems

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67
Q

Flexibility training is

A

important for MS patients

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68
Q

MS patients should train in flexibility

A

daily

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69
Q

MS patients tend to engage in this type of flexibility training

A

Static stretching (Passive and Active)

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70
Q

What is cerebral palsy?

A

A group of disorders of movement and posture causing disability

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71
Q

Is cerebral palsy progressive?

A

No, but it may worsen.

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72
Q

The most common cause of motor disability in children.

A

Cerebral palsy

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73
Q

Due to disturbances in fetal or infant brain

A

Cerebral palsy

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74
Q

Types of cerebral palsy

A

Spastic
Athetoid
Ataxic
Mixed forms

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75
Q

Prevalence of CP

A

500,000 - 764,000 people in the U.S.

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76
Q

8 year old children with CP

A

3.3 per 1,000

1 in 303

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77
Q

Cerebral palsy is more common among

A

Boys
Black non-hispanic children
Those living in low income neighborhoods

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78
Q

Incidence rate of cerebral palsy

A

1.5-2.5 per 1,000 live births

79
Q

Total direct cost of cerebral palsy

A

$2.2 billion per year

80
Q

Average lifetime cost of cerebral palsy

A

$11.5 billion for people born with CP in 2000

$921,000 per person

81
Q

Cerebral palsy is caused by

A

injury to the brain

82
Q

75% of CP cases are caused by

A

Pre-natal brain injury

83
Q

Brain damage causing cerebral palsy can occur during

A

Pre-natal
During birth
Post-natal

84
Q

Cerebral Palsy is characterized by

A

impairment in voluntary motor control

85
Q

Brain damage in different areas

A

affect people in different ways (symptoms vary between people.)

86
Q

Risk factors for cerebral palsy

A

Pre-mature births and low-weight births
Multiple births
Prolonged hypoxia during birth

87
Q

The risk of developing cerebral palsy during pre-mature births and low weight births can be increased by

A

Smoking
Alcohol abuse
Poor management of maternal conditions

88
Q

70-80% of CP cases

A

Spastic cerebral palsy

89
Q

Characterized by hypertonia, spasticity, contractures, and stiff muscles
Named by the limbs affected

A

Spastic cerebral palsy

90
Q

10-20% of CP patients

A

Athetoid cerebral palsy

91
Q

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

A

Athetoid cerebral palsy

92
Q

5-10% of CP patients

A

Ataxic cerebral palsy

93
Q

Usually due to cerebellum damage; hypotonia; tremor; motor control affected; balance problems; unstable and wide gait

A

Ataxic cerebral palsy

94
Q

A combination of symptoms from the other 3 types of CP

A

Mixed forms of cerebral palsy

95
Q

Most common combination of mixed form cerebral palsy

A

Spastic + athetoid cerebral palsy

96
Q

Symptoms of spastic cerebral palsy may affect

A

one or both sides

97
Q

Symptoms of spastic cerebral palsy

A

Tight and weak muscles
Abnormal gait
Paralysis

98
Q

Symptoms of other CP types

A

Abnormal movements (jerking, tremors, writhing)
Unsteady gait
Loss of coordination
Floppy muscles

99
Q

Additional symptoms of cerebral palsy (12)

A
  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
Q

Components of the primary disabling condition; not prevention

A

Associated clinical condition

101
Q

Health problems independent of the primary condition

A

Comorbid clinical condition

102
Q

Physical or psychosocial problems resulting from the primary disabling condition; preventable

A

Secondary clinical condition

103
Q

Associated conditions with CP (8)

A
  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
Q

Secondary conditions of CP (9)

A
  1. Cardiovascular conditions
  2. Deconditioning
  3. Fatigue
  4. Mobility problems
  5. Communication disorders
  6. Depression
  7. Obesity
  8. Pain
  9. Pressure sores
105
Q

Diagnosis for CP

A

Physical exam
EEG (for seizure disorders)
Hearing and vision testing
Imaging of the brain (CT scan; MRI)

106
Q

Physical exam for CP

A 
Maternal and infant medical history
Motor skill testing
Reflexes
Muscle tone/spasticity
Posture, balance, gait
Ruling out other conditions
107
Q

Is there a cure for cerebral palsy?

A

No

108
Q

Goal of treatment for cerebral palsy

A

Management to improve independence

109
Q

Medication for CP manages

A

spasticity, dystonia, seizures

110
Q

Ways of treating CP patiens (8)

A
  1. Medication
  2. Positioning and walking aids
  3. Braces, splints
  4. Hearing aids
  5. Glasses
  6. Rehabilitation
  7. Orthopedic surgery
  8. Electrical stimulation
111
Q

Lifespan of CP patients

A

Similar to general population, if no significant co-morbidities are present

112
Q

Exercise training improves

A

associated conditions and secondary conditions

113
Q

Endurance exercise for CP patients

A

Improves VO2peak, leg strength, gross motor functiong, decreases sub-maximal VO2

114
Q

Resistance exercise in CP patients

A

Improves muscle strength, walking ability; does not cause spasticity

115
Q

Flexibility exercise in CP patients

A

Prevents contractures, Increases ROM

116
Q

What exercise combinations are effective for CP patients

A

resistance and endurance

117
Q

Exercise programs that are effective with CP patients

A

Community and home based programs

118
Q

Cardiovascular fitness for CP patients

A

GXT with mild increases
Consider heterogeneity of responses
Upper body exercise is common

119
Q

Muscular strength and endurance exercise for CP patients

A

Exercise machines preferred

120
Q

Flexibility recommendations for CP patients

A

similar to non-disabled populations

121
Q

What is the fitness standard for CP patients

A

Low fitness is expected in CP patients

122
Q

Exercise prescription for CP patients

A

General principles apply
FITT for people with CP not known
Modifications based on function, mobility, associated and secondary conditions

123
Q

Cardiovascular training recommendations for CP patients

A

Non-weight bearing recommended
Start at low intensities (40-50% VO2R)
Consider interval training

124
Q

Why is non-weight bearing training recommended in CP patients?

A

Avoids muscle and joint pain

125
Q

Things to remember with the intensity of cardiovascular training in CP patients

A

Formulas that estimate VO2 cannot be used with CP patients

Evaluated potential for fatigue

126
Q

Muscular Fitness Training for cerebral palsy

A
  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
Q

What is the purpose of exercising weak muscles groups opposing hypertonic muscles

A

Improves strength of agonists

Normalizes tone of antagonists

128
Q

Neuromuscular electrical stimulation and whole body vibration

A

improve strength

No adverse effects on spasticity

129
Q

Why should contraction speed be slowed in CP patients?

A

Avoids the stretch reflex activity of opposing muscles

130
Q

Flexibility training in CP patients

A

Active and passive stretching may be used
Hypertonic muscles should be stretched slowly
Tai chi and yoga improve flexibility

131
Q

Hypertonicity in CP patients

A

may change during growth

132
Q

Functional potential in CP patients

A

can be drastically changed with medical intervention

133
Q

The primitve reflexes of CP patients may be controlled with

A

good positioning

134
Q

These simple modifications may improve positioning with CP patients

A

cuffed weights

velcro staps

135
Q

What type of injury are persons with CP susceptible to?

A

Overuse injury

136
Q

Down Syndrome

A

A chromosomal condition

Presence of part or all of an extra copy of the 21st chromosome

137
Q

Down Syndrome was named by

A

Dr. John Langdon Down in 1866

138
Q

Physical signs of down syndrome

A 
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
Q

Causes of down syndrome

A

Trisomy 21
Translocation
Mosaic trisomy 21

140
Q

95% of down syndrome cases

A

Trisomy 21

141
Q

Trisomy 21

A

caused by meiotic nondisjunction

142
Q

Meiotic nondisjunction

A

Gamete has extra copy of chromosome 21 (most commonly maternal gamete)
Embryo has 47 chromosomes (3 copies of chromosome 21)

143
Q

4% of down syndrome cases

A

Translocation

144
Q

Gamete with long arm of chromosome 21 attached to another chromosome (usually 14)

A

Translocation

145
Q

Fertilization results in karotype with 46 chromosomes
(2 copies of chromosome 21)
(1 copy of chromosome 14)
(1 copy of chromosome 14/21)

A

Translocation

146
Q

1% of down syndrome cases

A

Mosaicism

147
Q

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)

A

Mosaicism

148
Q

In mosaicism, physiological and cognitive impairment

A

may be less

149
Q

Is down syndrome inherited?

A

Not in most cases, it is a mistake in cell division

150
Q

Which type of down syndrome can be inherited?

A

Translocation

151
Q

The amount of newborns with translocation who have down syndrome

A

1/2 of newborns

152
Q

Chances of passing translocation down syndrome

A

Father - 3%

Mother - 10-15%

153
Q

Prevalence of down syndrome in 2008

A

250,700 persons in U.S.

8.27/10,000 persons

154
Q

Prevalence of down syndrome at birth

A

11.8-14.5 per 10,000 live births

Large increase

155
Q

Prevalence of down syndrome among U.S. children and adolescents

A

12 per 10,000 persons

Lower among black than white youth

156
Q

Official government wording for intellectual disability in 2004

A

Mental retardation

157
Q

Medical costs of down syndrome

A

12-14 times higher for down syndrome children than children without down syndrome
Higher with congenital heart defects

158
Q

Families of children with down syndrome

A

have a 1.8 time higher risk of experiencing financial problems than families of other CSHCN.

159
Q

Health costs of down syndrome in Australia

A

4.2 times higher than general population for 0-4 year olds

Costs decline with older age

160
Q

Risk factors of down syndrome

A

Increases with maternal age
age 20: 1 in 2000
Age 45: 1 in 20

Risk increases if parent is a carrier of translocation

161
Q

Can down syndrome be prevented?

A

No, but healthy pregnancies are the best deterrent

162
Q

Prenatal screening to detect down syndrome

A

Ultrasound
Blood tests
Amniocentesis - late in pregnancy

163
Q

Healthy pregnancies

A

Multi-vitamin with folic acid
No smoking
No drinking alcohol

164
Q

Associated conditions with Down Syndrome (13)

A
  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
Q

Secondary conditions of down syndrome (5)

A
  1. Dyslipidemia
  2. Obesity
  3. Lack of friend
  4. Depression
  5. Deconditioning
166
Q

Life expectancy of down syndrome patients

A

Has increased to 50’s and 60’s

167
Q

Death rates of Down Syndrome patients

A

accelerate after 40

higher among African American DS patients

168
Q

Mortality risk factors in mid-life intellectual disability and Down Syndrome

A

Older age
Functional abilities, motor skills, non-ambulation
Behavioral issues, IQ, limited communication
Parental death, self-help
Down Syndrome

169
Q

Causes of mortality in DS

A 
Leukemia
Respiratory illness
Congenital abnormalities
Cardiovascular diseases
Dementia
Cancers
170
Q

Is there a treatment for Down Syndrome

A

No, but persons with Down Syndrome are evaluated and treated for medical complications

171
Q

Early intervention for Down Syndrome

A

involves sensory, motor, and cognitive function

172
Q

Factors affecting movement in Down Syndrome

A 
Cerebellum abnormalities 
Joint laxity
Muscle hypotonia (decreased skeletal muscle tone; floppiness)
Lower strength
Faster biological aging
173
Q

Persons with Down Syndrome gross motor skill development

A

is delayed

174
Q

Movement performance in Down Syndrome

A

is reduced and more varied

175
Q

Persons with Down Syndrome have difficulty

A

with coordination

176
Q

Reaction time in Down Syndrome

A

is slower and more variable

177
Q

Persons with Down Syndrome experience co-contraction

A

during single joint movements

178
Q

Down Syndrome patients have a preference for this type of movement

A

Slow movement

179
Q

People with Down Syndrome favor

A

safety and accuracy in their movements

180
Q

People with Down Syndrome have a delayed onset

A

of independent walking (usually by age 2)

181
Q

DS has slow walking

A

Due to shorter legs and to optimize energetic costs

182
Q

Less stability in DS

A

due to cerebellum abnormalities, joint laxity, hypotonia reduced strength

183
Q

Stepping behaviors in DS

A

tend to be faster, shorter and wider steps

greater step width variations

184
Q

DS gait has

A

higher energetic costs

185
Q

The preferred walking speed of DS patients

A

saves energy by optimizing energy cost per unit of distance

186
Q

DS patients have low aerobic fitness

A

due to low activity and low heart rate max

187
Q

DS patients have a higher___ at 3.6 mph than non DS

A

VO2 (approximately 19.82 ml/kg/min at 3.6 mph)

188
Q

Physical activity in Down Syndrome patients

A

Is likely lower than general population

Likely declinces with age

189
Q

In DS patients, is max or sub-max testing preferred?

A

Max testing is preferred over sub-max

190
Q

How to test strength in DS patients

A

1 or 10 or 12 RM

191
Q

Cardiovascular training with DS

A

3-5x/week
Group activity preferred
40-85% VO2R or heart rate reserve

192
Q

Intensity with DS

A

should progressively increase

193
Q

HRmax formula for DS

A

HRmax = 210 - 0.56 (age) - 31

194
Q

Muscular and Flexibility training in DS

A

As for people without DS

consider safety

EP 4133: Exercise Programming for Clinical Populations (1 decks)

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