Final Exam Flashcards
Description of ADHD
Persistent and maladaptive symptoms of inattention, hyperactivity, and impulsivity.
When do symptoms of ADHD typically appear?
Before age 12.
True or False - ADHD is diagnosed more in boys.
True
Describe the etiology of ADHD.
Genetics play a significant role (combination of environment and genetics).
Hypothesized low levels of dopamine.
Neurobiological condition - changes to parts of the brain responsible for attention, planning, working memory, executive functioning, motor control, mediation of goal directed behaviour.
List 3-5 symptoms of inattentive ADHD.
Decreased attention to detail.
Difficulty listening when spoken to.
Difficulty managing and following through on tasks.
Forgetful in daily activities.
Difficulty sustaining attention.
Distracted by extraneous or unimportant stimuli.
List 3-5 symptoms of hyperactive-impulsive ADHD.
Often fidgets or squirms in chair.
Feels restless, runs about, always “on the go.”
Difficulties engaging in leisure activities quietly.
Talks excessively, frequently interrupting.
Difficulty staying seated when it is expected.
How does the clinical presentation of ADHD change over time?
Overactivity/impulsivity decrease with age.
Attention, focus, and organization difficulties into adulthood.
Lifelong condition.
Increased risk for lower educational achievement and unemployment.
Increased risk for accidents and injuries.
What kinds of medications are often prescribed for ADHD? What are some possible side effects?
Stimulant medications such as Adderall and Ritalin - increase dopamine and norepinephrine in the brain.
Side effects = decreased appetite, sleep problems, anxiety, mild headache, upset stomach, irritability.
True or False - CBT can be used as an intervention for ADHD.
True
What are some interventions that may be implemented in an educational setting for people with ADHD?
Sensory strategies - reduce distractions.
Attention strategies - break down assignments, movement breaks.
Peer mediated support.
How can ADHD impact occupational participation?
ADLs - challenges learning multi-step routines.
IADLs - driving (higher risk for accidents and violations).
Social - difficult to build relationships with peers.
Productivity - school = study skills, motor skills (writing), self-regulation, academic achievement; workplace = positive or negative challenges.
List some conditions that may co-occur with ADHD.
Sensory processing differences.
Substance misuse.
Learning disorders.
Anxiety and depression.
Developmental coordination disorder.
Bipolar disorder.
Describe Sensory Processing Disorder.
Neurophysiological disorder where sensory input from the body or the environment is poorly detected, modulated, or interpreted, resulting in atypical responses to sensory messages that manifest as problems with motor coordination, organization, attention, behavioural, or emotional responses.
True or False - There is a specific cause linked to Sensory Processing Disorder.
False.
True or False - Sensory integration as an intervention for Sensory Processing Disorder is widely accepted.
False - Functional approaches are more common.
How can Sensory Processing Disorder impact occupational participation?
ADLs - feeding, toileting, bathing, tying shoes, sleeping.
IADLs - shopping, driving.
Leisure - play (games, manipulating toys).
Social - establishing/maintaining interpersonal relationships.
What are some possible comorbidities with Sensory Processing Disorder?
Autism spectrum disorder.
ADHD.
Learning disabilities.
List the three sensory processing subtypes.
- Sensory over-responsivity.
- Sensory under-responsivity.
- Sensory craving.
Describe Sensory Over-Responsivity. How might it present?
Responses to stimuli that are more intense, faster, or have a longer duration than is “typical” for most people. Sensory defensiveness.
May present as - avoidance/withdrawal, irritation/aggression, stress/anxiety (activation of sympathetic nervous system).
Describe Sensory Under-Responsivity. How might it present?
Requires more intense and extended duration of sensory stimuli to reach optimal level of arousal.
May present as - higher pain tolerance (safety concern), not noticing mess/spills on self, decreased body awareness (clumsiness, motor delays), delayed response times in conversation or to sensory stimuli, quiet/passive.
Describe Sensory Craving. How might it present?
Seek sensory input with an approach that results in erratic, disorganized behaviour. More input does not provide regulation back into “optimal window.”
May present as - “fearless”, enjoys jumping, climbing, swinging, and twirling, “need” to touch everything, may be seen as intruding into others space, crashing into others and objects.
Describe Adaptive Behaviour in regards to Intellectual Disabilities.
The collection of conceptual, social, and practical skills that people have learned so they can function in their everyday lives.
Conceptual - receptive and expressive language, reading, writing, math, reasoning, knowledge, memory.
Social - empathy, social judgment, communication skills, the ability to follow rules, and the ability to make and keep friendships, gullibility, social problem solving.
Practical - ADLs, job responsibilities, managing money, recreation, organizing school and work tasks, home, and personal safety skills.
How are Intellectual Disabilities labelled if they appear before the age of 5?
Global development delay.
What are some biomedical risk factors for Intellectual Disabilities?
Genetic or chromosomal mutation/abnormalities.
Seen in down syndrome (chromosomal), fragile X syndrome (genetic), Hunter syndrome (genetic).
Describe some prenatal, perinatal, and post-natal risk factors related to Intellectual Disabilities.
Prenatal - maternal infections, herpes simplex II, poor nutrition.
Perinatal - injuries at birth, perinatal hypoxia, infectious diseases.
Post-natal - trauma, early severe psychosocial deprivation.
True or False - Severity and occupational participation barriers related to Intellectual Disabilities remain consistent throughout live.
False - may “ebb and flow” throughout life depending on supports and environmental demands.
What is the goal of interventions for Intellectual Disabilities?
Increase adaptive functioning and increase full potential of child in their various occupations.
True or False - There are no specific medications for intellectual disabilities.
True - medications may be needed for secondary conditions.
Describe possible impacts of Intellectual Disabilities on occupational participation.
ADLs - self-care routines, equipment for safe bathing/showering, safe feeding.
IADLs - post-secondary education, parenthood, career development/maintenance.
Leisure - challenges with participation in leisure activities.
Social - establishing/maintaining friendships.
Describe Developmental Coordination Disorder.
Delay in the development of motor skills, or difficulty coordinating movements, results in a child being unable to perform common, everyday tasks.
Acquisition and execution of coordinated motor skills is substantially below what is expected based on age and opportunity for skill learning and use. Repetition and observation do not help in development of motor skills.
True or False - Children with DCD (Developmental Coordination Disorder) have below average intellectual abilities.
False - typically have average or above average intellectual abilities.
Which term is sometimes used interchangeably with Developmental Coordination Disorder?
Dyspraxia - which is difficulty with motor planning/plan unfamiliar tasks; not a recognized diagnosis.
Describe the course and prognosis of Developmental Coordination Disorder.
50-75% of those diagnosed as children have symptoms that persist into adolescence.
Adults continue to have difficulty with a range of motor skills and learning new skills with motor components (e.g., driving).
Adults continue to report secondary complications, including depression, low self-esteem.
What does M.A.T.C.H. stand for in regards to an intervention for DCD? What is the goal?
M - Modify the task.
A - Alter your experience.
T - Teaching strategies.
C - Change the environment.
H - Help by understanding.
Goal is to support participation in meaningful occupations, which might mean that children with DCD have to do activities differently.
What is the Cognitive and Task-Based Learning intervention for children with DCD?
Providing children with metacognitive strategies so they can problem solve through their own challenges and solutions (Goal-Plan-Do-Check, Cognitive Orientation to Occupational Performance).
Task-Based Learning - focuses directly on the functional skills; break down a tasks into steps that can be practiced independently then linked back together to accomplish entire task; recognizes it may be difficult to generalize between tasks.
How can DCD impact occupational participation?
Self-care skills - especially those that require multiple motor skills and steps (washing hair, managing zippers/buttons).
Academic skills - handwriting, note taking.
Leisure and fitness - less opportunity and interest in healthy movement and activity.
Social - decreased opportunities to socialize with peers through sports, impaired self-esteem, and self-worth.
What are some co-occurring conditions/concerns associated with DCD?
Prematurity, low birth weight, prenatal alcohol exposure.
ADHD, learning disabilities, autism.
Describe Spina Bifida.
Neural tube defect - occurs early in uterine development (~week 4).
Defect of vertebral arches and spinal column.
Describe some risk factors associated with Spina Bifida.
Likely a combination of genetic, environmental, or nutritional factors – folic acid; family history; diabetes; medications (valproic acid).
Describe the four types of Spina Bifida. Which is the most severe?
- Occulta - “hidden”, mildest and most common.
- Meningocele - CSF and meninges protrude through abnormal vertebral opening, no neural elements; few to significant symptoms.
- Lipomeningocele - fatty mass under skin, can pull and lead to spinal cord tethering; does not always require surgical interventions.
- Myelomeningocele - most severe; spinal cord/neural elements exposed; typically see partial, or complete paralysis below affected level.
How can the prognosis of Spina Bifida be improved?
Early identification and intervention.
Access to regular medical treatment and support.
Less severe involvement of spinal cord.
Presence of secondary health conditions may lead to increased risk of infections and poorer quality of life and ability to participate in meaningful occupations (e.g., shunts, aspiration pneumonia from impaired breathing/swallowing with Chiari II malformations).
Describe occupational participation concerns related to Spina Bifida.
Vary depending on level and severity of injury in the spinal cord and presence/absence of secondary complications.
ADLs - toileting, dressing, grooming, bathing, donning/doffing orthoses.
IADLs - meal prep, adaptive driving/transportation, environmental modifications and mobility equipment.
Leisure - adaptive leisure opportunities.
Social - relationships and sexuality.
List and Describe possible secondary health conditions related to Spina Bifida.
Type II Chiari Malformation - impairments in breathing patterns, swallowing/gagging, arm weakness.
Tethered Spinal Cord - 20-50% of children with spina bifida, limits movement of spinal cord in the spinal canal; can present as progressive/severe pain, loss of muscle function, gait deterioration, changes in bowel or bladder function.
Wounds and Pressure Ulcers - may have little to no feeling in certain parts of their bodies; heat, friction, moisture, pressure can cause wounds.
Hydrocephalus - normal CSF circulation patterns are interrupted; children - can impact cognitive development (verbal and visual memory, attention, cognitive flexibility), adults - mimic signs and symptoms of dementia, gait impairments, urinary incontinence.
Describe Cerebral Palsy.
Cerebral palsy (CP) refers to a group of disorders in the development of motor control and posture, occurring because of a non-progressive impairment of the developing central nervous system. The motor disorders of cerebral palsy can be accompanied by disturbances of sensation, cognition, communication, perception, and/or seizure disorder.
Pre/Peri/Post-natal onset.
Post-natal considered ~2-8 years.
Pre-natal accounts for 70-80% of cases.
Typically diagnosed when a child does not meet expected motor milestones (e.g., sitting, using hands bilaterally, bearing weight through lower extremities).
List some signs and symptoms associated with Cerebral Palsy.
Vary with location and severity.
Tone abnormalities - hypertonicity, hypotonicity, dystonia.
Reflex abnormalities - hyperreflexia, clonus, +/- primitive reflexes.
Atypical posture.
Delayed motor development.
Atypical motor performance.
How does Cerebral Palsy develop with age?
Varies depending on type, severity, and presence of associated problems.
With age, secondary problems (contractures, deformities) become more common.
Adults - musculoskeletal difficulties & loss of function at an earlier age.
75% of people with cerebral palsy stopped walking by age 25.
86% survival rate at age 50.
What is the overarching goal of interventions for Cerebral Palsy?
Maximizing potential motor skill development and reducing secondary complications (e.g., reducing abnormal muscle tone, preventing complications from seizures).
What is the gold standard intervention for increased functional improvement in affected upper extremity in children with Cerebral Palsy?
Constrain Induced Movement Therapy
What are some interventions for spasticity management for Cerebral Palsy?
Botox with +/- splinting, serial casting in case of joint contractures.
Orthotics - ankle/foot orthoses, pharmacological (baclofen - oral or pump).
Surgical - joint lengthening, tendon transfers.
Selective dorsal rhizotomy.
What are the “F-words” in regards to childhood disability?
Fitness (body structure and function)
Functioning (activity)
Friends (participation)
Family (environmental factors)
Fun (personal factors)
What is a key point to remember when considering MACS as a functional classification for Cerebral Palsy?
Reflects usual performance, not potential.
Describe the five levels of GMFCS.
I - Walks without limitations.
II - Walks with limitations.
III - Walks using a hand-held mobility device.
IV - Self mobility with limitations; may use powered mobility.
V - Transported in a manual wheelchair.
What is the purpose of classifying Cerebral Palsy under MACS?
Considers the child’s ability to handle objects in important daily activities, for example - play, leisure, eating, and dressing.
Describe the five levels of MACS (Manual Abilities Classification System).
I - Handles objects easily and successfully. Any limitations in manual abilities do not restrict independence in daily activities.
II - Handles most objects but with somewhat reduced quality and/or speed of achievement. Certain activities may be avoided but does not usually restrict independence in daily activities.
III - Handles objects with difficulty; needs help to prepare and/or modify activities. ADLs can be performed independently if they’ve been set up or adapted.
IV - Handles a limited selection of easily managed objects in adapted situations. Requires continuous support and assistance and/or adapted equipment for even partial achievement of the activity.
V - Does not handle objects and has severely limited ability to perform even simple actions. Requires total assistance.
Describe Spastic Cerebral Palsy.
Characterized by hypertonicity, retained primitive reflexes in affected areas of the body, and slow, restricted movement.
Contractures - permanent shortening of a muscle or joint and deformities are common.
Describe Spastic Hemiplegia.
Involves one entire side of body, including head, neck, and trunk; upper extremity most affected. Asymmetrical hand use during first year, dragging one side of body. Child learns to walk later than typical, will typically hyperextend knee. Spasticity increases during physical activities and emotional excitement.
Describe Spastic Diplegia.
Involves both lower extremities, with mild incoordination, tremors, or less severe spasticity in the upper extremities. Most often attributed to premature birth and low birth weight. Ability to sit independently can be delayed up to 3 years of age or older - inadequate hip flexion and extensor and adductor hypertonicity in legs. Child will move forward on the floor by pulling along with flexed arms and stiffly extended legs. Excessive trunk and upper extremity compensatory movements are used when walking.
Describe Spastic Quadriplegia.
Entire body is involved. Difficulty with transitional movements such as rolling or coming up to sitting. Independent sitting and standing are difficulty for child because of hypertonicity, the presence of primitive reflex involvement, and a lack of righting and equilibrium reactions. Small percentage are able to walk independently. Oral muscles are usually affected - difficulties with dysarthria, eating difficulties, and drooling. Children are susceptible to contractures and deformities, particularly hip dislocation and scoliosis.
Describe Athetosis Cerebral Palsy.
Characterized by slow, writhing involuntary movements of the face and extremities or the proximal parts of the limbs and trunk. Abrupt, jerky distal movements may also appear. Movements increase with emotional tension and are not present during sleep. Head and trunk control are affected, as is oral muscles, causing drooling, dysarthria, and eating difficulties. Contractures rare.
Describe Ataxia Cerebral Palsy.
Characterized by a wide-based, staggering, and unsteady gait. Often walk quickly to compensate for lack of stability and control. Controlled movements are clumsy. Intention tremors may be present. Ability to perform refined movements (handwriting) is affected. Hypotonicity often present.
What are some impacts Cerebral Palsy may have on occupational participation?
All body function categories can be affected (depends on type, severity, associated disorders).
ADLs – Physical assistance (dressing, feeding, hygiene), movement (spasticity affects joint stability), impaired voluntary movements, toileting.
IADLs – Assistive technology (communication), visual delays.
Cognitive functioning impacted.
What are some co-occurring conditions/complications often associated with Cerebral Palsy?
Cognitive impairment.
Orthopedic complications – joint contractures, hip dislocations, scoliosis.
Seizures.
Visual impairments – strabismus, nystagmus, homonymous hemianopsia, cortical vision impairments.
Communication disorders – dysarthria.
Oral motor – dysphagia.
Gastrointestinal – gastroesophageal reflux (GERD).
Respiratory – aspiration pneumonia, sleep apnea, upper respiratory infections.
Describe the etiology of Duchenne Muscular Dystrophy.
Only affects males (X chromosomes linked condition).
Absence or deficiency in the structural protein dystrophin - maintains shape and structure of muscle fibers.
What are some common signs and symptoms associated with Duchenne Muscular Dystrophy?
Proximal weakness
Waddling gait
Enlarged calf muscles
Developmental delays – running, jumping, playing with peers
Fatigue
Toe walking
Speech delays
True or False - Most people with Duchenne Muscular Dystrophy are wheelchair dependent by age 12.
True.
True or False - Muscle weakness in Duchenne Muscular Dystrophy is always bilateral and symmetrical.
True.
What is the life expectancy of somebody with Duchenne Muscular Dystrophy?
Late teens to early twenties. Cause of death usually secondary infections to respiratory and/or cardiac complications.
What are the goals of interventions for Duchenne Muscular Dystrophy?
To maintain independence and muscle function as long as possible.
How might Duchenne Muscular Dystrophy affect occupational participation?
ADLs – Decline in functioning is expected – results in loss of ability to perform ADLs, require assistance with dressing, grooming, bathing, toileting, mobility equipment.
IADLs – Driving, community mobility, health management and maintenance, meal preparation, shopping.
Psychosocial Considerations – Children with DMD are at higher risk for co-occurring mental health conditions/psychosocial considerations.
These may also impact occupational participation in school, with peers, family/home life, and leisure and may include – Anxiety - decreased cognitive flexibility, depression, decreased social skills and peer relationships, anger/arguing, decreased cognitive skills – short-term memory, cognitive flexibility, decreased language skills, higher risk of co-occurring neurodevelopmental conditions like autism spectrum disorder, obsessive compulsive disorder, ADHD.
What is the “valley sign” in regards to Duchenne Muscular Dystrophy?
Present in 90% of males with this condition.
Depressed area on the posterior axillary fold that can be seen when the patient abducts shoulders to 90 degrees, elbows flexed to 90 degrees, with bilateral hands pointing upwards.
Describe Autism Spectrum Disorder.
Characterized by impairments in social interaction and social communication by the presence of restricted and repetitive behaviours. Diagnosis of ASD requires the presence of restricted, repetitive patterns of behaviour, interests, or activities. Outside what is “typical” for the social and cultural context. Insistence of sameness, adherence to routines, or ritualized patterns of verbal or nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transitions).
True or False - Symptoms of Autism Spectrum Disorder do not appear until the age of 4 or later.
False - Symptoms must be present in the early development period (12-36 months).
True or False - The treatment of Autism Spectrum Disorder relies heavily on the use of medications.
False - Medication may be used to treat secondary conditions.
What is the most effective intervention for children with Autism Spectrum Disorder?
Intensive early intervention (0-3 years old) are most effective for reducing behavioural problems and in increasing language, social, sensory, motor, and cognitive skills.
Describe some ways in which ASD may impact occupational participation?
Autism is a spectrum – occupational performance and participation will be varied.
May be influenced by – +/- intellectual/language impairments, co-existing sensory, psychiatric, motor deficits, socioeconomic factors – access to interventions, sufficient school, work, and family supports (e.g., access to augmentative and adaptive communication – AAC).
ADLs such as dressing, may struggle with toileting, experiencing pain, digestive system.
and eating can be made difficult if they are overresponsive to sensory stimuli.
IADLs such as shopping and driving.
Difficulty with memory functioning (academic performance).
Play and leisure - impacted by restrictive and repetitive behaviours.
Describe Rheumatoid Arthritis.
Systemic condition.
Generally, impacts same joint(s) bilaterally.
Joint inflammation - changes in synovial membrane and development of corrosive pannus (destructive tissue) – lead to cartilage and bone breakdown at joints.
Characterized by – subchondral cysts, signs of rebuilding bone and/or presence of osteophytes, small joints tend to be impacted and can have resulting deformities (e.g., MTP, PIP, CMC).
What are some signs of Rheumatoid Arthritis?
“Non-specific” signs of inflammatory process which can include – hot, red joints; joint edema, subluxation; joint pain - 3 joints; joint guarding; loss of joint range of motion; fatigue, generalized weakness
*Symmetrical pattern of pain, swelling, redness
True or False - 40% of adults are in remission within the first year of a Rheumatoid Arthritis diagnosis.
False - 20%, majority will develop chronic progressive disease.
What group of people have the worst prognosis for Rheumatoid Arthritis?
Women diagnosed prior to the age of 50.
What are some occupational participation concerns with a Rheumatoid Arthritis diagnosis?
Ambulation/Mobility.
Hand strength - Grip & Pinch.
Fatigue.
Sore, aching joints.
Pain with activity.
All can impact ADLs (dressing, eating), IADLs, leisure, productivity, relationships/socialization.
What are some possible co-occurring conditions with Rheumatoid Arthritis?
Wrist – carpal tunnel syndrome
Elbow – lateral epicondylitis
Shoulder – shoulder bursitis, rotator cuff tears
Hip – abnormal gait (foot)
Knee – popliteal cysts (can result in contracture)
Ankle and foot – “Claw toes”, hammer toes, hallux valgus
Because RA is systemic its impact carries to many organ systems including – rheumatoid/ subcutaneous nodules; pulmonary – chronic inflammation can cause scar tissues on lungs, cardiac manifestations, neurological manifestations, ophthalmic manifestations, depression and anxiety – ~1.5x more likely than unaffected population.
Nodules can enter organs.
What Rheumatic condition is often referred to as the “Unwalkable Disease” or “Disease of Kings”
Gout
Describe Delirium.
A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment.
The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during a day.
An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
What are some premorbid factors related to Delirium?
Advanced age
Dementia
Low educational level
High comorbidity burden
Frailty
Visual and hearing impairment
Depression
Alcohol abuse
Poor nutrition
Illicit drug, opioid, or benzodiazepine use
History of delirium
What are some hyperactive symptoms of Delirium?
Increased psychomotor activity that may be accompanied by mood lability, agitation, aggression (often not cooperative in care).
Symptoms that may be easy to observe.
What are some hypoactive symptoms of delirium?
Decreased psychomotor activity - sluggish, lethargic, stupor.
Occurs in roughly 50% of cases. Much harder to observe - can mimic symptoms of major depressive disorder.
Describe the course and prognosis of Delirium.
Acute course – hours to days.
Persistent course – weeks to months (more common in people with previously diagnosed neurocognitive changes).
Majority of adults <65 will resolve completely.
May be associated with long term cognitive decline in older adults, especially those with underlying cognitive impairments.
Hospitalized individuals 65 years or older with delirium are at greater risk for poor outcomes following discharge, including mortality, and requiring institutional care.
Should not be downplayed as something normal that occurs in hospitals – medical emergency.
How can Delirium impact an individuals occupational participation?
The early non-pharmacological management of delirium directly involves activities needed for occupational participation and can include –
Resume typical sleep/wake cycle.
Sitting up in chair for meals.
Dressed in regular clothing.
Frequent orientation to date and location (calendar, familiar items).
Visitors.
Remove unnecessary lines and tubes (i.e.) indwelling catheters; IV lines – promotes regular toileting routine.
Describe Alzheimer’s Disease.
Most common dementia.
Insidious, gradual, progressive onset of impairment in – memory, learning and one other cognitive domain.
May start with behavioural (neuropsychiatric symptoms) such as – agitation, sleep disorder.
What are some of the current hypotheses about the etiology of Alzheimer’s Disease?
Etiology unknown.
Beta-amyloid plaques caused by defective breakdown of amyloid precursor protein – plaques collect outside neurons and disrupt synaptic transmission.
Neurofibrillary tangles are abnormal accumulations tau protein that collect inside neurons and disrupt flow of signals from cell body down axons.
Build-up of microglia (intended to remove waste and excess proteins like Beta amyloid plaques) that do not perform their function.
What are symptoms of the mild phase of Alzheimer’s Disease?
Cognitive – impairment in memory and learning, sometimes accompanied by deficits in executive function (hippocampus impacted).
Behavioural/Neuropsychiatric – depression, irritability, and/or apathy.
What are some symptoms of the major phase of Alzheimer’s Disease?
Cognitive – impairments in visuoconstructional/perceptual-motor ability and language (e.g., word retrieval).
Behavioural/Neuropsychiatric – delusions, agitation, combativeness, and wandering are common.
Psychological – apathy, depression, delusions.
Physical – gait disturbances, dysphagia (swallowing), incontinence, myoclonus, and seizures are observed.
All related to atrophy of the brain.
What is the mean survival length after a diagnosis of Alzheimer’s Disease?
10 years from diagnosis.
Younger diagnosis = ~20 years.
What are the occupational participation concerns related to Alzheimer’s Disease?
Mild phase - early retirement from work and meaningful IADLs like driving.
Major phase - dependent for all ADLs, IADLs; loss of recognition of loved ones; decreased communication - basic and social communication; safety concerns (wandering).
At the end stages/most severe course of these health conditions, the individual will likely require 24-hour support for ADL, IADLs, functional mobility and safety – that may be at home or in institutional care.
Describe Multiple Sclerosis.
Inflammatory, immunological, neurodegenerative disease.
Immune system attacks myelin sheath around brain, SC, optic nerve (demyelination); cerebellar and its efferent/afferent pathways commonly affected.
What are some possible risk factors for Multiple Sclerosis?
Cause unknown. Demyelination is the main cause of impairment.
Chronic inflammation/diffuse demyelination to white/grey matter and axons. Formation of plaques.
Some hypotheses include - genetics + environmental factors, higher estrogen levels, vitamin D deficiencies, viral infection, smoking.
What are some symptoms of Multiple Sclerosis?
Physical - spasticity, fatigue, low endurance/energy, muscle weakness, ataxia, intention, tremor.
Vision/Vestibular - diplopia, loss of visual acuity, sense of balance, ocular control.
Sensory - abnormal sensation, burning/tingling.
Cognitive deficits - attention, memory, executive functions.
Psychosocial/Emotional - depression/euphoria, fatigue, anxiety, irritability.
What are some factors that influence course and prognosis of Multiple Sclerosis?
Subtype.
Symptom severity.
Age of onset (20s = ~46-60 yrs; 60s = ~13-22 yrs).
