FINAL EXAM - Progressive Neurological conditions Flashcards
-lepsy
Seizure
-phasia
Speech
Amyotrophic lateral sclerosis (ALS) also called Lou Gehrig’s disease
Progressive motor neuron disease that manifests in adulthood and progresses very quickly
Dementia
Progressive, irreversible deteriorationof mental function marked by memory impairment and, commonly, deficits in reasoning, judgment, abstract thought, comprehension, learning, task execution, and use of language
Alzheimer disease
Chronic, organic brain syndrome characterized by death of neurons in the cerebral cortex and their replacement by microscopic plaques, which results in dementia progresses to complete loss of mental, emotional, and physical functioning and personality changes
Epilepsy
Disorder that results from the generation of electrical signals inside the brain, causing recurring seizures in which some people simply stare blankly for a few seconds during a seizure, where as others have extreme convulsions
Huntington chorea
Inherited, degenerative disease of the CNS with symptoms developing in the middle age as nerve cells in the brain waste away, resulting in uncontrolled Bizzarre movements, emotional disturbances, and mental deterioration
Hydrocephalus
Excessive accumulation of cerebral fluid within the ventricles of the brain that is most common in Neonates, but can also occur in adults as a result of injury or disease; if left untreated, causes an enlarged head and cognitive decline
Multiple sclerosis
Progressive degenerative disease of the CNS characterized by demyelination of the myelin sheath in the gray and white matter of the brain, which produces weakness and other muscular symptoms (Driving on the GSP and there’s a road block; only one car can pass at a time)
Neuroblastoma
Malignant tumor composed mainly of cells resembling neuroblasts that occurs most commonly in infants and children
Neurosis
Non-psychotic mental illness that triggers feelings of distress and anxiety and impairs normal behavior
Palsy
Partial or complete loss of motor function; also called paralysis
Bell palsy
Facial paralysis on one side of the face as a result of inflammation of facial nerves
Cerebral palsy
Bilateral, symmetrical, nonprogressive motor dysfunction and partial paralysis, which is usually caused by damage to the cerebrum during gestation or birth trauma but can also be hereditary
Paralysis
Loss of muscle function, loss of sensation, or both as a result of spinal cord injury
Parkinson disease
Progressive neurological disorder caused by neurotransmitter deficiencies (dopamine) that affects the portion of the brain responsible for controlling movement (basal ganglia)
Poliomyelitis
Inflammation of the gray matter of the spinal cord caused by a virus, commonly resulting in spinal and muscle deformity and paralysis
Psychosis
Mental disorder marked by loss of contact with reality; often with delusions and hallucinations
Sciatica
Severe pain in the leg along the course of the sciatic nerve which travels from the hip to the foot
Shingles
Chronic viral disease in which painful blisters appear on the skin along the course of the peripheral nerve that is caused by inflammation secondary to herpes zoster virus, The same virus that causes chickenpox; also called herpes zoster
Spina bifida
Congenital neural tube defect characterized by incomplete closure of the spinal canal through which the spinal cord and meninges may or may not protrude
Spina bifida occulta
Most common and Lisa beer from a spina bifida without protrusion of the spinal cord or meninges
Spina bifida cystica
Most severe type of spina bifida that involves protrusion of the meninges spinal cord or both
Meningocele
The protrusion of meninges through the spinal canal
Stroke
In adequate supply of blood and oxygen to the brain do to a clot or ruptured blood vessel, which allows brain tissue to die and becomes a medical emergency; also called cerebrovascular accident CVA
Hemorrhage
Ruptured blood vessel
Transient ischemic attack TIA
Interruption in blood supply to the brain that does not cause permanent brain damage but may be an indication of a high risk or a more serious and debilitating condition (a stroke); also called mini stroke
Cerebrospinal fluid analysis CSF
Laboratory test that examines a sample of CSF obtained from a lumbar puncture or, which is analyze for the presence of blood, bacteria, and malignant cells as well as for the amount of protein and glucose present
Electroencephalography
Electrodes are placed on the scalp to record electrical activity within the brain; used to evaluate seizure and sleep disorders and periods of unconsciousness, monitor brain surgeries, and determine whether a person is in a coma or brain-dead
Lumbar puncture LP
Insertion of a needle into the subarachnoid space of the spinal column to withdraw a sample of CSF used for biochemical, microbiological, and cytological Laboratory analysis; also called spinal tap or spinal puncture
Craniotomy
Surgical procedure that creates an opening in the school to gain access to the brain during neurosurgical procedures
Thalamotomy
Partial destruction of the thalamus to treat the psychosis or intractable pain. Thalamus is also responsible for movement and this can help control Tremors in PD
Trephination
Excision of a circular disk of bone using a special I saw called a trephine to reveal brain tissue during neurosurgery, or to relieve intracranial pressure ICP
Anesthetics
Procedure partial or complete loss of sensation with or without loss of consciousness
General Anesthetics
Produce complete loss of feeling with loss of consciousness
Local anesthesia
Produce loss of feeling and affect a local area only
Anticonvulsants
Prevent or control seizures
Antiparkinsonian agents
Redo signs and symptoms associated with Parkinson disease
Antipsychotics
Alter neurotransmitters in the brain to alleviate symptoms of delusions and hallucinations
Thrombolytics
Dissolve blood clots in the process known as Thrombolysis
Trigeminal neuralgia TN
Neuropathic pain syndrome that involves the facial area stimulated by the trigeminal nerve (cranial nerve five); caused by blood vessels pressing on the route of the trigeminal nerve; trauma, tumor, MS, or herpes zoster
Spastic
Hyperactive reflexes
Flaccid
Loss of reflexes and tone
Cerebr/o
Cerebrum
etiology of ALS (2)
- familial ALS (FALS) inherited autosomal trait
2. 90% occur sporadically and cause is unknown
ALS risk factors (2)
- ALS clusters
2. Food related cycad bean
Course and Prognosis of ALS (4)
- Progressive
- Death within 2-5 years
- Respiratory Failure and inability to eat are typical end stage
- Earlier onset (
Medical Interventions for ALS (2)
- Few drugs slow the progression
2. prevention of respiratory symptoms is critical
OT intervention for ALS- Education (7)
- energy conservation
- compensatory strategies - using GE devices
- spints and orthotics to reduce pain, subluxation and fatigue
- adaptive devices
- safety, positioning, safe transfers, and skin integrity
- augmentative communication devices
- continued participation in shifted life roles and meaningful occupations
Things to consider with progressive neurological disease (3)
- burnout factor for everyone - pt, family, practitioner
- quality of life inventory - give them the most fn they can have for as long as they want
- consider their life as a whole not just who they are now; see them as the full person they once were.
The triad of classic signs of Parkinson’s Disease
- tremor starts as an intention tremor progresses into a resting tremor
- rigidity
- akinesia
Etiology of Parkinson’s Disease (3)
- cause is generally unknown
- gene may cause in a small percentage of cases
- pesticides and herbicides have been implicated in a small percentage of cases
Risk factors/ precaustions and prevention for parkinson’s
Risk factors - loosely associated to environment and genetics
No identified Precautions or preventions
Signs and symptoms of Parkinsons (4)
- tremors - intention to resting
- rigidity - lack of rotation in
- bradykinesia - slowness of the actual movement - difficulty adjusting body position
- Postural changed - stooped, unsteady
Course and Prognosis of parkinson’s (4)
- All signs get progressively worse but not at the same time
- tremors may peak and not become worse
- posture and gait abnormalities are the most difficult
- economic impact due to onset in the 50s and 60s - loss of income, increase cost for treatment and care
medical interventions and medications for Parkinson’s (3)
- does not decrease life span but the debilitation may
- L-Dopa is used but has significant side effects
- Deep brain stimulation for tremor management - has it’s own side effects
Therapy considerations with Parkinson’s disease
- external temporal constraints can help organize timing and speed
- fall precautions due to movement disorders
- Submax exercise results in higher heart rate and increased O2 consumption
- Interventions will not result in a cure; but, supplementary motor pathways bypassing the basal ganglia can be developed
Progressive diseases are also known as
degenerative diseases of the CNS
MRIs are pretty definitive in this progressive neurological disorder
MS
OTs may suspect MS when referral of clumsiness and general weakness. Why is this?
We ask the pt to do more than the MD does during their visit with them and we spend more time with them. Pts also share more with us b/c we build a rapport with them. Always notify MD if you suspect MS. We do not diagnose!
Etiology of MS (4)
- immune based disorder
- Virus can increase chance of an exacerbation
- Genetic - less than 5% from a first degree relative
- Environmental - children of parents who migrated from a high risk area to a low risk area have lower incidence
MS risk factors (3)
- possibly environment
- possibly genetics
- probably a combination of many factors
Precautions and preventions for MS
None known
symptoms of MS (12)
- paresthesia - localized
- blurred vision
- diplopia
- weakness and fatigue
- balance and coordination problems
- spasticity
- pain
- sensitive to heat
- bladder and bowel problems
- Problems with sexual function
- cognitive issues - mainly executive Fn. loss of short-term memory, concentration, judgement, or problem solving
- emotional changes - depression, mood swings, irritability, or pseudobulbar affect (uncontrolled laughing or crying)
4 types of MS
- relapsing-remitting
- secondary progressive
- primary progressive
- progressive relapsing
Relapsing - remitting MS
attacks that last for days/months followed by full or partial recovery - most common 85% of newly diagnosed pts
secondary progressive MS characteristics (5)
- relapse and remission progressive pattern
- 50% diagnosed evolve into this pattern
- Usually seasonal
- Diagnosed over 40yoa
- steady decline from the start don’t usually recover any loss
Primary Progressive MS characteristics(4)
steady decline from onset
episodes of minimal recovery
onset after 40 yoa
after every episode, never regain prior episode Fn.
Progressive relapsing MS characteristics ( 3)
- progressive from the start with clear exacerbations
- rarest type of MS
- Declines, may gain back some Fn, and declines again
Course of MS
depends on the type of MS and any co morbidities
Prognosis of MS (3)
- life expectancy reduced by maybe 10 yrs. Don’t die from MS. Die from co-morbidities.
- risk of dying of MS is associated with severe disability
- depression and related mental health issues due to young age of onset
Comorbidities that put Pts with MS at risk of dying (4)
- respiratory issues
- pneumonia
- renal failure
- heart failure
Medical management of MS (5)
- modify disease course - immunotherapy
- treat exacerbations - steroids
- manage symptoms - therapy and meds
- improve fn and safety - therapy
- provide emotional support - everyone
Occupational Therapy Interventions for MS (8)
- ADL and cognitive retraining
- energy conservation
- assistive technology
- environmental, employment, and home modifications
- Pain and stress management
- ROM/endurance/strengthening for desired activities
- safety awareness
- splinting
secondary signs and symptoms for PD (16)
- gait disturbances
- impaired dexterity and coordination
- involuntary immobilization
- speech difficulties
- swallowing difficulties
- poor balance
- oculomotor impairments
- reduced facial expression
- sleep disturbances
- reduced bowel and bladder fn
- painful cramping of muscles
- sexual dysfunction
- low BP
- sensory disturbances
- seborrhea (oily skin, dandruff)
- fatigue
Hoehn and Yahr staging system of PD Stage 1 (2)
mild movement - related symptoms on one side
able to function without disability
Stage II of PD (3)
bilateral signs of movement related symptoms
balance is NOT impaired
symptoms can improve with medication
stage III of PD (2)
mild imbalance during walking or standing
Moderately severe generalized dysfunction but typically remains physically independent
stage IV of PD (4)
motor symptoms are advanced and severe
Disabling instability while walking or standing
the individual is no longer able to live alone
Changes in speech and swallowing are also apparent.
stage V of PD (3)
severe and fully developed
individual is unable to stand or walk
requires constant care
LDopa side effects (8)
- nausea
- loss of appetite
- dyskinesias,
- dry mouth
- sleepiness
- confusion
- hallucinations
- neurotoxicity
Lower motor neuron symptoms of ALS (4)
- focal and multifocal weakness
- atrophy - progresses distal to proximal
- muscle cramping
- muscle twitching
Corticospinal tract symptoms of ALS (4)
spasticity
hyperactive reflexes
dysphagia - difficulty swallowing
dysarthria - impaired speech
symptoms of ALS (8)
- focal and multifocal weakness
- atrophy - progresses distal to proximal
- muscle cramping
- muscle twitching
- spasticity
- hyperactive reflexes
- dysphagia - difficulty swallowing
- dysarthria - impaired speech
PNDs impacts client factors and occupational performance. This includes
- self-care - gross and fine motor coordination
- difficulty eating - dysphagia, loss of strength and coordination
- Functional mobility - neuromuscular and motor problems
- IADLs - reduced sensory, cognitive, and perceptual functions
- Education - neuromuscular, motor problems, cognitive and perceptual deficits. Computer-based courses are an option
- Work - fatigue, weak or blurred vision, difficulties with bladder control, decline in motor skills, cognitive deficits
- Play and leisure - maintain balance as long as possible to have meaningful and fulfilling leisure.
- Social participation - communication, mobility, sexual dysfunction, eating problems affect normal socialization. Dysarthria - imperfect articulation - difficulty communicating needs.
OT interventions for ALS - Adaption (2)
- environmental modification to promote function
2. Adaptive utensils or equipments (wheelchairs, self-care devices, grab bars)
Motor symptoms with MS -5
Spasticity Limitations in tolerance/low energy Weakness Ataxia-like symptoms Intention tremor
Visual symptoms with ME -5
Double vision Pain behind the eyes Blurred vision Partial blindness/scotoma Nystagmus
Cognitive symptoms with MS -3
Memory loss or disturbance
Difficulty with complex ideas
Decreased attention span
Psychological symptoms with MS - 3
Depression or euphoria
Impulsivity
Lability
Secondary signs and symptoms of PD -16
Gait disturbances
OT interventions for ALS - Prevention (3)
- muscle deconditioning
- contracture through active and passive range of motion exercises
- pressure sores with proper positioning
OT interventions for MS - Educating Clients and caregivers about (7)
- disease process
- energy conservation strategies
- cognitive strategies
- grading activities
- use of mobility aids and assistive technology
- safety awareness
- work or home modifications
OT Intervention for PD in ADLs and IADLs (2)
- Teach use of adaptive techniques and tools to reduce the effect of tremors
- Provide strategies to assist with medication routines
OT Intervention for PD in sensorimotor (2)
- facilitate joint movement, maintain ROM, and prevent contractures by stretching
- improve motor planning and increase speed by adding cues such as music with beats
OT intervention for PD in psychosocial (5)
- group intervention can increase client functioning and perceptions of capabilities and self-esteem
- educate in self-management skills
- promote engagement in productive activities and leisure with suitable challenges
- encourage discussion of roles within the family and living unit
- educate the family about difficulties affecting social interaction, such as facial masking and oral rigidity
OT Interventions for PD in Environment (3)
- Suggest home modifications for increased safety
- encourage client and family to participate in support groups
- help client and family explore the community for resources
