Gold Level Clinical Application Templates Flashcards
What is Alzheimer’s Disease?
What causes it?
a progressive neurological disorders that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain resulting in the breakdown of several processes that normally sustain brain cells
Exact etiology is not known but there are amyloid plaques, cerebral atrophy and neurofibrillary tangles within the cytoplasm that result in an inflammatory process that causes damage to the nervous system and damage to the smooth muscle and arteries in the brain
How do patients with Alzheimer’s Disease typically present?
patients in early stages will usually have a noted change in higher cortical functions such as subtle changes in memory, impaired concentration, and difficulty learning new things, word finding issues, depression, and poor judgement
In middle stages patient will have behavioral and motor issues such as aphasia, apraxia, perseveration, agitation and violent or socially unacceptable behavior
End stage Alzheimer’s Disease sees the patient have no ability to learn new tasks and severe loss of long term memory and vegetative symptoms such as incontinence, functional dependence, and inability to speak
How is Alzheimer’s Disease managed with PT?
focus on maximizing remaining functional ability and family/caregiver education
PT can be useful to increase independence but it cannot alter or cease the progression of Alzheimer’s Disease
What is the typical outcome for patients with Alzheimer’s Disease?
this is a chronic and progressive disorder and the typical course of the disease averages between 7 and 11 years, the leading cause of death for patients with Alzheimer’s Disease is dehydration or infection
What is Amyotrophic Lateral Sclerosis (ALS)?
a chronic degenerative disease that produces both upper and lower motor neuron impairment due to demyelination, swelling in the axons, and atrophy within the cerebral cortex, premotor areas, sensory cortex and temporal cortex
What causes Amyotrophic Lateral Sclerosis (ALS)?
Which populations are at higher risk?
exact etiology is not know but leading theories are genetics, a slow acting virus, metabolic disturbances, or lead/aluminum toxicity
men are at higher risk and typical age of onset is between 40 and 70
How do patients with Amyotrophic Lateral Sclerosis (ALS) typically present?
Early ALS signs can include both upper and lower neurons symptoms.
Upper motor neuron symptoms can include loss of motor inhibition, clonus, positive Babinski sign and spasticity
Lower motor neuron symptoms usually present distally to proximally and includes asymmetric weakness, cramping and atrophy
Eventually patients with ALS will exhibit fatigue, oral motor impairments, motor paralysis, and respiratory paralysis
What are some primary indicators for diagnosis a patient with Amyotrophic Lateral Sclerosis (ALS) based on symptoms?
If a patient has motor impairments without any sensory impairments and if they have upper and lower motor neuron symptoms
What medication is typically used for patients with Amyotrophic Lateral Sclerosis (ALS)?
Riluzole (Rilutek)
What is the typical plan of care for patients with Amyotrophic Lateral Sclerosis (ALS) in PT?
What is the typical outcome for patients with ALS?
Maximize function and educate family/caregivers
this is a fast acting disease that usually kills the patient within 2-5 years after diagnosis, PT cannot alter or cease the progression of this disease
What is Carpal Tunnel Syndrome?
compression of the median nerve in the carpal tunnel due to increased pressure via inflammation or entrapment which can lead to ischemia, numbness, and motor disturbances in the median nerve distribution
usually effects women more than men and typical age of onset is 35-50 years old
How do patients with Carpal Tunnel Syndrome clinically present?
patients will typically present with sensory changes and paresthesia along the median nerve distribution which may radiate up the arm
Other common signs and symptoms are night pain, hand weakness, muscle atrophy, decreased grip strength, and decreased wrist mobility
What tests can help confirm a diagnosis of Carpal Tunnel Syndrome?
Tinel’s Test
Phalen’s Test
What is Central Cord Syndrome?
an incomplete spinal cord lesion that most often results from cervical hyperextension
How do patients who sustain an injury which results in Central Cord Syndrome typically present clinically?
motor loss that is greater in the upper extremities than lower extremities and is most severe distally in the UEs
sensory loss below the level of the lesion is usually limited but can be variable
Which ligament is typically injured in patients with Central Cord Syndrome?
Ligamentum Flavum
What is Cerebral Palsy?
an umbrella term used to describe a group of non-progressive movement disorders that result from brain damage and is the most common cause of permanent disability in children
How do patients with Cerebral Palsy typically present?
Depends on the extent of damage and what which limbs are involved, there are mild, moderate, and severe cases
general characteristics include abnormal muscle tone, poor postural control, high risk for hip dislocations, balance impairments, intellect, vision, hearing, and perceptual skills can also be affected
Intellectual disability and epilepsy are present in 50-60% of children diagnosed with Cerebral Palsy
All characteristics are classification dependent.
What is the difference between spastic Cerebral Palsy and athetoid Cerebral Palsy?
Spastic: involves upper motor neuron damage
Athetoid: damage to the basal ganglia
What is Duchenne Muscular Dystrophy?
a progressive neuromuscular degenerative disorder that manifests symptoms once fat and connective tissue begin to replace muscle that has been destroyed by the disease process
What causes Duchenne Muscular Dystrophy?
A mutation in the dystrophin gene Xp21 that normally codes for the muscle membrane protein dystrophin
this is a recessive gene so Duchenne Muscular Dystrophy only affects males and females are carriers
How do patients with Duchenne Muscular Dystrophy usually present clinically?
usually diagnosed between ages 2 and 5
first symptoms are a waddling gait, proximal muscle weakness, clumsiness, toe walking, excessive lordosis, large calves, and difficulty climbing stairs
Gower’s sign is typical and issues with upper extremity, thoracic, and shoulder girdle musculature weakness
usually some cognitive disability as well
Rapid progression with patient being unable to ambulate by age 10-12 typically and death typically occurring in teenage years
What is Erb’s Palsy?
an upper brachial plexus injury or palsy that usually results from a difficult birth, C5 and C6 are typically the nerve roots which are most affected leading to loss of function of the rotator cuff, deltoid, brachialis, coracobrachialis, and biceps
most common palsy relating to the brachial plexus
How do infants who have Erb’s Palsy typically present?
with a “waiter’s tip” deformity which is a loss of shoulder function, loss of elbow flexion, loss of forearm supination, and the hand being positioned in a pinch grip manner
What is Guillain-Barre Syndrome (Acute Polyneuropathy)?
a temporary inflammation and demyelination of the peripheral nerve’s myelin sheaths, potentially resulting in weakness with a distal to proximal progression, sensory impairment, and possible respiratory paralysis
How do patients with Guillain-Barre Syndrome (Acute Polyneuropathy) typically present clinically?
typically young adults or patients between 50 and 80, slightly more prevalent in Caucasian males
initially presents with distal symmetrical motor weakness and will likely experience mild distal sensory impairments and transient paresthesia
weakness will progress towards the UEs and head and disability usually peaks between 2-4 weeks after onset then is stagnant for 2-4 weeks and slowly gets better after a few months to a year
Can be life threatening if there is respiratory paralysis
What is the common outcome for patients who suffer from Guillain-Barre Syndrome (Acute Polyneuropathy)?
Most patient achieve full recovery but 20% do have some neurological deficits, and 3-5% of patient will die from respiratory paralysis
What causes Guillain-Barre Syndrome (Acute Polyneuropathy)?
Etiology is unknown but it is believed to be an auto-immune response to a previous respiratory infection, influenza, immunization, or surgery
What is Huntington’s Disease (Huntington’s Chorea)?
a neurological disorder of the CNS and is characterized by degeneration and atrophy of the basal ganglia (specifically the striatum) and cerebral cortex within the brain
the atrophy leads to extensive loss of small and medium sized neurons and an overall decrease in the quantity and activity of GABA and acetylcholine neurons that are produced in these areas
How do patients who have Huntington’s Disease (Huntington’s Chorea) typically present clinically?
average age is between 35-50
patients initially present with involuntary choreic movements and a mild alteration in personality
involuntary facial expression are common and as the disease progresses an ataxic gait will be present and speech disturbances are common
Late stage Huntington’s in characterized by a decrease in IQ, dementia, depression, dysphagia, inability to ambulate or transfer, and progressive choreic movements
What is the common outcome for patients diagnosed with Huntington’s Disease (Huntington’s Chorea)?
Usually die within 15-20 years after diagnosis
What causes Huntington’s Disease (Huntington’s Chorea)?
it is a genetically transmitted disease linked to chromosome four and to the gene identified as IT-15
What is Multiple Sclerosis?
a condition that produces patches of demyelination within the brain and spinal cord that results in plaque development that decreases the efficiency of nerve impulse transmission and produces symptoms that vary based on location and extent of demyelination
What causes Multiple Sclerosis?
What populations are most at risk for developing Multiple Sclerosis?
etiology is unknown but it is believed to have a genetic component or caused by a slow acting virus or possibly environmental
Highest incidence in patients between 20 and 35 and almost twice as common in females compared to males
also a high incidence in population in temperate climates
How do patients who have Multiple Sclerosis typically present in the clinic?
initial symptoms include visual problems, paresthesia and sensory changes clumsiness, weakness, ataxia, balance dysfunction, and fatigue
What are the different types of Multiple Sclerosis?
What are the differences between the types?
relapsing-remitting: has bouts of symptoms (relapses) followed by long durations of no symptoms (remitting)
secondary-progressive: Starts as relapsing-remitting MS but progressively loses bouts of remission and relapse and symptoms progress without going away
primary-progressive: Symptoms progress steadily with no bouts of remission like you normally see in secondary-progressive
progressive-relapsing: Least common form of MS where symptoms will relapse and remit but progressively get worse and worse with each new relapse
What does PT intervention focus on for patients with Multiple Sclerosis?
regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training, and core stabilization
What is Parkinson’s Disease?
a primary degenerative disorder characterized by a decrease in production of dopamine within the Substantia Nigra portion of the basal ganglia which creates an imbalance between dopamine and acetylcholine which produces the symptoms of Parkinson’s Disease
How will patients with Parkinson’s Disease typically present clinically?
Symptoms usually begin with a resting tremor in the hands (sometime called pill-rolling tremors) or feet that increases with stress and disappears with movement or sleep
balance disturbances, difficulty rolling in bed, fine motor impairments are common and can progress to hypokinesia, sluggish movements, akinesia and a festinating/shuffling gait
Patient can also notice “freezing” of gait, speech, blinking, and movements of the arms and also have very little facial expressions
What medications are typically used for treating patients with Parkinson’s Disease?
Dopamine replacement drugs such as Levodopa, sinemet, or madopar
these drugs are designed to minimize bradykinesia, rigidity, and tremors
What is Myelomeningocele Spina Bifida?
a form of spina bifida in which there is an incomplete fusion of the posterior vertebral arch with both meninges and spinal cord protruding outside the neural arch which may or may not be covered by skin
Most commonly found in the lumbar or sacral region (75%)
What impairments can be linked to Myelomeningocele Spina Bifida?
motor and sensory loss below the defect, hydrocephalus, Arnold-Chiara type 2 malformation, clubfoot, scoliosis, bowel and bladder dysfunction, and learning disabilities
Latex allergy is common
What are the three types of Spina Bifida?
Occulta (incomplete fusion of the posterior vertebral arch with no neural tissue protruding)
Meningocele (incomplete fusion of the posterior vertebral arch neural tissue/meninges protruding outside the neural arch)
Myelomeningocele (incomplete fusion of the posterior vertebral arch with both meninges and spinal cord protruding)
What is the prognosis for patients born with Myelomeningocele Spina Bifida?
a near normal life expectancy as long as the patient receives consistent and thorough health care
functional outcomes depend on the level of the injury, amount of support, and severity of impairments
How can Myelomeningocele Spina Bifida be caught early on in pregnancy?
by testing of alpha-fetoprotein (AFP) in the blood at week 16 of gestation
What is the likely functional outcome for patients with a complete C7 tetraplegia spinal cord injury?
outcomes include independence with feeding, grooming, dressing, self-range of motion, independent manual wheelchair mobility, independent transfers, and independent driving with adapted automobiles
What are the lowest innervated muscle for patient with a complete C7 tetraplegia spinal cord injury?
triceps, extensor pollicis longus and brevis, extrinsic finger extensors, and flexor carpi radialis
What is the highest level of function patients with a complete L3 paraplegia SCI will be able to achieve?
should be able to live completely independent with education regarding the management of their disability
What are the major limitations patients with a complete L3 paraplegia SCI may experience?
sexual dysfunction, a nonreflexive bladder, need for a bowel program, UTIs, muscle contractures, and pressure sores
What are the most distal muscles that should have at least partial innervation in patients who have a complete L3 paraplegia SCI?
gracilis, iliopsoas, quadratus lumborum, rectus femoris, and sartorious and full use of BUEs
What is Thoracic Outlet Syndrome?
a group of disorders that present with symptoms secondary to neurovascular compression of the fibers of the brachial plexus usually between the points of the interscalene triangle and the inferior border of the axilla or over the first rib
What tests can help confirm a diagnosis of Thoracic Outlet Syndrome?
Roos Adson maneuver Wright test Halstead maneuver Allen Test
