GOLD Neuromuscular Conditions Flashcards
What is Alzheimer’s disease?
A chronic progressive neurological disorder that results in deterioration and irreversible damage to the cerebrum
What is present in brain biopsies of patients with Alzheimer’s disease?
Neurofibrillary tangles
Beta amyloid plaques
List 6 sign and symptoms of Alzheimer’s disease.
- Intellectual decline
- Loss of memory
- Confusion
- Anxiety and depression
- Loss of reasoning
- Possible motor and gait impairments
How can a PT manage a patient with Alzheimer’s disease?
- Keep treatments consistent and redirect patient to another task if they become frustrated during treatment
- Instruct the patient to carry a memory log if memory loss is present
What is the main difference between senile and presenile Alzheimer’s type dementia?
Presenile dementia has an age of onset of 40-60, a rapid onset and a very poor prognosis as compared to senile Alzheimer’s type dementia.
True or False: There is a cure for Alzheimer’s disease.
FALSE
List 3 drugs used for treat Alzheimer’s disease short term.
Tacrine (Cognex)
Donepezil (Aricept)
Rivastigmine (Exelon)
What are the 2 leading causes of death for patient’s with Alzheimer’s disease?
Infection
Dehydration
What is Amyotrophic lateral sclerosis (ALS)?
Degenerative disease affecting the UMN and LMN, with degeneration of the anterior horn cells and descending corticobulbar/corticospinal tracts
Describe bulbar versus spinal cord onset of ALS.
Bulbar (poorer prognosis): dysarthria and dysphagia
Spinal cord: rapid progressive muscular atrophy
List the LMN and UMN signs and symptoms of ALS.
LMN: progressive weakness, cramping, atrophy muscle fasciculations or twitching
UMN: Spasticity and hyperreflexia
What functions are typically spared in those with ALS?
Cognition
Bowel and bladder function
ALS is characterized by little to no _____ symptoms.
Sensory
List 6 treatment goals for patients with ALS.
- Maintain respiratory function and activity levels
- PROM exercises
- Positioning and skin care
- Avoid overworking the muscles and teach energy conservation
- Symptomatic treatment of pain, spasm and spasticity
- Provide psychological support and reassurance
List 3 exercise precautions to keep in mind when working with patients with ALS.
- Monitor fatigue levels closely
- Avoid overwork injury (avoid exercise if less than 1/3 of motor units are functioning; teach energy conservation instead)
- Limited positions with decreased pulmonary function
What is Guillain-Barre Syndrome (GBS)?
Acute autoimmune polyneuropathic condition that results in rapid loss of myelin in peripheral nerves
List 5 signs and symptoms associated with GBS.
- Weakness secondary to demyelination of cranial and peripheral nerves
- Some sensory loss (stocking/glove) and paresthesia
- Progressive motor paresis (LE first then UE, distal to proximal progression)
- May produce full tetraplegia with respiratory failure
- Tachycardia
How is GBS diagnosed?
Through a CSF sample that contains high protein levels and little to no lymphocytes
Describe the recovery of a patient with GBS.
Recovery is slow (up to one year) with some mild weakness persisting
List 5 treatment goals to keep in mind when treating patients with GBS.
- Maintain respiratory function
- PROM within pain tolerance, positioning, skin care
- Prevent injury to denervated muscles (avoid overuse and fatigue)
- Teach energy conservation techniques
- Provide emotional support and reassurance to patient and family
What is Huntington’s disease?
Neurological disorder of the CNS characterized by degeneration and atrophy of the basal ganglia (specifically the striatum) and cerebral cortex within the brain
List 7 signs and symptoms of Huntington’s disease.
- Involuntary choreic movements
- Mild alteration in personality
- Unintentional facial expressions
- Ataxic gait
- Decrease in IQ
- Depression
- Dysphagia and incontinence
What is multiple sclerosis?
Chronic, progressive, demyelinating disease that decrease the efficiency of nerve impulse transmission.
List 5 signs and symptoms of multiple sclerosis.
- Sensory disturbances including tingling, numbness and pain
- Coordination problems and spasticity
- FATIGUE
- Adverse reactions to heat
- Hyperventilation and dehydration
Describe relapsing remitting MS.
Characterized by discrete attacks of neurological deficits (relapses) with either full or partial recovery (remission) in subsequent weeks or months
Periods between relapses are characterized by lack of disease progression. (85% of cases)
Describe primary progressive MS.
Characterized by disease progression and a deterioration in function from onset; patients may experience modest fluctuations in neurological disability but discrete attacks do not occur.
Describe secondary progressive MS.
Characterized by intial relapsing remitting course, followed by a change to a progressive course with a steady decline in function, with or without continued acute attacks.
Describe progressive relapsing MS.
Characterized by a steady deterioration in disease from onset but with occasional acute attacks
Intervals between attacks characterized by continuing disease progression
What is clinically isolated syndrome?
First episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs; can progress to relapse remitting MS
What are 2 common causes of death in patients with MS?
UTI
Respiratory infection
What are 5 treatment considerations to keep in mind when treating patients with MS?
- Avoid over rigorous exercise that could fatigue the patient or worsen symptoms
- Breathing exercises
- Ambulatory or w/c mobility
- Regulate tone
- Exercise to patient tolerance
What is Parkinson’s disease?
A progressive disease affecting the substantia nigra of the basal ganglia resulting in a decrease in dopamine production and/or receptors
What are 8 key impairments associated with Parkinson’s disease?
- Resting tremor
- Akinesia or bradykinesia
- Rigidity
- Postural instability
- Abnormal gait (festinating or shuffling)
- Flexed posture
- Mask like face
- Decreased postural reflexes
Describe the 5 stages of Parkinson’s disease as per the Hoehn Yahr Scale.
Stage 1: Minimal or absent disability; unilateral symptoms
Stage 2: Minimal bilateral or midline involvement, no balance involvement
Stage 3: Impaired balance; some restrictions in activity
Stage 4: All symptoms present and severe, stand and walks only with assistance
Stage 5: Confinement to bed or wheelchair
Describe the ‘on-off’ phenomenon as it relates to Parkinson’s disease.
On period refers to when a patient has taken levodopa
Off period refers to when a patient has not taken levodopa
List 5 treatment considerations to keep in mind when working with patients with Parkinson’s disease.
- Gait training to increase stride width and length
- Breathing and mobility exercises
- Relaxation techniques
- PNF diagonals with rhythmic initiation to overcome bradykinesia
- Visual and auditory cuing
Deep brain stimulation occurs at the ____ and ____ in patients with Parkinson’s disease.
Thalamus
Subthalamic nucleus
What is a concussion?
The most common and least serious type of traumatic injury caused by a sudden blow direct blow or bump to the head; movement of the brain within the skull cause bruising, damage to blood vessels and injury to nerves
List 7 signs of a concussion.
- Appears dazed or stunned
- Can’t recall events prior to or after a hit or fall
- Forgets an instruction, appears confused
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows mood, behavior or personality changes
List 7 symptoms of a concussion.
- Headache or pressure in the head
- Nausea or vomiting
- Balance problems, dizziness or blurry vision
- Bothered by light or noise
- Feeling sluggish, hazy, foggy, or groggy
- Confusion, concentration or memory problems
- Just not ‘feeling right’ or ‘feeling down’
Describe the 3 grades of concussions.
Mild (grade 1): symptoms last less than 15 minutes; no loss of consciousness
Moderate (grade 2): symptoms last long than 15 minutes; no loss of consciousness
Severe (grade 3): loss of consciousness lasting seconds to minutes
List 4 types of primary brain damage that can occur as a result of a TBI.
- Diffuse axonal injury: disruption and tearing of axons and small blood vessels from shear strain of angular acceleration; results in neuronal deal and petechial hemorrhages
- Focal injury: contusions, lacerations, mass effect from hemorrhage, and edema (hematoma)
- Coup-contrecoup injury: injury at point of impact and opposite point of impact
- Closed or open injury (with fracture of the skull)
List 5 characteristics of a mild TBI.
Loss of consciousness: 0-30 minutes Alteration of consciousness: brief; < 24 hours Posttraumatic amnesia: < 1 day Glasgow Coma Scale: 13-15 Imaging: normal
List 5 characteristics of a moderate TBI.
Loss of consciousness: > 30 minutes but < 24 hours Alteration of consciousness: > 24 hours Posttraumatic amnesia: >1 but < 7 days Glasgow Coma Scale: 9-12 Imaging: normal or abnormal
List 5 characteristics of a severe TBI.
Loss of consciousness: > 24 hours Alteration of consciousness: > 24 hours Posttraumatic amnesia: > 7 days Glasgow Coma Scale: < 9 Imaging: normal or abnormal
