Lecture 3 Flashcards
What is Amyotrophic Lateral Sclerosis (ALS)?
- A group of progressive degenerative conditions
- Late onset impacting UMN & LMN
- Causes death of the muscles that control voluntary muscles
Average on set of ALS
58 years (peak 55-75)
Symptoms of ALS
UMN: - Weakness - Spasticity - Hyperreflexia LMN: - Weakness of extremities - Cervical extensor weakness - Fasciculations - Breathing problems
What does ALS not impact (function wise)
- Eye, bowel/bladder or sensory function
Medical management of ALS
- Medication (muscles cramping, pain, etc.)
- Ventilator/feeding
OT & ALS
- Looking at what is important to the client, how ALS impacts their function and what their priorities are
- Want to maximise function to compensate for declining motor function
(e. g. occupational focus, exercise, equipment or AT) - Edu!
What is Friedreich’s Ataxia?
- Inherited disease
- Spinal cord and peripheral nerves degenerate
- Causes morot and sensory implications
Onset of Friedreich’s Ataxia
5 & 15
What does Friedreich’s Ataxia NOT impact
Cognitive functions
Signs & symptoms of Friedreich’s Ataxia
- Gait ataxia (difficulty with walking - spreads to upper limbs)
- Loss of sensation
- Scoliosis
- Dysarthria
- Diabetes
Medical management of Friedreich’s Ataxia
- Treat symptoms
- Often confined to a wheelchair
>think about home assessments
Addressing ataxia
- Provide stabilisation and support >reduce the degree of freedom >postural support - Modified approach to occupations - Adapted equipment and orthoses - Impact of emotional upset or fatigue
OT & Friedreich’s Ataxia
SAME AS ALS
What is MS?
- Condition that results from lesions of what matter in CNS
- Typically myelin damage on axons
Signs of MS
(related to area of CNA affected)
- Weakness
- Hyperreflexia
- Dysmetria
- Impaired vibratory or position sensation
What are the three patters of MS?
- Relapsing and remitting
- Secondary-progressive
- Primary-progressive
Atypical patterns of MS
- Benign course
>younger females with primarily sensory symptoms
>if minimal disability at 5 years then is considered benign - Progressive relapsing
>steadily progressive but has specific relapses
Medical management of MS
- Immune modulating medication
- Medications for fatigue, spasticity, depression, pain, etc.
Psychosocial consequences of MS
- Impact on worker role
- Financial consequences
- Other role changes
- Self-esteem/identity
- Adjustment to diagnosis
- Impact on family and relationships
OT & MS
Assessment - Occupational role performance - Occupational performance tasks - Task selection and analysis - Critical control parameters >environmental: performance context >person: performance components
OT & MS intervention
- Activity strategies and energy conservation >fatigue management - Task and environmental modification - Employment modifications - Exercise programs
What is Parkinson’s disease?
Condition that affects tremor and gait
Early signs of Parkinson’s
- Tremor
- Rigidity
- Postural instability
Later signs of Parkinson’s
- Festinating gait
- Difficulty swallowing
- Autonomic deficits
What are the stages of Parkinson’s Disease?
- Stage 1: Unilateral symptoms, no or minimal functional implications, usually a resting tremor
- Stage 2: Midline or bilateral symptom, no balance difficulty, mild problems with trunk mobility and postural reflexes
- Stage 3: Postural instability, mild to moderate functional disability
- Stage 4: Postural instability increasing, though able to walk. Functional disability increasing with impact on ADL, decreased manipulation and dexterity
Stage 5: Confined to a wheelchair
Medical management of Parkinson’s
- Levodopa - a dopamine agonist to counteract the loss of dopamine with destruction of substantia nigra
- Stereotactic surgery
Psychosocial consequences of Parkinson’s
- Distress with resting tremor
- Role changes
- Depression
- Self-esteem issues with increasing dependence
- Financial burden
OT & Parkinson’s
- Role of OT is dependent on stage of PD
- Activity program to maintain ROM & strength
- Developing habits and routines to promote OP
- Environmental modifications
- Task modifications
OT assessments for PD
- Occupational profile
- Occupational performance areas
- Environmental assessment
- Performance components
What is Guillain Barre Syndrome?
- Auto immune inflammatory condition what destroys myelin sheath and sometimes axons
Signs and symptoms of Guillain Barre Syndrome
- Weakness and sensory changes in distal aspects of extremities (progresses to proximal trunk)
- Problems with swallowing, breathing, speaking, blood pressure and HR
Medical management for Guillain Barre Syndrome
- Immunomodulatory therapy to reduce impact
- Medication to treat complications
OT & Guillain Barre Syndrome
- Psychosocial support
- Preventative strategies during period of paralysis
- Careful programming to increase movement
What is post-polio syndrome?
Development of new muscle pain and increasing weakness as adults
What are the 6 criteria for post-polio syndrome
- Acute poliomyelitis
- With a period of recovery
- Gradual or sudden onset of new progressive weakness or fatigue
- Difficulty breathing or swallowing
- Persist one year or more
- Other causes ruled out
OT & post-polio syndrome
- Occupational profile
- Occupational performance areas
>energy conservation and work simplification
>environmental adaptation
>assistive equipment - Psychosocial support
- Fatigue and pain management
