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Neuro > MS & ALS > Flashcards

MS & ALS Flashcards

1
Q

Multiple Sclerosis basic info

A 
Lifelong chronic neurological condition
Age of onset 20-50 (15 youngest)
Gender – women childbearing age
Autoimmune disease
  -Demyelination
  -Loss of central nervous system axons
Multitude of symptoms
  -“Multiple scars” accumulate on the brain and spinal cord
  -Mobility impairment one of the first signs
  -85% reporting gait disturbance
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2
Q

MS disease process

A
  • “Immune mediated disease” b/c don’t know what is actually getting attacked
  • Will feel sharp pain, burning from disruption of signals along myeline/nerve
  • Patches that body makes – similar to putting electrical tape around electrical wires
  • “multiple” and “sclerosed” plaques
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3
Q

MS symptoms: sensory

A

numbness, disturbed pain sensation, hypersensitivity, heat sensitivity, impaired position sense, paresthesia

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4
Q

MS Symptoms: Motor

A
  • Motor: weakness, spasticity, hyperreflexia, ataxia, intention tremors, fatigue, clumsy, foot drop, gait
  • Bowel/Bladder dysfunction
  • Speech problems, dizziness, tremors
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5
Q

MS Symptoms: Visual

A

Double vision, Pain behind eyes, Blurred vision, Blind spots, Nystagmus

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6
Q

MS Symptoms: Cognitive

A

Approximately 50% Memory loss/ disturbance, Decreased attention, Executive function disorders. Usually mild

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7
Q

MS Symptoms: Psychological

A

Depression/euphoria, Impulsivity, Lability (emotional, crying)

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8
Q

MS Diagnosis

A
  • Diagnosis: decreases in CNS (abnormal reflexes), changes in vision (evoked potentials) may suspect
  • Head MRI
  • Spine MRI
  • Lumbar Puncture
  • Neurological Exams
  • History of at least two “attacks” separated by a period of reduced or no symptoms for RRM
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9
Q

Types of MS

A

Four main types:

RR, SP, PP, PR

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10
Q

Relapsing-Remitting MS

A

-85% relapse, remit
– a lot of symptoms, decreased or completely resolved, then another flare up
-(steady increase in peak/valley line)

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11
Q

Secondary-Progressive MS

A

-Peak/valley some, then gradual decline in function – increase in symptoms (peak/valley at first, then straight line)

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12
Q

Primary-Progressive MS

A
  • 10% of MS patients

- constantly increasing in symptoms (straight line)

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13
Q

Progressive-Relapsing MS

A
  • slight improvements but continually progress

- (steep peak/valley line)

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14
Q

MS Mobility

A
  • Ability to move freely is affected
  • Upper and lower extremity
  • Upper extremity important to ADL’s and gait
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15
Q

MS Upper Extremity Impairments

A
  • Not routinely assess in individuals with MS
  • Need for valid and reliable outcomes
  • May be smaller less noticeable changes
  • Integration and targeted interventions
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16
Q

MS Prognosis

A
  • 60% remain fully functional after 10 years
  • 30% remain fully functional after 30 years
  • More than 60% are ambulatory after 25 years
  • Usually does not signify decrease in life expectancy
17
Q

MS: Common Problems an OT May Address

A
  • Fatigue (80%) !!!!!!!
  • Muscle weakness
  • Gait, Balance, & Coordination Problems
  • Numbness (face, body, extremities)
  • Vision Problems (double vision, poor contrast, eye pain, or heavy blurring)
  • Dizziness and Vertigo
  • Tremor or Ataxia
  • Cognitive Components
  • ADLs, personal hygiene (Debilitating, can’t do the simple things)
  • Generally people do better in the morning & not as much in afternoon
18
Q

Upper Extremity Tests Used in the MS Population

A

-Impairment - Fugl-Meyer (motor, sensory, coordination, reflexes)*
-Fine motor performance - 9 hole peg test**
-Gross motor performance - Box-&-block**
Combination fine and gross - Wolf motor function test* - & ARAT*
-Functional and task-oriented - Modified Jebsen test of hand function - TEMPA

19
Q

General OT Treatment for MS

A
  • Occupational performance modification (task, tools, ENERGY CONSERVATION)
  • Adaptive devices, techniques as needed
  • Conditioning/strengthening as tolerated
  • Cognitive compensation (day planners, pill boxes, electronic devices)
  • Visual compensatory techniques (contrast, large print, minimize eye fatigue, special glasses)
  • Pain/spasticity management (stretching, modalities)
  • Tremor/Ataxia intervention (proximal stabilization or support; task modification; adapted equipment; orthoses)
  • Home, workplace modifications
  • Patient/caregiver education, resources
20
Q

OT Utilization by Clients with MS

A
  • Literature suggests only 30-40% of client with MS have ever had OT services
  • Those most likely referred to OT have: greater severity of disease; poorer mobility levels; more severe musculoskeletal problems; greater difficulties in multiple functional areas
  • Areas of occupation requiring the most assistance (patient report): going up/down stairs; getting in/out of tub or shower; heavy housework; yard work
21
Q

MS Exercise Programs

A
    • For many years, patients with multiple sclerosis have been advised not to participate in physical exercise due to:
  • some patients were reported to experience symptom instability during exercise as a consequence of increased body temperature
  • Need to preserve energy: leaving more energy for ADL’s
  • Best solution: gradual, unhurried, progressive daily activity and exercise.
  • OT’s can facilitate the development of a balanced schedule.
22
Q

ALS =

A 
=Amyotrophic Lateral Sclerosis
=Lou Gehrig’s disease
-Fatal, late onset neurodegenerative disease UMN and LMN
-Age of onset – 40-60
-Gender – males more than women (3:2)
-Prevalence – one of most common
23
Q

Motor Neuron Disease

A
  • Group of progressive neurological disorders that destroy motor neurons, the cells that control voluntary muscle activity including speaking, walking, breathing, swallowing and general movement of the body.
  • Have cognitive ability
24
Q

Motor Neuron Diseases (NMD)

A
  • Amyotrophic Lateral Sclerosis (ALS) – UMN & LMN
  • Primary lateral sclerosis (PLS) – UMN
  • Progressive muscular atrophy – LMN
  • Bulbar palsy (pseudobulbar and progressive bulbar palsy) – cranial nerves 9-12
  • Spinal muscular atrophy (SMA) – wasting of muscles – genetic
25
Q

Why is it called ALS?

A
  • “Amyotrophic” comes from Greek roots that mean “without nourishment to muscles”
  • “Lateral” means “to the side” and refers to the location of the damage in the spinal cord.
  • “Sclerosis” means “hardened” and refers to the hardened nature of the spinal cord in advanced ALS.
26
Q

UMN vs. LMN

A

Upper motor neuron:

  • Babinski reflex
  • Overactive reflexes
  • Spasticity
  • General weakness

Lower motor neuron:

  • Atrophy/ weakness of extremities
  • Twitching, cramps/Fasciculations seen under the skin
27
Q

Corticobulbar Tract

A
  • Dysphagia - difficulty swallowing (choke)

- Dysarthria - impaired quality of speech production (lose ability to talk eventually)

28
Q

Epidemiology of ALS

A
  • Incidence: 4-8/100,000; 5,600 new cases/year
  • Sociodemographic profile:
  • Midlife: Onset 40-70 y/o; avg 58 y/o
  • Whites
  • Males (20% more common)

-ALS is responsible for 2 deaths/100,000
annually

29
Q

Etiology of ALS

A
  • Approximately 90% occurs spontaneously of unknown etiology (anyone, anytime)
  • 5 – 10% have familial ALS –(mutation of SOD 1 gene)
30
Q

Testing Procedures for Diagnosis of ALS

A

Diagnosis of exclusion

  • electrodiagnostic tests including electomyography (EMG)
  • blood and urine studies
  • spinal tap
  • x-rays, including magnetic resonance imaging (MRI)
  • myelogram of cervical spine (x-ray of spine)
  • muscle and/or nerve biopsy
  • thorough neurological examination
31
Q

Prognosis of ALS

A
  • About 50% of people with ALS live 3 or more yrs;
  • 20% live 5 or more;
  • 10% live 10 or more.
  • Most die of respiratory failure in 3-5 years
  • Cognition, occulomotor function, sensory skills, bowel and bladder function usually not impaired
32
Q

Six Stages of ALS

A

1: Ambulates, I w/ADL, mild weakness
2: Ambulates, moderate weakness in some muscles
3: Ambulates, severe weakness in some muscles
4: WC, almost I w/ADL, severe weakness LE’s
5: WC, dependent ADL, severe weakness UE/LE
6: Bedridden, maximum assistance required

33
Q

ALS Clinical Manifestations: Initial

A
  • Small muscles of hands and feet often 1st affected
  • Hand weakness/atrophy, asymmetrical foot drop
  • Problems using the hands for activities such as dressing, washing and buttoning clothes
  • Problems walking (pulling feet up, trips/falls)
  • Night cramps
  • Speech/swallowing problems
34
Q

ALS Clinical Manifestations: Progressing to..

A
  • Increasing weakness in muscles of extremities, head/neck, trunk
  • Loss of Voluntary movements of arms and legs
  • Increasing difficulty with speech, swallowing and chewing
  • Difficulty breathing - ventilation support
35
Q

ALS Medical Management

A
  • Riluzole
    • Only FDA approved drug for tx of ALS
    • Modest benefit in increasing survival time
    • Slows the disease process
  • Stem cell/gene therapy is promising…
  • Symptom management:
    • Spasticity/tone (Baclofen)
    • Night time breathing machines
    • Alternate feeding methods
    • Depression
    • Pain
36
Q

Newer ALS Treatment Methods

A

-BCI = Brain Computer Interface – electrodes placed in brain – cap on head or implanted – can stare at letters & communicate that way

37
Q

General ALS Management Goals

A
  • Provide information about the disease process, treatment options, and stay up-to-date with best practices
  • Promote functionality and independence
  • Communicate effectively with all other healthcare providers involved in the care plan to ensure seamless, well coordinated care
  • Give people with ALS emotional support, hope, encouragement, and attention (time) in an accepting environment
  • Respect the treatment preferences and priorities of people with ALS
  • Involve family caregivers – provide and refer support as necessary
  • Make ongoing assessments to guide timely referrals
  • Suggest ways to manage the activities of daily living in a safe, efficient, and comfortable manner
  • Assist in selecting, acquiring, and fitting assistive devices
  • Liaise with community agencies that offer support and assistance accessing necessary equipment, funding and services
  • Be open to discussions about death and dying, including reviewing advance directives and end-of- life care plans
38
Q

The ALS Healthcare Team

A
  • PCP
  • Neurologist
  • OT
  • PT
  • Speech Language Pathologist
  • Dietician
  • Gastroenterologist
  • Respiratory Therapist
39
Q

General OT Intervention for ALS

A
  • Occupational performance adaptation
  • Psychosocial adjustment
  • Community participation skills
  • Caregiver training
  • Functional mobility adaptation
  • Assistive technology (home, work, community)
  • UE management (activity/exercise, splints, coordination)
  • Joint protection, pain management, energy conservation
  • Positioning, safety, skin integrity

Neuro (13 decks)

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