MS, ALS, GBS, CNS Flashcards
UMN lesions
structure involved:
tone: inc or dec?
reflexes:
sensation: inc or dec?
involuntary mvmts:
voluntary mvmts:
structure: CNS
tone:** increased**
reflexes: increased, clonus, babinski
sensation: decreased
involuntary mvmts: mm spasm
voluntary mvmts: synergistic patterns
LMN lesions
structure involved: ____
tone: inc or dec?
reflexes: ____
sensation: inc or dec?
involuntary mvmts:
voluntary mvmts:
Dx:
PNS/CNs
tone: decreased
reflexes: decreased
sensation: decreased
involuntary mvmts: fasiculations
voluntary mvmts: weak/absent
Basal Ganglia lesions
structure involved: ____
tone: inc or dec?
reflexes: ____
sensation: inc or dec?
involuntary mvmts:
voluntary mvmts:
Dx:
BASAL GANGLIA (parkinsons)
tone: increased
reflexes: decreased/normal
sensation: normal
involuntary mvmts: tremor
voluntary mvmts: bradykinesia or akinesia
Cerebellar lesions
structure involved: ____
tone: inc or dec?
reflexes: ____
sensation: inc or dec?
involuntary mvmts:
voluntary mvmts:
Dx:
cerebellum
tone and reflexes: decreased
sensation: normal
involuntary mvmts: none
voluntary mvmts: ataxia, intention tremor, dysdiadokinesia, dysmetria, nystagmus
progressive autoimmune disease characterized by chronic, progressive, inflammatory demyelination of CNS neurons
MULTIPLE SCLEROSIS
Myelin produced by oligodendrocytes in the CNS
MS:
age range
F or M
ethnicity
age: 20-50
Females, although males have more aggressive disease course
African American > White
First neurological episode or “attack” in MS is called
clinical isolated syndrome (CIS)
could become MS if additional activity occurs
Relapsing remitting (80-90%) turns into ____ when they suddenly have decline without remission periods
secondary progressive MS
decline is progressive, no remission
RRMS: Clearly defined relapses or exacerbations followed by partial or f
In order to be diagnosed with CIS, symptoms must last ___
and _______
last at least 24 hours
one lesion in brain and:
1. increased tone
2. lhermitte’s sign
3. uhthoff’s sign
MS exacerbation
new and recurrent MS symptoms lasting over 24 hrs
pseudoexacerbation: less than 24 hours
MS is a diagnosis of:
exclusion by neurologist
*2 attacks, 2 brain lesions –> dissemination of space and time
4 unique ss of MS
- lhermitte’s
- uhthoff’s (heat = worse)
- charcot’s triad
- visual dysfunction
what is charcot’s triad
- scanning speech
- intention tremor
- nystagmus
cerebellum affected in MS
most common symptoms of MS
- fatigue (83%)
- heat sensitivity (80%)
- walking/balance issues 67% (gait impairments usually early in MS)
- stiffness/spasms 63%
motor symptoms in MS
Paresis or paralysis
Fatigue
Spasticity, spasms
Ataxia: incoordination, intention tremor
Postural tremor
Impaired balance and gait
PT exam: include spasticity, ataxia, B&B, tremors, balance, weakness
Your patient has visual disturbances (diplopia), and paresthesias progressing to numbness, weakness, fatiguability.
What are you thinking they have?
these are common early symptoms of MS
sensory symptoms of MS
hypoesthesia, numbness
paresthesia
*heat intolerance
pain symptoms of MS
Paroxysmal limb pain, dysesthesias
Headache
Optic or trigeminal neuritis
Hyperpathia
Chronic neuropathic pain
Fatigue symptoms in MS
primary vs seconary
primary: due to plaque location, hypometabolism
secondary: due to decreased efficiency of mvmt, more energy to perform ADLs
cognitive symptoms of MS
information processing
executive function
memory (short term)
attention, multitasking, concentration
overactive bladder causes ____
spastic bowel causes -___
overactive bladder: incontinence, frequency/urgency, nocturia
spastic bowel: constipation
underactive bladder causes;
flaccid bowel causes:
underactive bladder: urinary retention
flaccid bowel: incontinence or constipation
which diagnosis can impact vestibular system?
MS
75% have balance disorders
49-59% have vertigo/dizziness
MFIS
modified fatigue impact scale: for MS
21 items: fatigue impact on physical, cog, psychosocial function in past 4 WEEKS
FATIGUE SEVERITY SCALE
not MS specific, many neuro pop
*fatigue within last week
9 items
score of 1-4.5 on the Expanded Disability Status Scale
fully ambulatory for MS
examined by neurologist
score of 5-9.5 on expanded disability status scale
impaired ambulation with MS
ANPT MS-EDGE recommends students should learn how to use:
Theres a ton but key ones are:
12 item MS walking scale
ABC
DHI
Timed 25 foot walk
BERG, DGI, TUG, Trunk impairment scale
12 item MS walking scale (MSWS-12) is a __ reported outcome measure
patient reported
*higher score = more walking limitation
MS Functional Composite (MSFC) assesses ____
cognition, gait, UE function
1. timed 25 foot walk test
2. 9 hole peg test
3. 3 sec version of paced auditory serial additional test (PASAT-3)
scores determined with z-scores
What is an MS specific participation measure?
MS IMPACT SCALE (MSIS-29)
*impact of MS on day to day during past 2 weeks
4 Movement System Impairment Diagnoses for MS
Movement Pattern Coordination Deficit
Force Production Deficit
Fractionated Movement Deficit
Hypermetria
top 3 patient education for patients with MS
- energy conservation
- rest breaks
- heat sensitivity
also disease process
What is the most common form of motor neuron disease in adults
ALS
*alpha motor neuron degeneration in ventral horn of brainstem and motor cortex
ALS presentation:
diagnosis of ____
exclusion!
Dx requires UMN + LMN ss, and decline function
ALS affects what gender and what age
men > women
40-70 years (55 average)
By the time patients report weakness, most have lost ___% of motor neurons in weak areas
80%
(profound, extensive weakness)
*will report functional tasks: walking up stairs, falling, tying shoes
What are UMN signs of ALS
Spasticity
Hyperreflexia
Pathological reflexes
What are LMN signs of ALS
weakness, decreased endurance
*esp weak neck extensors
Muscle atrophy
Fasciculations
Hyporeflexia
Hypotonicity
Muscle cramps
What are Bulbar signs of ALS
Pseudobulbar Palsy
-Emotional lability i.e. inappropriate or uncontrolled laughing or crying
-Dysarthria
-Dysphagia
-Dysphonia
-Impairment of voluntary movements of the tongue and facial muscles
-Sialorrhea
what respiratory symptoms appear with ALS
Nocturnal respiratory difficulty
Exertional dyspnea
Accessory muscle use
Paradoxical breathing
Why might a patient have muscle/weight loss with ALS?
CACHEXIA
complex metabolic syndrome that causes weight and muscle loss.
What is a patient reported outcome measure for ALS to monitor progression of disability
ALS Functional Rating Scale-Revised
*higher = better function 0-48
Key impairments besides weakness to watch for with ALS
- respiration (vent?)
- dysphagia (precautions w/ swallowing, eating position
- dysarthria
- postural control *neck extensors
- positioning for pressure, pain, breathing
*also, keys: nutrition–> need to gain weight, family support, HCP referrals
Whats the main movement system impairment diagnosis in ALS
FORCE PRODUCTION DEFICIT
Movement: fractionated if present
Muscle tone: mixed (UMN and LMN)
Sensation: normal
Coordination: may be unable to test due to weakness
If your patient is recently diagnosed with ALS, what kind of exercise is safe?
moderate intensity to help maintain function
CV, strengthening without excess fatigue
Post exercise fatigue interfering w/ ADLs
Feeling weaker or pain >30 minutes post exercise
Excessive soreness 24 – 48h post exercise
Severe muscle cramping, heaviness in the extremities, prolonged SOB.
These mean that your patient with ALS ______
overworked/overexercised
Which disease is this:
Immune-mediated polyneuropathy that affects nerve roots and peripheral nerves, leading to motor neuropathy and flaccid paralysis with possible sensory and ANS effects
GBS AKA AIDP
rapid onset
usually after infection
Does GBS affect sensory?
Does ALS affect sensory?
Does MS affect sensory?
directly,
GBS: yes, stocking-glove
ALS: no, motor neuron
MS: yes
pattern of motor symptoms in GBS
distal–> proximal
(hands/feet first, then ascends)
relatively symmetrical
rapid, progressive
pattern of sensory loss in GBS
glove and stocking (distal–> prox)
tingling/numbness
Are respiratory or CNs involved in GBS?
What about reflexes?
YES
reflexes: decreased
single breath count test below __ indicates what in GBS
below 19
*mechanical vent may be required
1/3 of patients require ventilation
What is the outcome measure used in GBS
GBS Disability Scale
factors of poor prognosis with GBS
- Severe weakness (especially tetraplegia)
- If on vent
- CN involved: associated with loss of eye movement, swallowing
- Rapid progression from onset
- Length of time to nadir
- Older age
- History of GI illness
- Recent cytomegalovirus
primary movement impairment in GBS
force production deficit
What kind of exercises should you use in acute stage of GBS
AAROM, AROM
*if 3/5 or less MMT, avoid eccentrics
CDS note: We may be emphasizing compensatory quicker in this population to get them as functional as possible for as best qol as possible.
CNS tumor
*after tumor resection, they will temporarily get better
*plasticity can occur in short term but tumors can grow back, and they can get better/worse with chemo or radiation
Headache red flags
- interrupts sleep, worse when waking and better during day
- posture, coughing, or exercise elicits headache
- recent onset is worse than usual
- new onset in older person
- nausea, vomiting, papilledema, focal neuro signs
