nervous system Flashcards
what are the signs and symptoms of parkinsons disease
tremor (pill rolling)
bradykinesia (slow movement, short steps)
rigidity (stiff ms)
postural instability
balance
automatic movements
speech (changes in pace and intensity, monotone)
writing (challening, small text)
etiology of parkinsons
genetics and toxins
what is parkinsons disease
progessive neurologic condition that affects movement
parkinsons risk factors
middle aged-old people
men are higher risk
relatives
exposure to toxins and pesticides
predromal stage of parkinsons symptoms
REM sleep disorder
depression
constipatoin
anxiety
hypoxia (decreased smell)
daytime sleepiness
early stage parkinson symptoms
bradykinesia, rigidity,
fatigue
tremor
pain
apathy
mild cognitive impairments
mid stage parkinsons symptoms
fluctuations
dyskinesias
urinary symptoms
orthostatic hypotension
axial deformities
visual hallucinations
late stage parkinsons symptoms
dysphagia
falls
dementia
changes in the brain during parkinsons disease
gradual loss of cells in the substantia nigra (production of dopamine)
dopamine stimulates smooth muscle contractions/pathways
decreased dopamine leads to ms rigidty and tremors
prescense of lewy bodies in the brain (sticky proteins associated w dementia)
PT implications of parkinsons disease
cognitive change
depression and emotional change
dysphagia
sleep disorders
bladder incontinence
constipation
orthostatic changes
fatigue
pain
what is myasthenia gravis
an autoimmune neurologic disorder that is the most common primary disorder of neuromuscular transmission
what are some symptoms of myasthenia gravis
fluctuating weakness and rapid fatigue of skeletal muscle – improves with rest
what muscles are most affected with myasthenia gravis
muscles with small motor units such as ocular
severe cases - diapragm and intercostals
what percent of patients with MG have coexistent hyperthyroidism
about 5%
what percent of MG pts have a maternal relative with an autoimmune disease
about 30
risk factors of Myasthneia gravis
young women 20-30yrs
men>50 years
what happens in the presynaptic pathogensis of MG
number and size of vesicles are normal
what happens in the postsynaptic pathogensis of MG
muscle endplate shows sparse, shallow, and abnormally wide or absent synaptic cleft; fewer ACh receptors
electrophysiology of MG
postsynaptic membrane has decreased response to acetylcholine = lack of contractibility
signs and symptoms of MG
visual
muscle
thymus
flare ups
remission
muscular symptoms of MG
fatigue and weakness may vary rapidly in intensity over hours, days, and weeks
facial, swallowinf, neck, and limb muscles are involves
visual symptoms/signs of MG
extraocular muscle=ptosis or dropping eyelinds and diplopia or double vision
thymus symptoms of MG
abnormalities associated but nature of association is unclear
how to diagnosis MG
neurologic exam
blood test
ice test
nerve conduction test
electromyogram
treatment optoins for MG
pharmacology (anticholinesterase drugs, corticosteroids, immmunosuppressives)
thymectomy (remove thymus gland)
plasmapheresis (removal of abnormal antibodies)
immunoglobin (IVIg therapy to reduce autoimmune response
myathenis gravis PT implications management of symptoms
- exercise intensity, duration strategy to improve sx and function
- every individual is different
- medically managed MG before exercise prescription;
- no exercise = energy conservation, transfers, fall prevention
- exercise to elevates baseline function
exercise for stable MG pts
energy conservation
medication at peak dose
large proximal muscle
short duration - HR no greater than 30bpm from baseline
upper body ergometer, stationary bike, large ms groups
posture exercise
what is dementia
an acquired decline in intellectual function and memory - loss of social independence, symptoms progress over months and years
three types of dementia
alzheimers
lewy body dementia
frontotemporal dementia
what is lewy body dementia
intracellular accumulation of Lewy bodies in the neurons mainly in the cortex
what is frontotemporal dementia
deposition of proteins in the frontal and temporal lobes; early personality and behavior changes and aphasia
causes of dementia
affects 5-20% age 65+, incidence increases with age
alzheimers 50% of cases
multiple cerebral infarcts (2nd most common cause)
dementia with lewy bodies
alcoholism
alzheimers disease
slow progressice disorder od the CNS begins w impairments of learning and recent memory
progresses to anomia, aphasia, and acalculia (loss of employability)
symptoms and characteristics of alzheimers
spatial disorientation and apraxia ( pts become lost easily and difficulty cooking, cleaning and self care)
short shuffling steps, flexed posture,social disconnect, aphasia
pathogenesis of alzheimers
extracellular aggregates of amyloid plaques
intracellular neurofibrillary tangles
how many people globally living w Dementia
47 Mill
risk factors of AD
age is a major risk factor
3 major symptoms; memoru function, brain atrophy, accumulations of amyloid protein
amyloid plaques =
= neuron death and inflammation
alzheimers symptoms
confusion w time and locatoin
withdrawal from social activities
difficulty completing tasks, solving problems, w words
misplacing items
memory loss
poor judgement
trouble w images and spaces
what percent of alzheimers cases accounts for dementia cases
60-80%
