Neuro- Concise Version Flashcards
What is bradykinesia a symptom of? Mutiple answers.
a] ALS
b] HD
c] MS
d] PD
a] ALS
d] PD
What is tremors a symptom of? Multiple anwsers.
a] ALS
b] HD
c] MS
d] PD
c] MS
d] PD
What is ridigity a symptom of? Multiple answers.
a] ALS
b] HD
c] MS
d] PD
b] HD
d] PD
What conditions have fluctuating energies throughout the day ? Multiple answers.
PD
ALS
MG
What conditions have symptoms of spasticity and rigidity ?
a] ALS
b] HD
c] PD
a] ALS
Primary Lateral Sclerosis: UMN
What conditions can affect swallow and speech ?
MG
ALS
HD
GB
dysphasia, dysarthria
What conditions can affect sensory?
a] GBS
b]MG
c] MD
d] ALS
e] HD
f] MS
g] AZ
h] PD
a] GBS - impacts pain, texture, heat, B&B
g] AZ- Visual spatial orientation, B&B (middle to late stages)
h] PD- VP/visual processing, B&B
Which conditions are cognition INTACT?
GBS
ALS
Prognosis for MG, ALS, HD
MG-improves weeks/months after plasma exchange; relapse period ; quadripareis may develop; can be life threatening if respirator muscles are involved
ALS- FATAL; 2- 5yrs
HD-FATAL; progresses over a 15-20 yr period
MG-MAX weakness during first year after diag.
Prognosis for GB, MD, MS
GB-
Not fatal/chronic 3-4 yrs
-intial (2-4 wks)
-plateau (few weeks)
-recovery phase (6 months to 2-3 yrs)
Best chance of recovery with early diagnosis
MD-
FATAL; onset childhood/ rarely survives beyond early 20s
- Duchenne MD (only boys; x-recessive trait;starts in legs/pelvic)
-w/c by age 12
-respirator by age 20
-death by 30 - Beckers MD (milder symptoms with slower progression)
-onset age:2-16
-survives into middle age
MS-
Not fatal; prognosis: 5-10 yrs
* young adults (mostly Caucasians)
* Genetics/cold,flu, viral illness
TYPES:
* RRMS - most common; clear episode, remission
* SPMS -RRMS + neuro. function declines
* PPMS -primary, decline from 1st episode
* PRMS -steadily worsens from onset (w/w/o remissions)
GB
- Autoimmune disorder where PNS destorys myelin after respiratory illness/gastrointestinal
-
Rapid onset of symptoms:
- PAIN
- FATIGUE
- tingling/numbness/weakness ascending from feet/hands up to legs and arms; paralysis
-sensory issues
-Dilopia, face droop, dysarthria (chew, speak, swallow)
-respiratory issues if severe (breathing)
NO COGNITIVE/hearing ISSUES
- Phases:
-Initial: onset 2-4 weeks
-Plateau: few weeks
-Recovery: 6 months to 1-2 years (3-4 if chronic)
Occurs after upper repiratory/gastroin. viral infection w/i 1-2 wks
PNS
GB-EVAL
Plateau Phase
- Screen/eval in ICU
- Assess PAIN FIRST
- Assess sensory such as HEAT
- HR/BP/blood clots
- Assess communication/env.
WEAKEST, but paralysis is rare
GB-EVAL
Recovery Phase
- Physical abilities
- Focus on mobility
- Self-care, etc (inpatient/outpatient/home/work)
GB-INTERVENTION
Plateau Phase
- AddressPAIN FIRST + FATIGUE + positioning (Skin break down)
- swallow screen/communications (EADLs)
- Bladder
- Passive ROM (gentle/pain free)
- Splint to prevent contractures
PAIN/FATIGUE
GB-INTERVENTION
Recovery
- Focus on occupations (3 Rs) for motivation
* Roles
* Rituals
* Routines - Family support (mental health important for recovery)
- EC/fatigue managment
- Resistive exercise ( with Joint protection /fatigue)
- Mobile arm supports
Work simplification
OT TREAT>PHYSICAL+EMOTIONAL>HOSPITAL>HOME
MG
- Autoimmune response attacking nicotinic acetylcholine receptors and interferring with synapse at the Neuromuscular junction
- Affects **voluntary **movements
- Weakness/fatigue (stronger in the morning)
- Aspiration/dysphasia
5.Vision impairment
PNS
MG-Intervention
- Depends on EVAL results
- EC/ monitor fatigue
- self-care/exercise ( monitor MMT/strength; report changes )
- Vision /fall prevention
- Psychosocial /fear of choking, appearance of drooping eyes
MD
- Progressive degeneration muscle weakness (decline of muscle fibers)
- Coritcosteroids used to slow down m. degeneration
- Muscle spasm/weakness
PNS
MD-Intervention
- Rehab FOCUS on maintaining and maximizing FUNCTION
- WORK SIMPLIFICATION/EC
- Active exercise NO OVEREXERTION & FATIGUE
- Coping & maintaining life balance (ENCOURAGE MEANINGFUL ACTIVITIES and PLAY/LEISURE )
ALS
Lou Gehrig’s disease
- A group of progressive degenerative neuromuscular disease that involves destruction of motor neurons within the spinal cord, brain stem, and motor cortex
- occurs when 3-4 regions are invovled:
* Bulbar - jaw, face, palate, larynx, and tongue
* Cervical -neck, arm, hand, and diiaphragm
* Thoracic - back and abdomen
* Lumbosacral - back abdomen leg and foot - Sporatic and familia (more in males, WWII, genetic)
UMN/LMN
CNS
ALS:
Early Symptoms
- Focal weakness in arm/leg
- Fatigue
- Ability to perform ADLs independently
Stage 1 : Clumsiness
Stage 2 : Cannot raise arm
Stage 3 : Easily fatigue when walking
CAN WALK & PERFORM ADLS INDEPENDENTLY
Stages 1-3: Mild, Mod, Severe Weakness
ALS:
Progression
- W/C dependent (cannot walk)
- Muscle atrophy
- Weight loss
- Spasticity
- Fasciculation (twitch of muscules at rest)
Stage 4 :
* MILD weakness in UE
* Can still perform ADLs , but may fatigue easily
Stage 5 :
* Dependent in ADLs
* MODERATE weakness in UE
* Difficulty with weight shift
*Moderate arm function
Stage 5: Mod arm function
W/C dependent
ALS:
End stage
Stage 6 :
1. Completely dependent in ADLs and positioning
2. Extreme fatigue
3. Tube feedings and ventilator
Sensory: Eye function, B & B intact
ALS:
Evaluation
- Middle stage of ALS has more opportunities to benefit from OT
- Identify client factors including cultural, social, and spiritual values (which influences ongoing decisions about personal care and life support)
- Identify roles
- Assessments:
-COPM
-ALS Functional Rating Scale
-Multidimensional Fatigue Inventory
-Dysphagia screening and testing (report baseline at stage 2); evaluate dysphagia, and recommend appropriate diet (stage 5)
What is the focus of ALS Intervention?
- Focuses on occupations most important to the indvidual
- Focuses on the application of adaptation methods as performance skills decline
adapt to functional activties as d
ALS Intervention:
Early Stage
- EC /work simplification (plan, pace)
- AVOID FATIGUE ; breathing exercises
- AE/AD /AFO/orthotics ( stage 2 )
- May benefit from manual/powered w/c w/ postural support for long distances ( stage 3 )
- Work simplifcation (stage 3)
ALS intervention:
Progressive Stage
- Manage PAIN and muscle spasms
* sling/mobile arm support
* splint
* HEAT and massage - AAROM/PROM/ Isometric exercises (stage 4); pressure relief/PROM (stage 5)
- Augmented communication device
- Psychological support in decisions about extent of life support and medical intervention
- Electric hospital bed (stage 5)
- EC/ home modifications (stage 4)
Stage 4-5
ALS intervention:
End Stage
- PROM
- Sensory stimulation
- Educate family on Positioning/skin inspection
SPL for dysphagia and augmentative speech device
Stage 6
MS
- Progressive autoimmune disease in young adults (mostly Caucasians)
- Demylination of CNS
- Plaques in spinal cord, optic nerves, brainstem/cerebellum
- Symptoms:
*incoordination, ____ ataxia
* Visual loss:
- Acuity double vision/diplopia
- Nystagmas: scanning and tracking
* Pain/Numbness/ Weakness/ Fatigue
* Cognition: attention and short-term memory
* sensorimotor, spasticity, increase reflexes
* intention tremors
CNS
MS:
Evaluation
-
Observe throughout the day
* MMT- does not accurately reflect degree of weakness
* schedule around meds
* Identify performance patterns ( REST PERIOD ) - MFS-fatigue/sleep
- AMPs; Cog screening
- Identify family support
MS:
Intervention
- EC/Fatigue
- REST BREAKS
- Problem-solving compensatory strategies
- Plan and prioritize; delegate; AE
hot temp is a contradiction
PD
- Progressive motor disorder d/t degenerative changes in the basal ganglia (loss of dopamine)
- Affects speed and accuracy of motor skills, postural stability, cognition, and affect and expression
- Cause is unknown; genetic and environment
PD: 4 Cardinal S&S
- tremor
- rigidity
- bradykinesia
- postural stability
rigidity
- increase tone
- may demo cogwheel motions (jerky & sometimes painful with joint mobility)
- fatigue d/t increased effort needed to voluntary movement
resting tremor
- early sign: “pill rolling” on one side
- worse with stress
Bradykinesia
- Slow movements
- Shuffling gait
- Difficulty moving from sit to stand
Postural stability
- posural stoop, with a lack of arm swing during mobility and loss of postural refleces
- fall risk
PD:
Evaluation
- Interview for brief history
- Observe how symptoms affect OP
- Assess occupation/preferred activities that have been altered
- COPM
- Cog screening if warrented
* May experience fluctuating energy levels during the day; symptoms tend to increase just BEFORE the next medication*
PD:
Interventions
- EC/pacing, prioritizing, planning (scheduled bathroom/around meds)
- AD/environmental modifications
- auditory cues, rhytmic cues, music
- mobility techniques
- Reduce distractions/avoid multitasking/de-clutter/avoid rushing
- Educate caregivers to speak slowly and clearly with simple, 1-step instructions (1 concept at a time)
- psychological: hallucination, delusions, psychosis, behavior changes
- micrographia/ reduce volume of speech (hypophonia)
- PAIN: moist heat, gentle ROM; cold temp. increases stiffness
AD
- Primary dementia of progressive cognitive decline
- Accumulation of amyloid-beta senile plaque and tau protein neurofinuillary tangles
AD: S&S
- Impaired memory and executive functioning skills cog.
- Impaired speech and language
- Agnosia
- mood and behavioral changes (wander)
- Psychosis, hallucination, behavior changes
- Sensory loss
AD: Evaluation
Early stages:
1. Functional eval of work, home, driving (determine if there is a cognitive deficit), and safety
Later stages:
1. Focus shifts to self-care, mobility, communication, and leisure skills
Determine functional level, context (env. fam support)
AD:
Assessments
Assessments:
1. Kitchen Task Assessment (KTA) -determing cog skills for cooking
2. Exectuive function test -standarized
3. ACL- determins quality of problem-solving
4. Cognitive Performance Test - identify cognitive deficits that are predictive of functional capacity using several ADL and IADL tasks
5. Assessment of Motor and Process Skills AMPS- Measures motor (posture, mobility, and strength) and process )attentional organizational, and adaptive) skills by using task performance in IADLs
6. Disability Assessment for Dementia (ADA) - uses informant ratings to determine tha bility of indvidual with AD to complete task in both ADL & IADL; determine executive functining skills (intiate, plan, execute).
AD: Stage 1
- Mild loss of memory
- difficulty with word choices
- repeats self
- mild issues with gonosis/praxis
VERY MILD TO MILD COG DECLINE
AD: Stage 1
Intervention
- Help client/caregivers estabilish routine; post it in a central place
- Psychological support
- Environmental aids-Calendars, appointment book; adapting activities
- Communcation training
AD: Stage 2
- Moderate loss of memory (personal history, recent/current events, losing objects)
- Supervision slowly increases; no longer employed
- Mild impairment in ADLs
- Denial, labile moods, anxious, hostile, w/d from activity/social decreases, paranoia
- Concentration and problem solving, learning new tasks, visuospatial deficits
MILD TO MOD COG DECLINE
AD: Stage 2
Intervention
- Maintain routines and design environmental support (lists, posters, and pictures) and level of assistance for cues to remember daily routine and important events
- Simplify complex tasks
- Verbal cues for IADLs and some ADLs
- Socalization
- Encourage walk, stretching, balance activities
AD: Stage 3
- Progressive memory loss of wel-known amterial; some past history retained
- Cannot perform ADLs and IADLs
MOD-MODERATLY SEVERE COG; DIFFICULTIES WITH PHYSICAL STATUS
AD: Stage 3
Intervention
- Managing behavior
- Maintain function
- Simplify task
- Environmental adaptation (perceptual loss)
- Rehearse names of camily and others, using pictures
AD: Stage 4
- Severe memory loss (forget family, but recognize famliar people)
- Confusion even in familiar surroundings
- Gait and balance distubrances
- Communication (grunts, single word)
- Unable to walk, urinate, eat (SNF)
SEVERE COG DECLINE AND MODERATE TO SEVERE PHYSCIAL DECLINE
AD: Stage 4
Intervention
- Maintain recreation and leisure activities (respite program)
- Positioning in bad/ w/c/ skin inspection
- AAROM/AROM/PROM
AD: Stage 5
Intervention
- Total A in ADLs and mobility
HD
- genetic hereditary neurological disorder
- caused by defective gene on chromosome 4
- impacts physical (motor) and mental (mood and thinking) ability
- Basal ganglia-motor control/learning, emotion, behavior; cerebral cortex-attention, thought, memory, language
HD symptoms
- slow progression for 15-20 yrs from onset (occurs between age 30-50)
- leads to uncontrollable movements of limbs
- Brain changes impact mood, esp. depression, irritability, anxiety, and obsessive-compulsive qualities
Motor difficulties in HD
- Chorea/choreiform-rapid, irregular, involuntaryily movements (muscle jerks)
- Akathisia-restlessness/fidgety
- Dystonia-abnormal sustained posture (muscle spasm in head, trunk, arms)
HD: Stage 1
- 0-8 yrs from onset
- can work part-time and needs MIN A for some ADLs
HD: Stage 2
1.. 3-13 yrs from onset
2.typically unable to work
3. min A in ADLs or MAX A in one area while other basic functions are independent
HD: Stage 3
- 5-16 yrs from onset
- unable to work
- MAX A for most basic ADLs
HD: Stage 4
- 9-21 yrs from onset
- MAX A ADL/IADL
- In home care/extended care facility needed
HD: Stage 5
- 11-26 yrs from onset
- full time SNF required
- chorea becomes hypertonicity, slow movement (bradykinesia), and akinesia present (delayed initation or loss of movement)
Overview of HD stages
- Early stage: still working but maintaining work perfromance gets harder
- Middle stage- cognition and gait decrease; descision making, memory, and motor coordination/balance are all impacted
- Late stage- long-term care and hospitalization
Other symptoms:
1. dysarthria
2. dysphagia
3. depression
4. high susceptibility to pneumonia
HD treatment
- Enviornmetal mod
- safety/fall edu
- EC (simplify)
- cog strate-(simple step, use lists, cal, labels)
- AE to support meal time/FMskills
- coping
- splints-contractures/positioning
