Neuro differential diagnoses and interventions

Question 1

cause of PD

Answer 1

depletion of dopamine in substantia nigra
- males>females
- sxs present with 80% loss of dopamine

Question 2

PD main symptoms

Answer 2

TRAP
1. - tremor (resting):
- pill rolling
- usually unilat
2. - rigidity
- cogwheel or leadpipe
- initially asymmetrical
- proximal
3. - akinesia
- bradykinesia, akinesia, hypokinesia (small movements)
- freezing, cant initiate movements
4. - postural instability
- thoracic kyphosis and forward head

Question 3

other signs and sxs with PD

Answer 3

Early sxs:
loss of smell, constipation, sleep disorders
Motor sxs: hypophonia (small, monotone voice), micrographia, mask-like face
Cardio sxs: orthostatic hypotension, abnormal response to exercise, fatigue, weakness
Respiratory sxs: restrictive lung disease due to decreased chest expansion
Cognition/behavior: difficulty with dual task, depression, dementia

Question 4

PD gait

Answer 4

• freezing of gait: inability to initiate movement
• festinating gait - short stride/shuffle, increased speed, anteropulsive
• decreased step width and step length
• decreased trunk rotation and arm swing
• En bloc turning

Question 5

PD interventions

Answer 5

• FOG: visual targets
• festinating gait: toe wedge/declined heel
• metronomes, music, visual cues, one step commands when freezing/frozen
• rotation exercises and crossing midline
• prone lying
• hypokinesia: BIG movements, stretching/ROM/chest mobility
• balance training
• tai chi, yoga, cycling, dance therapy

Question 6

PD pharm treatment

Answer 6

• levadopa/carbidopa
• on/off phenomenon - dyskinesia on phase
  dystonia=off phase
• takes 1 hr to kick in (schedule PT after kick in)
• dont eat a lot of protien

Question 7

dyskinesia

Answer 7

• involuntary, repetitive, smooth mm movements
• ex snake like twisting of arm
• affects large m groups (arms, head, trunk, legs)
• not usually painful
• ON phase of PD

Question 8

dystonia

Answer 8

• OFF phase for PD
• prolonged involuntary m contractions; muscle spasm
• ex toe curling
• affects specific m group or group of mm
• causes pain (can be debilitating)

Question 9

MS pathophysiology

Answer 9

• demyelination of nerves in spinal cord and brain (UMN)
• autoimmune
• women ages 20-40

Question 10

MS signs and sxs

Answer 10

UMN and cerebellum signs (and others)
- sensory: decreased/paresthesia
- motor: hypertonia, hyperreflexia, LE extensor spasticity
- cerebellum: nystagmus, ataxia, decreased coordination, intention trempr
- gait: scissoring, ataxic, uneven steps
- dysphagia, dysphonia
- optic neuritis, trigeminal neuralgia
- bladder: spastic or flaccid
- pseudobulbar affect
- cognition: diminished attention, concentration
- FATIGUE

Question 11

Lhermitte’s sign

Answer 11

• flex neck leads to electric shock sxs going down spine

Question 12

Uhthoff’s phenomenon

Answer 12

• heat intolerance leads to increased sxs

Question 13

Charcot’s triad

Answer 13

SIN (cerebellar signs)
- scanning speech (cant find words)
- intention tremor
- nystagmus

Question 14

Cranial N II sxs for MS

Answer 14

• optic neuritis - blindness, pain
• impaired pupillary light reflex
• Marcus Gunn pupil (do pupillary light test, eyes dilate) - Marcus pulls out gun

Question 15

MS interventions

Answer 15

F - 3-5x/wk
I: low intensity50-70% HRMax, submaximal
T: 30 mins
T: cycle, walk, swim, circuit training
- do not over-fatigue, morning, manage overheating

Question 16

what is ALS

Answer 16

progressive neuro disorder that damages nerve cells and causes disability
- death of motor neuron
- 3-5 years life expectancy because resp mm will be affected

Question 17

ALS signs and sxs

Answer 17

• only motor nerves affected!
• LMN sxs: m atrophy, fasciculations
• UMN sxs: spasticity, hyperreflexia
• bulbar: dysphagia, dysarthria
• higher motor CNs are affected: affect mouth, eyes are fine
• cognition: dementia, attention deficits
• pseudobulbar affect
• cervical spine extensor weakness - neck stuck in flexion

Question 18

ALS interventions

Answer 18

• focus on functional activities and ADLs
• soft neck collar for neck weakness
• breathing exercises
• avoid over-fatigueing: take frequent breaks
• ROM/positioning

Question 19

Guillan Barre syndrome pathophysiology

Answer 19

• autoimmune
• after infection
• acute inflammatory demyelinating polyradiculoneuropathy
• rapid asymmetrical loss of myelin in N roots, peripheral Ns and CNs
• LMN disorder

Question 20

GBS signs and sxs

Answer 20

-LMN
- distal to proximal motor loss
- rapid/progressive
- glove and stocking sensory loss
- burning, tingling, numbness
- decreased reflexes
- respiratory involvement
- CN: 7,9,10,11,12