Neuro Pathologies Flashcards
1
Q
Parkinsons Overview
A
- Degeneration of neurons in basal ganglia (which produces dopamine)
- Basal Ganglia = memory, movement initiation, regulate trunk and limb musculature, cognition, and store/initiating well learned and repetitive movements
- Male, 50-60 years old
- Patient normally has for 5 years before seeking treatment, progression is about 13 years, and most common cause of death is CVD and pneumonia
2
Q
Parkinsons Signs/Symptoms
A
- Rigidity (lead-pipe or cogwheel)
- Bradykinesia / freezing of gait
- Diminished motor recruitment and force (LVST BIG)
- Tremor (resting or action)
3
Q
Hoehn-Yahr Classification of Disability for Parkinsons
A
- Stage 1 = subclinical, not getting PT yet, minimal or absent symptoms, unilateral if present
- Stage 2 = minimal bilateral or midline involvement, balance not impaired
- Stage 3 = impaired righting reflexes, some activities limited but can live independently
- Stage 4 = all symptoms present and severe, standing and walking possible only with assist
- Stage 5 = confined to bed or w/c
4
Q
Parkinsons Impairments
A
- Gait disturbances
- COM shifted anteriorly
- Rigidity
- Postural instability
- Balance
- Orthostatic hypotension
5
Q
Parkinsons Pharmacology
A
- Levodopa (Sinemet)
- Exercise should be done during optimal effectiveness = 45mins
- Side effects are hallucination, paranoia, depression, dyskinesia, cardiovascular changes, or orthostatic hypotension
6
Q
Improving Gait in Parkinsons
A
- Freezing of Gait (akinesia) = stationary floor markings, laser lights on AD, rhythmic auditory stimulation (set 25% faster than pts selected speed)
- Festinating gait (shuffling gait) = shoe orthotics with toe wedges to shift COM back
- PNF = rhythmic initiation, rhythmic rotation, D2 flexion
- Balance = slow position changes from orthostatic hypotension side effect of Sinemet
7
Q
ALS Overview
A
- Progressive neurodegenerative disease
- UMN and LMN issue
- Cause unknown
- Male, 50s (can be early onset in 20-30 years old)
- Rapid progression, no cure, pt normally dies
- Death occurs within 3-5 years after diagnosis from respiratory failure
8
Q
ALS Symptoms
A
- Early Symptoms = distal and asymmetrical focal muscle weakness, bulbar weakness (dysarthria, dysphagia, dysphonia - tongue, swallowing, speaking), spasticity in extremities, UMN signs come first
- Late Symptoms = flaccidity, wide spread weakness, respiratory depression, LMN signs happen, pseudobulbar affect (poor emotional control, laughing when should be crying)
9
Q
ALS Impairments
A
- Lung secretion clearance (without this, lung infection can happen)
- Widespread weakness (cervical extensor weakness common)
- Respiratory weakness
- Energy conservation
- Fatigue
- Spasticity in earlier phases with decreased ROM
10
Q
ALS Respiratory Intervention
A
- High frequency chest wall oscillation vest
- MI / E = mechanical insufflation exsufflation (assisted coughing machine)
- IMT = inspiratory muscle training for restrictive conditions
- Diaphragmatic breathing (for restrictive conditions)
11
Q
ALS Treatment for Weakness & Fatigue
A
- 3/5 is the magic number because overuse weakness does not occur in muscles that have a MMT grade of 3/5 or greater (anything under 3/5 MMT can have overuse weakness where muscles can degrade)
- Strength gains can occur in muscles that are 3/5 MMT
- Heavy eccentrics should be avoided and do NOT exercise patients to fatigue
12
Q
FITT Values for ALS
A
- Frequency = 2-3x/week on alternate days to give patient rest time
- Intensity = moderate level (70-80% 1RM)
- Time = 30 minutes per session or a minimum of 10 minute sessions x3
- Type = strength, aerobic (remember 3/5 rule)
- Morning is better time for this population for exercise
13
Q
ALS Wheelchair Prescription
A
- Early to middle stage = rent short term lightweight wheelchair
- Late stage = purchase power w/c with required modifications (such as sip and puff, head control, potentially joystick)
14
Q
ALS Orthotics
A
- HKAFO and KAFO are too heavy, pt would need w/c if this is required
- SAFO chosen if pt is homebound, not moving a lot, spasticity, and lacking ankle mobility
- Hinged AFO (articulated) chosen if pt is more active, has stairs or ramp to negotiate, but still require ankle control
15
Q
ALS Spasticity
A
- Avoid contractures
- Can do splint, PNF, botox, orthotics, serial casting
- Positioning out of synergy for 3 minutes to 3 hours
- Gentle prolonged stretching and PROM would not be wrong but probably not best option bc those are therapist intensive
16
Q
Autonomic Dysreflexia Overview
A
- Life threatening medical condition
- SCI at T6 or above (are those who are at risk)
- Caused by bowel/bladder distention, catheter kink, pressure sores/ulcers, or cutaneous noxious stim (tight clothing)
- Sympathetic outflow happens below T6, sympathetic response causes vasoconstriction, which causes increased BP, and body cannot decrease BP below T6 due to SCI
17
Q
Autonomic Dysreflexia Symptoms
A
- Increased BP
- Pounding HA
- Tinnitus (ringing in ears)
- Flushing of skin above level of lesion
- Red / warmth in face
18
Q
Autonomic Dysreflexia PT Responsibility
A
- (1) Check for noxious stim and remove stim if kink in catheter or tight clothing (however if pt is supine, sit pt up first then check for noxious stim, if pt isn’t supine then check for noxious stim first then sit/stand pt up)
- (2) Sit pt up or stand pt (because this will decrease their BP)
- (3) Call 911 = if in a position where we are unable to get BP down
- Still notify physician so that they are aware that pt had this
- Side Note – if pt has Orthostatic Hypotension then we should lie patient in supine in order to increase their BP
19
Q
Myasthenia Gravis (MG) Overview
A
- Autoimmune disorder whose action takes place at site of neuromuscular junction and motor end plates
- LMN issue
- 20-30 years old for females OR 50-60 years old for males
- With treatment, pt will have a normal life expectancy
20
Q
Myasthenia Gravis (MG) Risk Factors
A
- Hyperthyroidism (this is common with MS, fibromyalgia, and carpal tunnel syndrome)
- 75% of people with MG have abnormalities of the thymus
21
Q
Myasthenia Gravis (MG) Signs & Symptoms
A
- Ptosis and facial weakness
- Fatiguability and weakness combo (more they do throughout the day, more fatigued they get, and more energy in mornings)
- Respiratory weakness
- NOOO sensory changes or issues with DTRs (these remain normal)
- Quad Ds (dysarthria, dysphagia, dysphonia, diplopia happen due to generalized weakness)
22
Q
Differentiating MG from GB, ALS, and MS
A
- MG is female dominated
- MG has retention of DTRs and sensation
- MG has remissions and exacerbations
- MG strength improves with rest
- MG has proximal muscle weakness
- MG has daily fluctuations in strength
- MG has fatiguability and weakness combo (due to low endurance, can rest and improve strength and this does not happen with MS)
- MG has weakness and flaccidity because of LMN while MS has spasticity due to UMN
23
Q
Myasthenia Gravis (MG) Ice Pack and Rest Test
A
- Ice Pack Test = place latex free glove filled with crushed ice over eyelid for 2 minutes then reevaluate eye, there should be significant improvement in eye
- Rest Test = place cotton filled latex free glove over eyelid while holding eyes closed for 2 minutes and this should improve eye in pts with MG bc eye got to rest
24
Q
Myasthenia Gravis (MG) Treatment
A
- Immunosuppressive drugs (prednisone)
- Precautions need to be taken to avoid injury caused by steroid induced osteoporosis
- Exercise should be done early in the morning
- Do not overwork patient because this can lead to exacerbation
- Avoid prolonged exposure to hold or cold environments
- Avoid strenuous exercise and stress
- Avoid eccentric based training because it tears down the muscle tissue
25
Q
Myasthenia Crisis
A
- Medical emergency characterized by sudden onset of severe respiratory weakness
- This patient will require a ventilator and treatment in ICU
- An impending crisis will present as a sudden onset of increasing muscle weakness, respiratory stress, with difficulty talking, chewing, and/or swallowing
26
Q
Multiple Sclerosis (MS) Overview
A
- Autoimmune disease that causes inflammation and damage to myelin coating wrapped around nerve fibers in CNS
- Etiology unknown
- Females, 20-40 years old
- Areas prone to attack are optic nerves, spinal tracts, spinal cord, and cerebellar peduncles
27
Q
Multiple Sclerosis Types
A
- Relapsing/Remitting = 85% of cases, unpredictable attacks followed by periods of remission which may or may not leave permanent deficits
- Primary Progressive = 10% of cases, disease progression and steady functional decline from onset, no relapses or remissions, no discreet attacks, typically a later onset
- Factors that influence exacerbation = stress, infections, sleep deprivation, dehydration, exhaustion, and warm temperature (heat breaks down myelin)
28
Q
Multiple Sclerosis Top Signs and Symptoms
A
- Uthoff’s Sign (heat intolerance) = symptoms present after a patient has been in heat who has MS
- Quad Ds (diplopia, dysarthria, dysphagia, dysphonia)
- Spasticity
- Lhermitte’s sign = electrical shock sensation when flexing neck
29
Q
Multiple Sclerosis Impairments
A
- Weakness = corticospinal tract impacted
- Spasticity
- Balance = loss of sensory system
- Gait = cerebellar dysfunction
- Weakness = cerebellar issue
- Energy conservation and fatigue
- Side note = hypothyroidism is also common in this demographic and has heat intolerance
30
Q
Multiple Sclerosis Treatment
A
- Diminished vision = eye patch for diplopia, use floor markers or constructing colors for low vision
- Diminished proprioception = associative stage of learning, weight on extremities, tapping, verbal cues and biofeedback
- Deleterious effects of overheating = aquatics (less than 85 degrees) and avoid working into fatigue
- Exercise early in the morning because its cooler
- 70-80% 1RM or 60-85% HRpeak
- Exercise on alternate days
- Spasticity = excessive extensor tone, avoid contractures so position out of synergy or use PNF stretching techniques
- Gait = PF spasticity and foot drop (so use hinged AFO with PF stop), ataxic gait (so do pool walking to reduce fatigue and tone or use ankle weights), and body weight supported treadmill training (for improvements found in strength, spasticity, endurance, balance, and walking speed)
- Frankels Exercises with MS = coordination and proprioception exercises done in lying, then sitting, then standing position
31
Q
Guillain-Barre (GB) Overview
A
- Autoimmune condition that also affects myelin, however, GB affects the PNS (so there is LMN symptoms)
- Male, 20-30 years old OR 50-80 years old
- 50% cases the symptoms cease within 2 weeks and 90% of cases the progression ends by 4 weeks
- Recovery occurs proximal to distal and may take months to years for return to function
32
Q
Guillian-Barre Top Signs and Symptoms
A
- Rapidly ascending, symmetrical motor weakness and sensory loss
- Symptoms come on distal to proximal (but when patient is recovering then that happens from proximal to distal)
- Flaccid paralysis (distal to proximal)
- Impaired facial muscles
- LMN signs
- Impairments = ROM, energy conservation and activity tolerance, weakness, skin breakdown, and respiratory dysfunction (secretions, ventilation, and GB is restrictive condition)
- There are deleterious effects of overuse and overstretching (because it can further damage myelin)
- Skin Care = pressure relief/turning every 2 hours while lying down and every 15-30 minutes while seated
33
Q
Guillian-Barre - Functional Independence Measure (FIM) Scores
A
- 7 = compete indepndence
- 6 = modified independence with no helper
- 5 = supervision or setup with helper (pt doing 100%)
- 4 = minimal assistance with helper (pt doing 75% or more)
- 3 = moderate assistance with helper (pt doing 50% or more)
- 2 = maximal assistance with helper (pt doing 25% or more)
- 1 = total assistance with helper (pt doing <25%)
34
Q
Guillian-Barre Respiratory Dysfunction
A
- Caused by progressive weakness of trunk musculature including diaphragm
- Development of atelectasis (lung collapse - use incentive spirometry to prevent this)
- Coughing and clearance of tracheal secretions
- Endotracheal Suctioning (poisoning is contraindicated, should be done in rotational motion for 5-10 seconds, then 10 seconds rest, then repeat)
- Diaphragmatic breathing because restrictive condition
- Bronchopulmonary hygiene to mobilize secretions and clearing them
- Huffing if patient has abdominal control
- Suctioning
