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Exam Prep > Neurodegenerative > Flashcards

Neurodegenerative Flashcards

1
Q

Guilian-Barre Syndrome

A

Inflammatory disease causing demyelination of peripheral nerve axons

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2
Q

Most frequently reported GBS symptom

A

Fatigue

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3
Q

Phases of GBS

A
  1. Acute inflammatory: progressive increase in symptoms (2-4 weeks)
  2. Plateau: symptoms most disabling with little or no change (days to weeks)
  3. Progressive recovery: gradual improvement to baseline starting at head/neck and travel distally (up to 2 years - 50% full recovery)
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4
Q

GBS presentation

A

Typically symmetrical ascending pattern of flaccid paralysis that starts in the feet and moves to UE

Distal weakness greater impairment compared to proximal weakness

Paralysis can occur in respiratory muscle (20-30% need ventilation)

Mild sensory loss in hands/legs “glove and stocking distribution”

Autonomic involvement - postural hypotension

Cognition intact

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5
Q

Interventions in GBS plateau phase

A
  • Modifications deemed temporary
  • Communication tools/system
  • Environmental modifications to ensure access to call bell
  • Positioning to optimize function and prevent skin breakdown
  • Caregiver/family education
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6
Q

Interventions in GBS recovery phase

A
  • Resume occupations, roles, routines
  • Dynamic splinting and activities to maintain ROM
  • Safe mobility and transfers
  • Modified techniques for self-care
  • Energy conservation and fatigue mgmt.
  • FMC activities for strength, coordination and sensation in hands
  • Home assessment to ensure pt. safety
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7
Q

Akinesia

A

Impairment of voluntary and spontaneous movement initiation resulting in freezing, most common during gait activities

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8
Q

Bradykinesia

A

Slowed motor movements

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9
Q

Dysmetria

A

Decreased coordinated movements - overshooting and undershooting

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10
Q

Rigidity

A

Muscle stiffness that impaires motor movement

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11
Q

Fasciculation

A

Involuntary muscle contraction and relaxation, muscle twitch

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12
Q

Festinating gait

A

Small rapid steps in attempt to maintain center of gravity with anterior trunk and cervical flexion posture

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13
Q

Paresthesia

A

Numbness and tingling due to changes in nerves

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14
Q

General intervention strategies for neurodegenerative diseases

A
  1. Teach compensatory strategies
  2. Provide energy conservation training
  3. Delegate roles and routines
  4. Provide environmental modifications and AE
    5.Recommend exercise program within limitations that balance activity with rest
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15
Q

Multiple sclerosis

A

Chronic and progressive demyelinating disease of CNS where own body attacks myelin sheath covering neurons in the brain and spinal cords impacting axon ability to send impulses

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16
Q

Early intervention for MS to delay onset of disability

A

Functional mobility and ADLs
Fatigue mgmt.
Role/routine modifications

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17
Q

Initial MS symptomology

A

Insidious, diverse and unpredictable - visual disturbances, dizziness, weakness with exacerbation and remission present most common

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18
Q

MS motor symptoms

A

Ataxia
Partial/complete paralysis of different body parts
Muscle spasticity (most prominent in LE)
Muscle weakness
Fatigue
Intension tremor
Dysphagia

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19
Q

Ataxia

A

Impaired balance and coordination

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20
Q

Most debilitating symptom of MS

A

Fatigue

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21
Q

MS sensory symptoms

A

Paresthesia
Vertigo
Pain
Heat intolerance

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22
Q

How can paresthesia present in MS

A
  • Impaired proprioception, pain, touch, temp sensations
  • Impaired perceptual skills including stereognosis and kinesthesia
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23
Q

MS visual symptoms

A

Diplopia
Blurred vision
Optic neuritis

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24
Q

Optic neuritis

A

Sudden loss of vision with pain often lasting 3-6 months with pernament partial vision loss, nystagmus and decreased visual acuity

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25
Q

MS communication symptoms

A

Dysarthria
Slow enunciation and hesitants

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26
Q

MS Bladder/bowel and sexual symptoms

A

Incontinence
Urinary retention
Increased urinary urgency
Constipation
Erectile dysfunction in men
Decreased libido and lubrication in woman
(pregnancy not impacted)

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27
Q

MS cognitive symptoms

A

STM loss
Attention deficits
Decreased processing
Impaired visuospatial
Impaired EF

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28
Q

MS emotional symptoms

A

Depression
Mood swings and irritability

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29
Q

MS diagnostic requirements

A

Episodes of exacerbation and remission
Slow progression over 6 months
Evidence of lesions in white matter
No other neurological explanation of symptoms

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30
Q

Four categories of MS

A

Relapsing-remitting
Secondary progressive
Primary progressive
Progressive relapsing

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31
Q

Clinically isolated syndrome (CIS)

A

First episode of neurological symptoms that signals high risk for experiencing reoccurring symptoms - not everyone with a CIS will develop MS

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32
Q

Relapsing-remitting MS (RRMS)

A

Defined exacerbation and remission episodes, disability does not always increase after each exacerbation episode

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33
Q

Secondary progressive MS

A

Neurological function declines over time and disability increases, previous diagnosis of RRMS

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34
Q

Primary progressive MS

A

Disability starts to increase with first episode of symptoms

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35
Q

Common OT standardized assessments for MS

A

COPM
Modified fatigue impact scale
Beck depression
FIM
9-hole
Purdue peg
SW
Home assessment

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36
Q

Visual intervention MS

A

Home safety modifications
AE for visual acuity

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37
Q

Sensory intervention MS

A

Sensory reeducation
Compensatory strategies to rely on other senses to protect impacted limbs
Heat sensitivity

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38
Q

Exercise interventions MS

A

Monitor body mechanics to avoid stressing joints
Therapeutic exercise with rest and avoiding fatigue

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39
Q

Pain interventions MS

A

Use of standing program using standing frame
Resting orthotics
Maintain hips at 90 degrees flexion to reduce extensor tone
Heat modalities on trigger points

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40
Q

Fatigue interventions MS

A
  • Diary log to identify occupations that result in fatigue to make modifications to routine/tasks
  • Use of appropriate AE
  • Ergonomic positioning
  • Cooling techniques (liquid cooling vest, showers, ice pack)
  • Energy conservation
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41
Q

Energy conservation components

A

Planning, pacing, prioritizing, positioning

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42
Q

Ataxia interventions MS

A
  • Promote proximal stability fo rdistal mobility
  • Modify tasks with hand-over-hand to control intention tremor
  • Use of orthotics
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43
Q

Common AE for MS

A

Built-up handles, reachers, sock aid to compensate for weak muscles and maintain joint integrity

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44
Q

Cognitive intervensions MS

A

CBT activities
External memory aids
Stress mgmt
Relaxation techniques
Coping strategies during exacerbation periods

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45
Q

PD

A

Progressive condition causing motor impairment (speed/accuracy) postural instability, cognitive deficits, decreased affect/expression due to degenerative change in basal ganglia and grey matter and reduction of dopamine by substantia nigra

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46
Q

PD symptoms

A
  • Resting tremor “pill-rolling”
  • Muscle rigidity/stiffness “cog-wheel”
  • Increased effort to produce voluntary movement
  • ## Bradykinesia
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47
Q

Primary PD symptoms

A
  • Resting tremor “pill-rolling”
  • Muscle rigidity/stiffness “cog-wheel”
  • Increased effort/time to produce voluntary movement
  • Bradykinesia
  • Postural instability: stooped with lack of arm swing
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48
Q

Secondary PD symptoms

A
  • Festinating gait “shuffle steps”
  • Inability to initiate or continue movement
  • Overshooting targets
  • Impaired executive functioning
  • Memory loss
  • Visuospatial deficits
  • Micrographic (reduced handwriting size)
  • Hypophonia (reduced speech volume)
  • Muffled speech with lack of verbal inflection
  • Reduced facial expression/flat affect
  • Sensory loss including bowels and bladder
  • Dysphagia
  • Depression, apathy, withdrawal
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49
Q

Five stages of PD

A

Stage 1: unilateral symptoms, resting tremor, no or minimal loss of function

Stage 2: bilateral symptoms, balance not affected, deficits with trunk mobility and postural reflexes

Stage 3: impaired balance due to postural instability, mild to moderate loss of function

Stage 4: decrease in postural stability and function, impaired mobility, assistance for ADL, poor FM and dexterity

Stage 5: TD for mobility and ADLS

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50
Q

Dyskinesia

A

Involuntary, erratic, writhing movements of the face, arms, legs or trunk

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51
Q

L-dopa

A

Decrease PD symptoms by increaing dopamine level in the brain with nausea and dyskinesia as side effects

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52
Q

Strategies for decreasing PD resting tremor

A
  • Distal wrist weights
  • Use proximal muscles to stabilize distal joints/muscles (UE support on table, self-care activities close to body)
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53
Q

Feeding equipment for PD

A

Build-up or weighted utensils, cups with lids, plate guards, non-slip surface

54
Q

Intervention for PD rigidity and pain

A

Moist heat
Warmer home temperature
Gentle stretch
Gentle ROM
Anti-spasticity orthotic or dynamic/static progressive splint for low-intensity stretch

55
Q

ALS

A

Progressive degenerative disease of UMN and LMN resulting in progressive muscle atrophy

56
Q

Presentation of symptoms

A

Distal to proximal - often starts with weakness in small muscles of the hand or asymmetrical foot drop

57
Q

Corticospinal tract symptoms

A

Spasticity and hyper reactive reflexes

58
Q

Corticobulbar tract symptoms

A

Dysphasia, dysarthria

59
Q

Six stages of ALS

A

Stage I: Some weakness, can walk, independent with ADL

Stage II: Moderate weakness, can walk

Stage III: Severe weakness, can walk, no strengthening, PROM/AAROM

Stage IV: require w/c, some assistance with ADL, severe weakness in LE

Stage V: require w/c, dependent for ADL, severe weakness in LE/UE, pain, ulcer risk

Stage VI: confined to bed, dependent for ADL and most self-care, pain, ulcer risk

60
Q

Riluzole

A

Medication that helps manage ALS symptoms and can help slow disease progression

61
Q

Evaluation of ALS

A

COPM
ALS functional rating scale
Perdue peg
Fatigue inventory
Dysphasia screening

62
Q

ALS neck collar or universal cuff

A

Provides UE stability during FM tasks

63
Q

Wheelchair for ALS

A

Early: high backed and reclining, lightweight, provides cervical, trunk and extremity support

Late: power w/c with adaptable controls with tilt feature and supports

64
Q

OT dysphagia strategied

A

Minimize distractions
Adapt food consistency
Manual swallowing technique
Increased time for meals
Ensure nutritional needs are met

65
Q

Huntington’s disease

A

Hereditary neurological disorder resulting in cognitive and physical limitations due to progressive nerve loss in brain with symptoms progressing over 15-20 year period leading to hospitalization

66
Q

Involuntary motor patterns associated with HD

A

Choreiform hand movements
Chorea
Akathisia
Dystonia

67
Q

Choreiform

A

Jerking or writhing movements

68
Q

Chorea

A

Spastic movement of extremities and facial muscles

69
Q

Akathisia

A

Motor restlessness

70
Q

Dystonia

A

Abnormal sustained posturing of body part

71
Q

Voluntary movement patterns associated with HD

A

Bradykinesia
Akinesia

72
Q

Cognitive impairments associated with HD

A

Forgetfulness
Difficulty concentrating
Difficulty sequencing tasks
Memory impairement

73
Q

Other symptoms of HD

A

depression
Irritability
Dysphagia
Dysarthria

74
Q

Early stage intervention for HD

A
  • Establish daily routine
  • Use of checklists and written activity steps
  • Task breakdown
  • Introduce home/work modifications
  • Work site evaluation
  • Refer for driving evaluation
  • Home exercise program to address flexibility and endurance
75
Q

Middle stage intervention for HD

A
  • Focus on engagement in purposeful activity
  • Education on positioning techniques and AE
  • Use of built-up utensils
  • Fatigue mgmt
  • Oral motor exercise and dietary changes to accommodate oral-motor changes
  • Strategies for bathing and dressing
  • Mental imagery
76
Q

Late stage intervention for HD

A
  • Positioning
  • Splinting to prevent contracture
  • Transition to feeding tube
  • Put environmental controls in place
77
Q

Early stage Alzheimers

A

Function largely independently
Aware of having some memory lapses and forgetfulness

78
Q

Middle stage Alzheimers

A

Frequent forgetfulness
Mood changes with mental/social challenges
Poor decision making
Disoriented
Risk of wondering/becoming lost

79
Q

Late stage Alzheimers

A

Unable to engage with environment
Cannot carry out conversations
Significant assistance for ADL

80
Q

Vascular dementia

A

Multiple small strokes lead to focal lesion on the brain and NT disruption resulting in cognitive decline similar to AD with less severe memory involvement gait disturbance common

81
Q

Course of vascular dementia

A

Step-wise decline opposed to continuous with sudden appearance of symptoms

82
Q

Fronto-temporal dementia

A

Neuronal cause with two variants with distinct and progressive course
1. Large personality and behavior changes
2. Progressive aphasia

Both involve muscle weakness and stiffness

83
Q

Dementia with lewy bodies

A

Gradual deficits due to decline in dopamine/acetylcholine levels resulting in attention, executive function, memory, visual hallucinations, Parkinsonism, autonomic dysfunction

Rapid eye movement sleep disorder as prodromal symptom

Early: EF, attention, memory
Later: aphasia, apraxia, spatial disorientation

84
Q

Parkinsonism

A

Motor syndrome that manifests as rigidity, tremors, and bradykinesia.

85
Q

Recent memory

A

Recall of recent events - affected first in dementia

86
Q

Procedural memory

A

Recall how to perform a task

87
Q

Personal episodic memory

A

Recall of time-related info about oneself

88
Q

Semantic memory

A

Recall names of objects

89
Q

Aphasia

A

Language impairment - expressive, receptive or both

90
Q

Agnosia

A

Inability to interpret sensations and hence to recognize things

91
Q

Hyperreflexia

A

Hyperactive deep tendon reflexes

92
Q

Paratonia

A

Involuntary resistance to PROM of extremities

93
Q

Early dementia functional impairment

A

ADL intact
Memory loss with IADL
Poor orientation to place
Disoriented during community mobility
Financial mgmt and shopping impaired
Learning and reading become difficulty
Poor relationship mgmt/ social withdrawal
Sticks with repetitive routines
Communication impaired

94
Q

Middle stage dementia functional impairment

A

Impairment in all occupations including ADL
Unable to live alone
Weight loss
IADLs neglected
Simple home tasks completed with assistance
Dependent for community mobility and financial mgmt
Cooking/cleaning with supervision
Large safety concern
No work/education
No longer able to differentiate days

95
Q

Allen cognitive level 6

A

Planned actions
Patient independent
Can plan, reflect and anticipate

96
Q

Allen cognitive level 5

A

Exploratory actions
Standby assistance or supervision
Learn new activities
Trial and error problem solving
Can follow 5-step process
Difficulties with judgement and planning

97
Q

Allen cognitive level 4

A

Goal-directed activity
Min Assist
Attention with visual and tactile cues
Benefits from model
Can understand cause and effect
Can follow familiar 3-step activity
Simple/concrete tasks
Decreased safety awareness

98
Q

Allen cognitive level 3

A

Manual actions
Mod assist
Focus on tactile cueing
One-step activities
Cannot learn new behaviors
Need routine
Avoid sensory overload
Can wash hands and brush teeth
Items for grooming presented one at a time in sequential order
30 min attention span
24/7 supervision

99
Q

Allen cognitive 2

A

Postural actions
Max assist
Thinking highly disorganized
Gross motor patterns for ADLs can be accomplished by imitating caregiver
Physically guide through task
Paces and wonders
Around the clock supervision
3 min attention span

100
Q

Allen cognitive 1

A

Automatic actions
Total assist
Attention limited
Motor actions in response to one word “sip”
Assistance for functional mobility and transfers
Dependent on caregiver
ROM to prevent bed sores, infection, contracture
Terminal phase

101
Q

Standardized function-based cognitive screening tools

A

Allen cognitive level screen
Assessment of motor and process skills
Cognitive performance test
Executive function performance test
Independent living scale
Kitchen task assessment
OT-ADL neuro behavioral evaluation

102
Q

Standardized cognitive screening tools

A

Blessed dementia scale
Mini-mental

103
Q

Cognitive functioning interventions

A
  • Psycho-education (early stages)
  • Reminiscing groups for cognitive facilitation/stimulation
  • Relaxation techniques
  • Environnemental modification (visual aids)
104
Q

Affective functioning interventions

A
  • Structured and planned socialization
  • Structured activities
  • Movement and exercise
105
Q

Memory enhancement strategies

A

Large print calendars
Daily schedules
Seasonal decorations
Familiar furniture
Photographs
Favorite music
Notices of current events

106
Q

7 stages of Alzheimers

A

Stage 1: NO DEMENTIA

Stage 2: VERY MILD COGNITVE DECLINE

Stage 3: MILD COGNITIVE IMPAIRMENT

Stage 4: MODERATE COGNITIVE DECLINE

Stage 5: MODERATELY SEVERE COGNITIVE DECLINE

Stage 6: SEVERE COGNITIVE DECLINE,

Stage 7: VERY SEVERE COGNITIVE DECLINE

107
Q

AD 2: subjective memory loss

A

Basic Forgetfulness (words, recent events, where items were left), no serious enough to impact social life/work etc., patient may start to notice

108
Q

AD 3: mild cognitive impairment

A

Decrease performance at work/social settings

109
Q

AD 4: moderate cognitive decline

A

Clear deficits on clinical interviews, still oriented to time/place, difficulties with IADLs, sequencing, planning, denial, require assistance at home

110
Q

AD 5: moderately severe cognitive decline

A

Decreased Independence, cannot live alone, assistance for ADL and IADL, forget major aspects of life (phone #, address), frequently disoriented

111
Q

AD 6: severe cognitive decline

A

Cannot speak in full sentences, difficulty with 1-2 step tasks, personality changes, delusional behaviors, incontinence, increased caregiver burden

112
Q

At what stage of AD do patients begin to experience changes in vision

A

Stage 3

113
Q

What diagnosis benefits from use of rhythm and music to support mobility

A

PD

114
Q

Intention tremor

A

MS

115
Q

Resting tremor

A

PD

116
Q

Donepezil

A

AD medication to improve memory/cognition, reduce mood/hallucinations/anxiety with dizziness side effect

117
Q

Is motor imagery a successful intervention to support motor planning?

A

Yes

118
Q

Biofeedback strategies

A

Provide auditory or visual cues to gain volitional control over physiological response

119
Q

Modifications to support bed mobility

A

Light bedding
Firm mattress
Lowered bed height
Bedrails

120
Q

MS nerve involvement

A

CNS

121
Q

GBS nerve involvement

A

PNS

122
Q

Best type of exercise for MS

A

Structured aerobic program as boyancy of water reduced effects of weakness

123
Q

Akinesia

A

Impairment with spontaneous movement most evident with gait, freezing

124
Q

Fasciculation

A

Involuntary muscle twitching

125
Q

Dyskinesia

A

Involuntary erratic writhing movements

126
Q

Acute focus with GBS

A

Pain mgmt
Fatigue mgmt
Swallow impairement

127
Q

Presentation of ALS

A

Begins distally and typically aysmmetrical

128
Q

UMN symptoms

A

Spasticity
Weakness
Involuntary and rhythmic muscle contractions

129
Q

LMN symptoms

A

Weakness
Muscle atrophy (wasting)
Fasciculations (muscle twitching)

130
Q

Erb’s palsy

A

Paralysis of upper brachial plexus resulting in paralysis of UE musculature including supraspinatus, infraspinatus, deltoid, biceps, subscapularis, elbow flexion and scap mobility weakened

131
Q

Erb’s palsy contracute

A

Arm straight with wrist fully bent “waiter’s tip position” with supination, IR, adduction UE deformity present later

132
Q

Athetosis

A

Dyskinetic condition impacting timing, force and accuracy of trunk/limb movement

Exam Prep (19 decks)

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