Neurodegenerative Flashcards
1
Q
Guilian-Barre Syndrome
A
Inflammatory disease causing demyelination of peripheral nerve axons
2
Q
Most frequently reported GBS symptom
A
Fatigue
3
Q
Phases of GBS
A
- Acute inflammatory: progressive increase in symptoms (2-4 weeks)
- Plateau: symptoms most disabling with little or no change (days to weeks)
- Progressive recovery: gradual improvement to baseline starting at head/neck and travel distally (up to 2 years - 50% full recovery)
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
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
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
7
Q
Akinesia
A
Impairment of voluntary and spontaneous movement initiation resulting in freezing, most common during gait activities
8
Q
Bradykinesia
A
Slowed motor movements
9
Q
Dysmetria
A
Decreased coordinated movements - overshooting and undershooting
10
Q
Rigidity
A
Muscle stiffness that impaires motor movement
11
Q
Fasciculation
A
Involuntary muscle contraction and relaxation, muscle twitch
12
Q
Festinating gait
A
Small rapid steps in attempt to maintain center of gravity with anterior trunk and cervical flexion posture
13
Q
Paresthesia
A
Numbness and tingling due to changes in nerves
14
Q
General intervention strategies for neurodegenerative diseases
A
- Teach compensatory strategies
- Provide energy conservation training
- Delegate roles and routines
- Provide environmental modifications and AE
5.Recommend exercise program within limitations that balance activity with rest
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
16
Q
Early intervention for MS to delay onset of disability
A
Functional mobility and ADLs
Fatigue mgmt.
Role/routine modifications
17
Q
Initial MS symptomology
A
Insidious, diverse and unpredictable - visual disturbances, dizziness, weakness with exacerbation and remission present most common
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
19
Q
Ataxia
A
Impaired balance and coordination
20
Q
Most debilitating symptom of MS
A
Fatigue
21
Q
MS sensory symptoms
A
Paresthesia
Vertigo
Pain
Heat intolerance
22
Q
How can paresthesia present in MS
A
- Impaired proprioception, pain, touch, temp sensations
- Impaired perceptual skills including stereognosis and kinesthesia
23
Q
MS visual symptoms
A
Diplopia
Blurred vision
Optic neuritis
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
25
MS communication symptoms
Dysarthria
Slow enunciation and hesitants
26
MS Bladder/bowel and sexual symptoms
Incontinence
Urinary retention
Increased urinary urgency
Constipation
Erectile dysfunction in men
Decreased libido and lubrication in woman
(pregnancy not impacted)
27
MS cognitive symptoms
STM loss
Attention deficits
Decreased processing
Impaired visuospatial
Impaired EF
28
MS emotional symptoms
Depression
Mood swings and irritability
29
MS diagnostic requirements
Episodes of exacerbation and remission
Slow progression over 6 months
Evidence of lesions in white matter
No other neurological explanation of symptoms
30
Four categories of MS
Relapsing-remitting
Secondary progressive
Primary progressive
Progressive relapsing
31
Clinically isolated syndrome (CIS)
First episode of neurological symptoms that signals high risk for experiencing reoccurring symptoms - not everyone with a CIS will develop MS
32
Relapsing-remitting MS (RRMS)
Defined exacerbation and remission episodes, disability does not always increase after each exacerbation episode
33
Secondary progressive MS
Neurological function declines over time and disability increases, previous diagnosis of RRMS
34
Primary progressive MS
Disability starts to increase with first episode of symptoms
35
Common OT standardized assessments for MS
COPM
Modified fatigue impact scale
Beck depression
FIM
9-hole
Purdue peg
SW
Home assessment
36
Visual intervention MS
Home safety modifications
AE for visual acuity
37
Sensory intervention MS
Sensory reeducation
Compensatory strategies to rely on other senses to protect impacted limbs
Heat sensitivity
38
Exercise interventions MS
Monitor body mechanics to avoid stressing joints
Therapeutic exercise with rest and avoiding fatigue
39
Pain interventions MS
Use of standing program using standing frame
Resting orthotics
Maintain hips at 90 degrees flexion to reduce extensor tone
Heat modalities on trigger points
40
Fatigue interventions MS
- 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
41
Energy conservation components
Planning, pacing, prioritizing, positioning
42
Ataxia interventions MS
- Promote proximal stability fo rdistal mobility
- Modify tasks with hand-over-hand to control intention tremor
- Use of orthotics
43
Common AE for MS
Built-up handles, reachers, sock aid to compensate for weak muscles and maintain joint integrity
44
Cognitive intervensions MS
CBT activities
External memory aids
Stress mgmt
Relaxation techniques
Coping strategies during exacerbation periods
45
PD
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
46
PD symptoms
- Resting tremor "pill-rolling"
- Muscle rigidity/stiffness "cog-wheel"
- Increased effort to produce voluntary movement
- Bradykinesia
-
47
Primary PD symptoms
- 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
48
Secondary PD symptoms
- 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
49
Five stages of PD
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
50
Dyskinesia
Involuntary, erratic, writhing movements of the face, arms, legs or trunk
51
L-dopa
Decrease PD symptoms by increaing dopamine level in the brain with nausea and dyskinesia as side effects
52
Strategies for decreasing PD resting tremor
- Distal wrist weights
- Use proximal muscles to stabilize distal joints/muscles (UE support on table, self-care activities close to body)
53
Feeding equipment for PD
Build-up or weighted utensils, cups with lids, plate guards, non-slip surface
54
Intervention for PD rigidity and pain
Moist heat
Warmer home temperature
Gentle stretch
Gentle ROM
Anti-spasticity orthotic or dynamic/static progressive splint for low-intensity stretch
55
ALS
Progressive degenerative disease of UMN and LMN resulting in progressive muscle atrophy
56
Presentation of symptoms
Distal to proximal - often starts with weakness in small muscles of the hand or asymmetrical foot drop
57
Corticospinal tract symptoms
Spasticity and hyper reactive reflexes
58
Corticobulbar tract symptoms
Dysphasia, dysarthria
59
Six stages of ALS
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
Riluzole
Medication that helps manage ALS symptoms and can help slow disease progression
61
Evaluation of ALS
COPM
ALS functional rating scale
Perdue peg
Fatigue inventory
Dysphasia screening
62
ALS neck collar or universal cuff
Provides UE stability during FM tasks
63
Wheelchair for ALS
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
OT dysphagia strategied
Minimize distractions
Adapt food consistency
Manual swallowing technique
Increased time for meals
Ensure nutritional needs are met
65
Huntington's disease
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
Involuntary motor patterns associated with HD
Choreiform hand movements
Chorea
Akathisia
Dystonia
67
Choreiform
Jerking or writhing movements
68
Chorea
Spastic movement of extremities and facial muscles
69
Akathisia
Motor restlessness
70
Dystonia
Abnormal sustained posturing of body part
71
Voluntary movement patterns associated with HD
Bradykinesia
Akinesia
72
Cognitive impairments associated with HD
Forgetfulness
Difficulty concentrating
Difficulty sequencing tasks
Memory impairement
73
Other symptoms of HD
depression
Irritability
Dysphagia
Dysarthria
74
Early stage intervention for HD
- 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
Middle stage intervention for HD
- 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
Late stage intervention for HD
- Positioning
- Splinting to prevent contracture
- Transition to feeding tube
- Put environmental controls in place
77
Early stage Alzheimers
Function largely independently
Aware of having some memory lapses and forgetfulness
78
Middle stage Alzheimers
Frequent forgetfulness
Mood changes with mental/social challenges
Poor decision making
Disoriented
Risk of wondering/becoming lost
79
Late stage Alzheimers
Unable to engage with environment
Cannot carry out conversations
Significant assistance for ADL
80
Vascular dementia
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
Course of vascular dementia
Step-wise decline opposed to continuous with sudden appearance of symptoms
82
Fronto-temporal dementia
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
Dementia with lewy bodies
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
Parkinsonism
Motor syndrome that manifests as rigidity, tremors, and bradykinesia.
85
Recent memory
Recall of recent events - affected first in dementia
86
Procedural memory
Recall how to perform a task
87
Personal episodic memory
Recall of time-related info about oneself
88
Semantic memory
Recall names of objects
89
Aphasia
Language impairment - expressive, receptive or both
90
Agnosia
Inability to interpret sensations and hence to recognize things
91
Hyperreflexia
Hyperactive deep tendon reflexes
92
Paratonia
Involuntary resistance to PROM of extremities
93
Early dementia functional impairment
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
Middle stage dementia functional impairment
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
Allen cognitive level 6
Planned actions
Patient independent
Can plan, reflect and anticipate
96
Allen cognitive level 5
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
Allen cognitive level 4
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
Allen cognitive level 3
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
Allen cognitive 2
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
Allen cognitive 1
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
Standardized function-based cognitive screening tools
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
Standardized cognitive screening tools
Blessed dementia scale
Mini-mental
103
Cognitive functioning interventions
- Psycho-education (early stages)
- Reminiscing groups for cognitive facilitation/stimulation
- Relaxation techniques
- Environnemental modification (visual aids)
104
Affective functioning interventions
- Structured and planned socialization
- Structured activities
- Movement and exercise
105
Memory enhancement strategies
Large print calendars
Daily schedules
Seasonal decorations
Familiar furniture
Photographs
Favorite music
Notices of current events
106
7 stages of Alzheimers
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
AD 2: subjective memory loss
Basic Forgetfulness (words, recent events, where items were left), no serious enough to impact social life/work etc., patient may start to notice
108
AD 3: mild cognitive impairment
Decrease performance at work/social settings
109
AD 4: moderate cognitive decline
Clear deficits on clinical interviews, still oriented to time/place, difficulties with IADLs, sequencing, planning, denial, require assistance at home
110
AD 5: moderately severe cognitive decline
Decreased Independence, cannot live alone, assistance for ADL and IADL, forget major aspects of life (phone #, address), frequently disoriented
111
AD 6: severe cognitive decline
Cannot speak in full sentences, difficulty with 1-2 step tasks, personality changes, delusional behaviors, incontinence, increased caregiver burden
112
At what stage of AD do patients begin to experience changes in vision
Stage 3
113
What diagnosis benefits from use of rhythm and music to support mobility
PD
114
Intention tremor
MS
115
Resting tremor
PD
116
Donepezil
AD medication to improve memory/cognition, reduce mood/hallucinations/anxiety with dizziness side effect
117
Is motor imagery a successful intervention to support motor planning?
Yes
118
Biofeedback strategies
Provide auditory or visual cues to gain volitional control over physiological response
119
Modifications to support bed mobility
Light bedding
Firm mattress
Lowered bed height
Bedrails
120
MS nerve involvement
CNS
121
GBS nerve involvement
PNS
122
Best type of exercise for MS
Structured aerobic program as boyancy of water reduced effects of weakness
123
Akinesia
Impairment with spontaneous movement most evident with gait, freezing
124
Fasciculation
Involuntary muscle twitching
125
Dyskinesia
Involuntary erratic writhing movements
126
Acute focus with GBS
Pain mgmt
Fatigue mgmt
Swallow impairement
127
Presentation of ALS
Begins distally and typically aysmmetrical
128
UMN symptoms
Spasticity
Weakness
Involuntary and rhythmic muscle contractions
129
LMN symptoms
Weakness
Muscle atrophy (wasting)
Fasciculations (muscle twitching)
130
Erb's palsy
Paralysis of upper brachial plexus resulting in paralysis of UE musculature including supraspinatus, infraspinatus, deltoid, biceps, subscapularis, elbow flexion and scap mobility weakened
131
Erb's palsy contracute
Arm straight with wrist fully bent "waiter's tip position" with supination, IR, adduction UE deformity present later
132
Athetosis
Dyskinetic condition impacting timing, force and accuracy of trunk/limb movement
