Neurodegenerative Flashcards
Akinesia
impairment in voluntary movement and initiation that causes “freezing” especially during gait activities
Bradykinesia
slowed motor movement
Dysmetria
decreased coordination of movement
Fasciculation
observed as a muscle twitch; involuntary muscle contraction and relaxaiton
Festinating gait
small rapid steps that result in forward tilted head an trunk
Multiple Sclerosis (MS)
demyelinating disease, own body attacks myelin sheath of brain and spinal cord
Motor symptoms of MS
ataxia, paralysis, weakness, fatigue, tremors, dysphagia
Sensory symptoms of MS
paresthesia, vertigo, pain
Visual symptoms of MS
diplopia, optic neuritis (sudden loss of vision), blurred vision
Communication symptoms of MS
dysarthria, scanning speech
Bladder/Bowel symptoms of MS
incontinence, urgency/frequency
Cognitive symptoms of MS
ST memory, attention, decreased processing, executive functioning, visuospatial ability
OT eval for MS
pain, medication review, ask questions about dizziness, sensaiton, fine motor skills, fatigue, balance, sleep, etc
Standardized eval tools for MS
- COPM
- mod fatigue impact scale
- beck depression
- 9 hole peg/purdue pegboard
- semmes weinstein
PAMs for MS
focal heat to trigger points
Fatigue management for MS
- diary card to monitor activity level
- reduce standing
- cooling techniques (cooling vest, ice packs)
- energy conservation techniques
Ataxia management for MS
- proximal stabilization to improve distal movement
- hand over hand techniques (using non-affected UE over hand with tremor when dialing phone)
T/F: maintaining hip flexion for MS reduces extensor spasms
TRUE
- you can provide stools to reach during LB dressing or bathing
Parkinson’s Disease
affects production of dopamine, influences speed and accuracy of movement, psoture, cognition, affect, and expression
Stage 1 PD
unilateral symptoms, no/minimal loss of function
Stage 2 PD
BL symptoms, balance not affected
Stage 3 PD
impaired balance/posture, mild-mod ADL impairment
Stage 4 PD
needs assistance with ADLs
Stage 5 PD
total dependence for ADLs/mobility
What type of cues should be used with a pt with PD?
single auditory cues
- produce quicker and smoother movement
- rhythm also helps
ALS
destroys motor neurons in the brain, spinal cord, and PNS
Initial signs of ALS
weakness of small muscles of the hand or foot drop causing tripping/stumbling
LMN symptoms
muscle atrophy, cramping, twitching
T/F: cognition, sensation, vision, and bladder/bowel are affected with ALS
FALSE
How many stages of ALS are there?
6
Stage IV ALS
requires WC, some assistance with ADL
Stage V ALS
WC, dependent in ADL
Stage VI ALS
confined to bed, dependent in ADL
Stage I ALS
some weakness, independent in ADLs
Stage II ALS
can walk, moderate weakness
Stage II ALS
can walk, severe weakness
Life expectancy for ALS
1-5 years
OT treatment for ALS
- compensatory
- keeping person active and independent for as long as possible
Ideal WC for ALS
high back, recliner, lightweight
- power WC as ALS advances
Guillain Barre Syndrome (GBS)
demyelination of axons in peripheral nerves
What phase of GBS is most disabling?
Plateau phase
- little or no change in days/weeks
What phase of GBS indicates a significant, if not complete, return to function?
Progressive recovery
T/F: individuals with GBS may experience postural hypotension?
True
Sensory deficits in GBS
hands and legs “glove and stocking” distribution
What is the most frequently reported symptom of GBS?
fatigue
OT role in plateau phase of GBS
- TEMPORARY modifications
ex) communication tools, hands-free telephone, positioning
OT role in recovery phase of GBS
resumption of occupations and roles
ex) safe mobility, dynamic splinting for ROM, modified techniques for self-care, energy conservation/fatigue management, home assessments
Huntington’s Disease (HD)
severe physical and mental disabilities characterized by loss of nerve cells in the brain
HD involuntary movement pattersn
Chorea (rapid, involuntary), akathisia (restlessness), dystonia (abnormal posturing)
HD voluntary movement patterns
Bradykinesia, akinesia (delayed initiation), incoordination
T/F: HD causes difficulty with smaller movements and hand-eye coordination
TRUE
T/F: At the later stages of HD, pt’s are unable to talk, walk, and perform BADLs
TRUE
OT Eval tool for HD
Unified HD Rating Scale, assesses motor, cognitive function and functional capacity
OT intervention for early stage of HD
- address memory and concentration (checklists, routines, use of open ended questions)
- work sit evals
- home mods/safety (reminders to turn off appliances, unbreakable dinner-wear, covered mugs for hot liquid)
- support groups
OT intervention in middle stage of HD
- engagement in leisure activity
- pt/family education (use simple written cues/words for self care completion, positioning, adaptive equipment)
- fatigue management
- oral-motor exercises
OT intervention in final stages of HD
- positioning
- environmental controls
- consistent schedules/routines
- smooth transition to tube feeding
Procedural memory
info on how to perform a task (e.g., how to ride a bike)
- stays intact with Alzheimer’s/Dementia
Topographic orientation
orientation to self within the environment, gets lost easily
Cognitive assistance level: ACL 1 (automatic actions)
totalA
Cognitive assistance level: ACL 2 (postural actions)
maxA
Cognitive assistance level: ACL 3 (manual actions)
modA
Cognitive assistance level: ACL 4 (goal-directed)
minA
Cognitive assistance level: ACL 5 (exploratory actions)
stand-byA
Cognitive assistance level: ACL 6 (planned actions)
independent
At what ACL does a patient: wander, pace, eat finger foods, performs one-step motor patterns, and requires 24hr supervision?
ACL 2 (postural reactions)
At what ACL does a patient: require tactile cues, cannot learn new behaviors, and should perform activities that reinforce predictable tactile effects on the environment (e.g., walking, washing/drying dishes, wiping countertops)
ACL 3 (manual actions)
At what ACL does a patient: no longer problem solve, participate in simple, concrete activities, require visual/tactile cues?
ACL 4 (goal-directed)
At what ACL does a patient: participate in self-initiated motor actions, have difficulty with judgement, reasoning, and planning, and use trial-error learning?
ACL 5 (exploratory actions)
