Neurodegenerative Conditions Flashcards
akinesia
impairment of voluntary and spontaneous movement initiation leading to freezing
bradykinesia
slowed motor movements
dysmetria
decreased coordination of movements
rigidity
muscle stiffness
fasciculation
involuntary muscle contraction and relaxation such as muscle twitches
festinating gait
small rapid steps resulting from forward-tilted head and trunk
parasthesia
numbness and tingling
general eval of neurodegenerative disorders
- assess abilities and environment
- motor, sensory, cognition
- how they are affected by variable symptoms and progression of disease
- how well they understand and accept progression
ALS etiology
- scar tissue replaces motor neurons in spinal cord, bain and peripheral system
- plaques lead to muscle atrophy
typical symptoms of ALS
- distal to proximal progression
- weakness of small muscles of hands
- assymetrical foot drop with or without night cramps
- tripping or stumbling
symptoms of ALS in bulbar tract
difficulty breathing, slurred speech, impared swallowing
Lower motor neuron symptoms of ALS
- focal and multifocal weakness
- muscle atrophy
- cramping
- fasciculation
- twitching at rest
corticospinal tract symptoms of ALS
spasticity and hyperactive reflexes
corticobulbar tract symptoms of ALS
dysphagia and dysarthria
what is typically not affected with ALS
- cognition
- sensation
- vision and hearing
- bowel and bladder control
what are the stages of ALS
- some weakness, can walk and I with ADLs
- moderate weakness, can walk
- severe weakness can walk
- severe wekaness in legs, w/c for mobility, some assist for ADLs
- sever weakness in UE and LE, w/c for mobility, Dependent for ADLs
- unable to get out of bed, D for ADLS and most self-cares
Prognosis of ALS
- often progresses rapidly
- 1-5 year life expectancy
- death usually occurs secondary to respiratory failure
chorea
involuntary, irregular, unpredictable movements
OT eval of ALS
- home eval and safety assessment
- reevaluation as needed as disease progresses
goal focus for ALS
minimize symptoms to improve performanc
OT intervention for ALS
- compensate and adapt to disability
- prevent secondary conditions
- safety, positioning, skin integrity
- voice operated hands free technology
- adress dysphagia
w/c considerations for ALS
- high back reclining, lightweight, small turn radius
- later on consider PWC with adaptable controls
etiology of Alzheimer’s Disease
- amyloid plaques and tau protein tangles
clinical features of alzheimer’s
- impairments in memory, executive funciton, attention, language, visual processing, praxis
- behavioral disturbances
early/mild stage of alzheimer’s
mostly I with activities, may be aware of memory loss or forgetting words
middle/moderate stage of alzheimers
- frequent forgetfulness
- mood changes with social/mental challenges
- poor decision making
- personality changes
- disorientation
- wandering
late/sever stage of alzheimers
- unable to engage with environment
- can’t carry on conversations
- significant assist with activites
describe vascular dementia
cerebrovascular disease often from small strokes leading to focal lesions in brain and neurotransmitter disruption
clinical features of vascular dementia
- cognitive decline similar to AD without severe memory involvement
- gait disturbance
- aburpt/stepwise declines rather than continuous
medical management of vascular dementia
-immediate emergent treatments
- treatment of cardiovascular factors
pathology of frontotemporal dementia
neuronal, intranuclear inclusions
clinical features of frontotemporal dementia
- immediate, distinct onset
- progressive
- varied symptom patterns
medical management of frontotemporal dementia
treatment of some behaviors with SSRI
pathology of lewy body dementia
lewy body protiens in brain usually in limbic or neocortical areas and overall decline in dopamine and acetylcholine
clinical features of lewy body dementia
progressive deficits in attention, executive function, memory impairment, fluctuating cognition, hallucinations, parkinsonism, falls, autonomic dysfunction, REM sleep disorders
medical management of lewy body dementia
- increase family involvment, safety assessment
- neuroleptics
- cholinesterase inhibitors
early stage of dementia occupational performance
- ADLs intact
- memory affects IADLs and community mobility
- language impairments affect communication
-clinging to old habits and repetitive routine
middle stages of dementia occupational performance
- impairments in all occupations and can no longer live alone
- safety is major concern
- diminished orientation
late stages of dementia occupational performance
- all areas of occupation lost
- dependent in all ADLS
- no longer ambulate safely or communicate
- no understanding of cultural or social contexts
OT intervention of dementia
- emphasize remaining strengths, maintain physical and mental activity
- address cognition and environmental modifications
- behavior managment
etiology of guillan barre syndrome
inflammatory disease causing demyelination of axons of peripheral nerves
3 phases of GBS
-onset and acute phase
- plateau phase
- progressive recovery phase
onset and acute phase of GBS
- weakness in 2+ extremities reaching max 2-4 weeks-
- rapid progression of symptoms in symmetrical ascending pattern
plateau phase of GBS
symptoms at most disabling with little change
progressive recovery phase of GBS
- remyelination and axonal regeneration up to 2+ years
- recovery is proximal to distal with significant return of function
Symptoms of GBS
- pain mostly in BLE
- fatigue
- initial mild sensory loss in hands and legs
- facial pasly
- autonomic system involvement
- bladder dyscfunction
Prognosis of GBS
- recovery is variable
- fatigue often persists
- possible minor cognitive difficulties
OT intervention during plateau phase of GBS
-modifications are temporary
- comminication tools
- positioning
OT intervention during recovery phase of GBS
- resume occupations and roles
- dynamic splinting
Describe Huntington’s Disease
Progressive loss of nerve cells in brain affecting movement, cognition, emotion and behavior
signs and symptoms of Huntington’s Disease
- involuntary movements
-slow and uncoordinated movements - difficulties with fine motor and hand-eye coordination
- Wide based gait
etiology of MS
chronic and progressive demyelinating disease of CNS where scar tissues form on myelin sheath interfering with nerve pulses
Clinical presentation of MS
- difficult to predict
- visual disturbances initially then dizziness, parasthesia and weakness
motor symptoms of MS
- impaired balance nad coordination
- paralysis or spasticity especially in LE
- fatigue
- intention tremors
- dysphagia
intention tremor
tremors that occur when a person attempts to engage in a meaningful activitiy
sensory changes in MS
- parasthesia
- vertigo
- pain
- diplopia or loss in vision -
cognitive changes in MS
- short-term memory loss
-attetion deficits - impaired executive functioning - impaired
emotional changes in MS
- depression or inappropriate eupohria
- mood swings or irritability
describe clinically isolated syndrome in MS
first episode of MS
describe relapsing-remitting MS
active and nonactive phases
describe secondary progressive MS
follows relapsing-remitting MS but worsens progressively
describe primary progressive MS
neurologic function woresens progressively with no remission
OT eval of MS
- assess pain
- assess cognition, dizziness, sleep
- endurance, strength
- vision and sesnation
- urinary incontinence
what should OT goals for MS address
exacerbation and remission stages
OT intervention for MS
-home safety and falls assessment
- sensory reeducation
- bladder training
- avoiding stressing joints
- proximal stabilization techniques
etiology of Parkinsons
- degenerative changes in basal ganglia
- substantia nigra becomes depigmented affecting dopamine
signs and symptoms of Parkinsons
- tremors
- muscle rigidity
- Bradykinesia
- postural instability
secondary symptoms of Parkinsons
- gait dysfunction
- fine motor
- cognitive deficits
- communication dificulties
- dysphagia
- mood disturbances
describe tremors in Parkinsons
- resting tremor affects one side
- decreasing at rest and increases with stress
- absent with voluntary movement
Prognosis of Parkinsons
progression is not always linear and may show occasional improvement
Stage 1 of Parkinsons
- unilateral symptoms
- function is maintained
stage 2 of parkinsons
- bilateral symptoms
- balance not affected
Stage 3
- bilateral symptoms
- balance impaired
- mild to moderate impairments in function
Stage 4
- Significantly decreased function
- impaired mbility
- needs assistance iwth ADLs
- Poor fine motor skills and dexterity
Stage 5
Total dependence for mobility and ADLs
OT Eval of Parkinsons
-observation of symptoms on function
- COPM
- Cognition
What affects OT eval of Parkinsons
Eval one day or at one time of day may not be accurate to other times
