Neurodegenerative Diseases

Question 1

ataxia

Answer 1

describes a lack of coordination while performing voluntary movements; may appear as clumsiness, inaccuracy, or instability; movements not smooth; may appear disjointed or jerky

Question 2

chorea

Answer 2

brief, purposeless, involuntary movements of the distal extremities and face; usually considered to be a manifestation of dopaminergic overactivity in the basil ganglia

Question 3

dystonia

Answer 3

results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone; maybe generalized or focal

Question 4

dyskinesias

Answer 4

involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proxmial and axial musculature in varying combinations. most from basal ganglia disorders

Question 5

hemiballismus

Answer 5

usually characterized by involuntary flinging motions of the extremities. The movements are often violent and have wide amplitudes of motion.; continuous and random and can involve prox/distal m. on one side of the body

Question 6

myoclonus

Answer 6

a brief and rapid contraction of a muscle or group of muscles; knee jerk

Question 7

tics

Answer 7

brief and rapid involuntary movements, often resembling fragments of normal motor behavior; tend to be stereotyped and repetitive, but not rhythmic

Question 8

tremor

Answer 8

rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation

Question 9

Parkinson’s disease (PD)

Answer 9

1. a hypokinetic CNS movement disorder that is idiopathic, slowly progressive, and degenerative
2. loss of dopamine-movement/coord./cant control start and stop
3. slow movements

progressive

Question 10

Symptoms of Parksinson’s disease

Answer 10

1. tremor (pill-rolling)
2. bradykinesia
3. rigidity (loss of dopamine)
   [cog wheel-intermittent change in tone to passive movement of joint; lead pipe-continuous resistance]
4. postural instability (BRIT)
5. akinesia
6. festinating gait
7. falling backwards/forwards
8. mask face
9. micrographia

Secondary symptoms: issues with gait, FM, freezing, overshooting, cog def., communication, sensory loss (B&B), dysphasia (drool, choke), mood/behavior

Question 11

Evaluation of PD

Answer 11

1. FM, mobility, ADL/IADL, swallowing/feeding, sexual dysfun., sleep, social, caregiver
2. Evaluating only one time may not provide an accurate picture of strength/def d/t fluctuating energy levels during the day.
3. USE COPM

Question 12

Intervention for
PD

Answer 12

1. EC
2. caregiver training
3. support/advocacy groups
4. HEP
5. safety/mobility/AD/DME/Environment adapt.( reduce distractions )/home assessment
6. Feeding/ADL adaption/AE
7. communication adaption/cog ( one-step direction, visual cues, rythemic cues/music )
8. sexual routine/B&B
9. stress reduction
10. address pain/rigidity ( moist heat, stretch, gentle ROM )
11. orthotics for contractures
12. rest/stretch

Question 13

spina bifida

Answer 13

1. genetic, intrauterine, and/or environmental factors contribute to the failure of the spinal column’s vertebral arches to fully form to enclose and to protect the neural tube., resulting in protrusion of the neural tube.
2. maybe caused by certain meds/lack of folic acid
3. -Can cause paralysis (W/C) and bowel and bladder functions affected- affect ability to voluntarily relax the muscle sphincters. – Antegrade continence enema (ACR) procedure may be used to help
   [slight instability and neuromuscular impairments (mild gait, B&B issues)]
4. Present-from-birth malformations: other:
   Hydrocephalus, scoliosis, hip dislocation and clubfoot (talipes varus or valgus)

Question 14

spina bifida with meningocele

Answer 14

1.protrusion of a sac through the spine, containing cerebral spinal fluid and meninges (does not include spinal cord)
2. occasionally slight instability/neuromus. impairments, (mild gait, B&B issues)

Question 15

spina bifida with myelomeningocele

decription, treatment

Answer 15

1. protrusion of a sac through the spine, containing cerebral spinal fluid and meninges as well as the spinal cord/nerve roots
2. affects both sensory and motor below the level of lesion and may result in LE paralysis and/or deformities, B&B incontinence (S2-S4), decubitus ulcer, and DVT

Treatment:
OT must first address basic ADLs before medication, exercises modifications, and ROM.
Ex. Educate on self-catherization to help promote independence

Question 16

bulging fontanel/shunts

S&S for 1st, 2nd yr, adoles, adult

Answer 16

1. sign of intracranial pressure; increased ICP may develop into hydrocephalus and lead to neurological complications (paralysis of CN6, visual impairments, sz disorder, deterioration of physical/ cog. function.); infection of shunts
2. important to measure head
3. notify the neurosurgeon ASAP if symptoms appear

S&S:
1st yr. : extreme head growth/soft spot on forehead

2nd yr: severe headache, vomiting, and/or irritability

adolescents : increasing head size, change in UE function, regression in milestones/decline in academia , neck pain, severe headache, and/or loss of balance

adults: vomit, severe headache, vision/memory prob, irritability , personality change, loss of coordination , m numbness in UE, head and neck pain, and/or difficulty swallowing

Question 17

muscular dystrophies/atrophies

Answer 17

1. a ground of degenerative disorders resulting in muscle weakness and dec. muscle mass d/y hereditary disease process; absents of dystrophin (m. protein)
2. first symptoms may not be apparent until 2.5 y.o; avg age of diagnosis is 5 yrs

-Genetic diseases that result in progressive muscle loss and weakness
-Difficulty with running, walking, and jumping
-May present with the child walking on toes
-May develop as the child ages

3. progress maybe rapid and fatal or may remain stable t/o life

Question 18

Duchenne’s muscular dystrophy

Answer 18

1. most common muscular dystrophy
2. enlargement of calf m. forearm, thigh m (looking healthy, but not)
3. Trendelenburg
4. weakness in all voluntary m. (inc heart & diaphragm
5. behavior/learning/speech (delays) difficuties
6. rarely survives beond early 20s ; in W/C by age 9.

Question 19

A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are distressed about the client’s increasingly inappropriate and tactless behavior, and the client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have?

Frontotemporal dementia
Alzheimer’s dementia
Vascular dementia
Dementia with Lewy bodies

AOTA

Answer 19

Solution: The correct answer is A.

A distinguishing feature of frontotemporal dementia (FTD) is marked behavioral changes. The behavior can be either impulsive (disinhibited) or bored and listless (apathetic). It includes inappropriate social behavior; lack of social tact; lack of empathy; distractability; loss of insight into the behaviors of oneself and others; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation.

B: Although behavioral changes occur with Alzheimer’s disease, they occur later in disease progression. The client in the question has a recent FTD diagnosis.

C, D: None of these dementia categories has behavioral changes as a significant symptom.