Neurodegenerative Diseases Flashcards
What are neurodegenerative diseases?
progressive and usually chronic conditions resulting from damage to the peripheral nervous system, central nervous system or both
Multiple sclerosis (MS)
chronic/progressive disease of the CNS. your body attacks the myelin sheath around the brain/spinal cord. This produces scar tissue/plaque of the nerve fibers.
Symptoms
- weakness/fatigue
- impaired balance/coordination (ataxia)
- partial/complete paralysis of a part of the body, muscle spasticity in LE
- Intention tremors (when a person attempts to engage in activity
- Dysphagia
- Paresthesia
- Vertigo
- Pain
- Diplopia
- Slurred speech
- Incontinence
- Short term memory loss
- Attention deficits
- Decreased processing speed
- difficulty w/new learning, abstract reasoning, problem solving
OT Rehabilitation Treatment: to minimize the severity, amount, and length of exacerbations in order to improve function.
OT Interventions
- AE= optical devices, large-print material, large button tech, talking watches, audiobooks
- Sensory reeducation
- bladder training/educate on self-catheterization or use of sanitary pads, absorbent underwear
- body mechanics to avoid stressing joints
- yoga/group exercise classes
- stress importance of resting/avoid fatigue
- Aquatic therapy can reduce the effects of weakness
- proximal stabilization for improved distal movements!!!!
- hand-over-hand techniques for fine motor tasks (unaffected arm over the hand w/tremor to dial phone)
- external memory aids (day planners)
- step-by-step instructions
- allow for increased time,delegation, and repetition when learning new ideas
- stress management/relaxation tech
- coping strategies
- AE equipment w/built-up handles, weighted utensils for feeding or wrist weights during self-care activities to reduce tremors!!!!!
OT Contraindications
-Hot temperatures, heat modalities, fluidotherapy, increased emotional/physical stress, excessive physical activity or overexertion,
Dysphagia
difficulty swallowing
Diplopia
Double vision
MS Stage: Relapse-Remitting
fluctuating course of relapses w/associated neurologic deficits, followed by periods of relative quiet
MS Stage: Secondary Progressive
cessation of fluctuations w/slow deterioration
MS Stage: Secondary progressive w/relapses
fluctuation w/relapses and deterioration between relapses
MS Stage: Primary progressive
deterioration from beginning
MS Stage: Progressive relapsing
progressive w/relapses
Parkinson’s Disease (PD)
Progressive condition. Degenerative changes occur in the basal ganglia (gray matter that contributes to complex movements). Also the substantia nigra becomes depigmented affecting dopamine production (a neurotransmitter that influences the speed/accuracy of motor skills, postural stability, cognition and affect and expression.
Symptoms
- Tremor= resting tremor which affects one side and is called a ‘‘pill-rolling’’ movement of the hand. Tremors disappear when the person is asleep or calm and increase w/stress/cognitive tasks.
- Muscle rigidity/stiffness= tone is increased affecting movement. Pts demonstrate cogwheel motions (jerky, painful movements). Fatigue is a big issue because of an increased effort to produce voluntary movements.
- Bradykinesia= extreme slowness when initiating/performing volitional movements (shuffling gait, moving from sitting to standing, freezing, increased time for fine motor tasks (shaving/fastening clothes)).
- Posture= is stopped, with a lack of arm swing during mobility, fall risk when balance is challenged.
Secondary parkinsonism
a condition in which people experience symptoms similar to those of PD caused by ingestion of drugs/toxic chemicals
Myriad Secondary Symptoms to PD - severity differ among people with PD
- gait dysfunction= festinating gait/shuffling steps, no arm swings
- fine motor/bimanual impairments
- freezing/inability to initiate/continue movements
- impaired executive functioning, memory loss
- communication difficulties, micrographia, hypophonia, muffled speech, reduced facial, flat affect
- dysphagia, drooling
- mood/behavior disturbances, apathy, social isolation, withdrawal
OT Evaluation= symptoms tend to increase just before a medication dose. Looking a person w/PD at only one time of day may not provide an accurate picture of strengths/deficits. Using a tool such as a COPM to establish client-centered goals empowers the client and minimizes their stress.
OT Interventions
- Energy conservation/pacing, prioritizing activities around medication times to ensure participation when meds are most effective
- Home exercise programs=walking
- Train in sit-to-stand/bed mobility
- Managing freezing=avoiding crowds, tight spaces, eliminating clutter in pathways
- AE=cane/walker
- music therapy=to enhance motor skills
- Feeding=smaller portions, remove distractions, eat more slowly, use AE (built-up/weighted utensils, cups w/lids, plate guards, nonslip surfaces)
- Modify clothing=eliminate fasteners or switch to hook-and-loop closures, use button hooks, zipper pulls, elastic shoelaces.
- Use distal wrist weights in decreasing tremors
- self-cares=work as close to the body as possible and UE support on a table. Using proximal muscles can help stabilize distal joints/muscles may reduce tremors.
- Use a mirror=to increase the pts awareness of facial expressions.
- phrase questions in a way to get a short response from pt.
- Use larger paper/large felt-tip pens and rest before writing.
- Whole-body exercises
- Stress management as stress exacerbates symptoms
- Moist heat, stretching, and gentle ROM
- Antispasticity splint/dynamic/static progressive splint gives low-intensity stretch against the contraction of the antagonist muscles.
-Hard to monitor pain as pt will have “masklike” facial expression!!!!
Micrographia
smaller and smaller handwriting
hypophonia
reduced volume of speech
apathy
lack of interest, enthusiasm, or concern
5 Clinical Stages of PD
Stage 1: unilateral symptoms, typically resting tremor, no/minimal loss of function
Stage 2: bilateral symptoms, trunk mobility/postural reflexes problems
Stage 3: impaired balance secondary to postural instability resulting in mild/mod impairment in function
Stage 4: decrease in postural stability, decrease in function, impaired mobility, need for assistance w/ADLs, poor fine motor/dexterity
Stage 5: total dependence for mobility/ADLs
Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) (ALS)
A progressive, degenerative disease in which motor neurons in the brain, spinal cord, and peripheral system are destroyed and replaced by scar tissue. This results in plaques that lead to progressive muscle atrophy.
Symptoms
- progressive and move distal to proximal.
- weakness of the small muscles of the hand
- muscle atrophy (from distal to proximal)
- Cramping/twitching of muscles
- dysphagia
- dysarthria
- Cognition/sensation, vision/hearing, bowel/bladder control are typically not affected!!!!
- Life expectancy is 1-5 years!!!!
OT Interventions
- compensatory “focusing on adapting to disability and preventing secondary complications.
- positioning, transfers, skin integrity, safety education
- Augmentative communication equipment
- Neck collar or universal cuff is used for UE stability during self-care or fine motor tasks.
- Mobility aids (foot-drop splint, cane, walker) minimize exertion during ambulation, compensate for LE weakness/reduce risk of falls
- Ideal W/C=high backed, reclining
- Adapt food=thicken liquids, downgrade to diet to soft foods
- Manual swallowing techniques
muscle atrophy
when muscles waste away
dysarthria
difficulty w/speech
ALS 6 Stages
Stage 1: person can walk, is Indep w/ADLs, some weakness
Stage 2: person can walk and has mod weakness
Stage 3: person can walk but has severe weakness
Stage 4: person requires a w/c for mobility, needs some assistance w/ADLs, has severe weakness in the legs
Stage 5: Person requires a w/c for mobility, in dependent for ADLs, has severe weakness in the arms/legs
Stage 6: person is confined to bed/dependent for ADLs and most self-care tasks.
Guillain-Barre Syndrome
Inflammatory disease that causes demyelination of axons in peripheral nerves.
Symptoms
- Acute weakness occurs in at least two extremities
- Plateau phase: Most disabling symptoms
- Recovery Phase: Tends to start at the head/neck and travel distally.
- Pain, fatigue, edema, mild sensory loss
- Autonomic Nervous System
OT Intervention-Plateau Phase
- Communication tools=signs/picture boards
- Adjust supine/sitting positions that optimize function/comfort and reduce risk of skin breakdown.
- Position pt for trunk, head, UE stability
OT Intervention-Recovery Phase
- Dynamic splints to help ROM
- AE
- Energy conservation/fatigue management
Autonomic Nervous System (ANS)
result in postural hypotension (when someone rises from a horizontal position, blood pressure drops to low levels)
-facial flushing, diarrhea, impotence, urinary retention, increased sweating
Huntington’s Disease (HD)
Hereditary neurological disorder that leads to severe physical/mental disabilities. Progressive loss of nerve cells in the brain, affecting movement, cognition, emotions and behavior.
Symptoms
- Choreiform movements of hands
- later stages=hypertonicity
- gait/balance problems=wide-based gait pattern
- smaller movements of hand-eye coordination
- forgetfulness
- difficulty concentrating
- difficulty w/mental calculations, sequencing of tasks/memory
- irritability/depression
- dysphagia
OT Intervention-Early Stages
- address cognitive components of memory/concentration
- establish daily routine, checklists, tasks analysis to break down tasks into manageable steps
- avoid open-ended questions to pts
OT Intervention-Middle stages
- engagement in purposeful activities
- simple written cues/words to promote completion of self-cares
- walker or w/c
- routine breaks to deal w/fatigue
- positioning techniques/AE
- wrapping legs around the chair legs to stabilize the pelvis and placing the elbows on the table to stabilize the upper trunk
- Utensils w/built-up handles
- nonskid placement
- covered cups/mugs
- switch to soft foods to accommodate changes in oral-motor function
- ring on zipper for easier fastening
- built-up handle on toothbrush
- sitting in a sturdy chair
OT Intervention-Final stages
- attention to positioning
- splinting to prevent contractures
- tube feedings
- daily schedules/routines constant
Chorea
rapid, involuntary, irregular movements, increasing during stressful situations and lessening or absent during voluntary motor activities/sleep
Akathisia
motor restlessness
Dystonia
abnormal, sustained posturing of a body part, typically in the arms, head or trunk
hypertonicity
excessive tone, tension
Dementia - Alzheimer’s Disease (AD)
- progressive impairment of memory, executive function, attention, language, visual processing, praxis
- behavioral disturbances
- slow/progressive until death
- decline in cognitive abilities=decision making, language skills, problems recognizing family/friends
Dementia - Vascular Dementia
series of small strokes leading to lesions on the brain
- cognitive decline similar to AD but often less severe memory involvement
- gait disturbance
Dementia - Frontotemporal Dementia
-progressive aphasia, symptoms similar to AD or PD
Dementia With Lewy Bodies
- decline in acetylcholine and dopamine levels
- deficits in attention/executive function, memory impairment, visual hallucinations, parkinsonism, autonomic dysfunction, rapid eye movement
- aphasia, apraxia, spatial disorientation
aphasia
inability to speak, read, or write
apraxia
inability to perform particular actions because of brain damage
spatial disorientation
inability of a person to correctly determine their body position in space.
recent memory
recall of recent events
Procedural memory
recall information on how to perform a task, such as knowing how to write/ride a bike
Personal episodic memory
recall of time-related information about oneself, such as where/whether one ate breakfast
Semantic memory
ability to remember the names of objects
hyperflexia
overflexion of a limb
paratonia
involuntary resistance to passive movement of the extremities
sundowning behaviors
- adequate lighting
- reassurance in a calm/caring manner
- reduce noise/clutter
- avoid using restraints
wandering
- calm approach
- rocking chair
- walk w/the client
Dementia - OT Interventions
- provide pt w/a sense of belonging
- promote positive behaviors
- appropriate verbal/nonverbal communication
- repetitive, familiar and routine
- relaxation tech (rocking chairs/soothing music)
- sensorimotor therapy
- structured activities (leisure/interests)
- social functioning
