Neurodegenerative Diseases

Question 1

Identify interventions that address the motor, sensory, and social/emotional issues associated with Guillain-Barre Syndrome.

Answer 1

GUILLAIN-BARRE SYNDROME [gee-on bahray]

• MAJOR SYMPTOMS- adaptive equipment
• Flaccid motor paralysis
• Loss of sensation below level of inflammation
• Pain in proximal muscles
• Pain during PROM or muscle palpation

SECONDARY SYMPTOMS- must range them

• MOTOR PARALYSIS
• Skin breakdown
• Contractures
• Loss of respiration
• Fatigue
• Dysphagia- if hits CNs
• Dependent ADLs- for 1-2 yrs
• Unable to work
• ABSENT SENSATION
  
  • Loss of proprioception
  • Skin breakdown
• COGNITION, PERCEPTION
  
  • No problems
• SOCIAL/EMOTIONAL
  
  • Fear & anxiety
  • Frustration
  • Helplessness

MOTOR INTERVENTION

• ROM, splinting, positioning to prevent contractures
• Positioning to prevent skin breakdown
• Adaptive equipment to allow maximum function
• Coordination exercises during recovery

MOTOR INTERVENTION

• Increase strength
• Gentle non-resistive activity until nerves fully recovered
• F+ muscle grade or higher may begin gently resistance
• Endurance training
• Avoid overfatigue- lots of breaks/rest
• Energy conservation

SENSORY INTERVENTION

• Sensory stimulation during recovery-
• Patient education on skin protection until full sensory return
• Proprioceptive & vestibular stimulation during recovery

SOCIAL/EMOTIONAL INTERVENTION

• Patient/family education
• Psychosocial OT for coping skills
• Provide successful activities to increase feelings of control and life satisfaction
• Modifications of home & work environment

Question 2

Identify interventions that address motor, sensory, and social/emotional issues at each stage of Amyotrophic Lateral Sclerosis

Answer 2

Amyotrophic Lateral Sclerosis- prognosis 3-5yrs

• MOTOR PRIMARY SYMPTOMS- strictly motor upper and lower and sometimes CNs
• Ascending weakness progressing to atrophy
• Muscle spasticity
• Muscle cramping
• Muscle fasciculations
• Dysarthria
• Dysphagia
• Decreased ROM
• Fatigue

SECONDARY SYMPTOMS

• MOTOR
• Contractures
• Skin breakdown
• Loss of mobility
• Decreasing ADL function
• Loss of ability to work
• SOCIAL/EMOTIONAL
• Fear, anxiety
• Depression
• Dependency

Stage I (Phase 1 – Independent)

• Prevent disuse atrophy and depression
• Energy Conservation Techniques
• Provide psychosocial support and patient voices concerns
• ROM program
• Strengthening program of gentle resistance
• Use caution to prevent overwork fatigue
• Coping skills for client and family

Stage II (Phase 1 – Independent) ​

• Adapt ADL, work, and leisure
• Balance of roles; Include significant other
• Use of adaptive equipment
• Integrate use of hand orthotic into daily activities
• Baseline dysphagia evaluation
• Stretching to avoid contractures
• Strengthening of muscles with MMT grade above F+ (3+)
• Orthotic support

Stage III (Phase 1 – Independent)

• Manual or power wheelchair
• Prioritize activities and work simplification
• Reassess for adaptive equipment needs
• Assess and adapt communication devices

​Stage III

• Encourage physical independence
• Explore alternative activities if there is loss of employment
• Begin home modifications
• Education regarding types of bathroom equipment for ECT’s and safety
• Deep breathing exercises, chest stretching, postural draining

Stage IV (Phase II – Partially Independent)

• Evaluate the need for slings, MAS, overhead slings, arm troughs, lap trays, splints for resting and positioning

Stage IV

• Pain and spasm management: Heat, massage, anti-edema measures, AROM, PROM, and isometric exercises to tolerance
• Power wheelchair with adaptable controls
• Assistive technology

Stage IV

• Role negotiation and psychosocial issues of loss
• Home modifications
• Closure activities
• Coping skills for client and family ​

Stage V (Phase II – Partially Independent)

• Family education in ADL, transfers, and positioning
• Family training on use of mechanical lift

Stage V

• Adapt and select environmental control devices
• X-ten technology
• Adapt wheelchair for respiratory unit; Assess wheelchair cushion
• Family education in skin inspection, use of electric hospital bed, and anti-pressure device

Stage VI (Phase III – Dependent)

• Evaluate dysphagia
• Evaluate for suction machine
• Augmentative speech devices
• PROM in all joints
• Sensory stimulation with massage and skin care ​ ​

Question 3

Identify interventions that address cognition, motor, fatigue, and social/emotional issues associated with Huntington’s Disease.

Answer 3

•EARLY SYMPTOMS

• Personality changes
• Irritability, anger, depression
• Cognitive decline
• Decision making, new learning, memory
• Physical
• Mild balance problems, clumsiness, involuntary facial movements

LATER SYMPTOMS

• Chorea—sudden jerky movements
• Rigidity
• Severe balance & coordination problems
• Shifting gaze
• Hesitant, halting, or slurred speech
• Dysphagia
• Dementia
• Seizures

Cognition: Early Stages

• Daily Routine
• Checklists
• Task Analysis
• Environmental Modification for Impaired Cognition
• Quiet workplace
• Organizers
• Kitchen timer
• Watch with a beeper
• Visual cues for sequencing tasks

Fine Motor

• Modifications to diminish chorea and fine motor incoordination
• Clothing modification
• ECU’s – Late Stage

Gross Motor

• Decreased balance
• Perform activities in sitting
• Use of a wheelchair or rollator walker ​

Wheelchair Positioning

• Padding on armrests
• Move wheelchair with feet
• Firm seat and back
• Positioning - Final Stages
• Splints to prevent contractures

Home Modifications

• Cooking and eating utensils with built-up handles
• Unbreakable dishes ​
• Shower bench or seat with tub safety bars
• Sturdy chairs with high backs and armrests
• Remove throw rugs
• Remove clutter ​

Fatigue: Middle Stage

• Frequent rest breaks
• Scheduled breaks ​

Adapted Clothing

• Clothing with few or no fasteners

Adapted Equipment

• Shower mitts
• Electric razor
• Covered mugs
• Non-slip placemat
• Bed with railing and padding ​

Question 4

What are the areas for evaluation and assessments used for an individual with Multiple Sclerosis?

Answer 4

Primary Symptoms

• Fatigue, weakness
• Intention tremor
• Double vision, optic neuritis
• Paresthesia, neuralgia, spasticity
• Ataxia, unsteady gait
• Pain
• Decreased cognition
• Dysarthria, Dysphagia
• Evaluation
• Reevaluation
• Evaluation over a period of time
• Daily activity patterns
• Habits and Routines
• Home Assessment
• Modified Fatigue Impact Scale (MFIS)
• MS Quality of Life Inventory
• Symptom Management
• Spasticity
  
  • Medication
• Bladder
  
  • Incontinence Pads or Catheters
  • Prevention of UTI’s
• Pain and Fatigue
  
  • Nutrition
  • Prevent overfatigue with ECT’s
  • Regular exercise
  • Routines for rest and sleep
  • Control stress

MOTOR

• Intermittent muscle weakness or paralysis
• Intermittent intention tremor
• Possible spasticity
• Low endurance
• Cerebellar ataxia

MOTOR INTERVENTION ​

• Strength, endurance, ROM, coordination
• Energy conservation
• Adaptive equipment and environment

SENSORY

• Impaired or Absent vibratory, temperature, pain, touch, proprioception, kinesthesia
• Vertigo
• Visual problems***
• Diplopia
• Nystagamus
• Color discrimination
• Decreased acuity
• Acute pain
• Electric like shocks–Lhermitte’s sign

SENSORY INTERVENTION

• Visual acuity, tracking, and scanning
• Adaptive equipment and techniques
• Patient education for safety

COGNITIVE ​

• Short attention span
• Short term memory loss
• Difficulty learning
• Decreased problem-solving

COGNITION EVAL & INTERVENTION

• Executive Function Performance Test
• Memory aids
• Patient/family education
• Level of supervision
• Problem-Solving Compensatory Strategies
• Time Management
• PERCEPTUAL EVAL & INTERVENTION ​

SOCIAL/EMOTIONAL/BEHAVIORAL

• Indifference
• Emotional lability
• Decreased ability to work or do ADLs
• Cognitive Deficits + Denial of progressive nature of disease = Behavior that puts client at risk****
• Client and family education to understand and recognize behavioral problems and fluctuating nature of disease
• Examples: Depressed, labile, poor memory, refuses assistance from others, poor judgment and safety with medication and transfers

SOCIAL/EMOTIONAL/BEHAVIORAL INTERVENTION

• Stress management , coping strategies
• Family, caregiver education
• Activity adaptation ​

SECONDARY SYMPTOMS

• Contractures
• Urinary tract infections
• Decubitus ulcers
• Pain
• Cognitive impairments

Goal Setting

• Client’s need to adapt as the disability progresses
• Family and client need to negotiate role changes ​

Role Delegation

• Eliminate
• Modify
• Delegate ​

Question 5

Identify the interventions that address the motor, fatigue, cognitive, dysphagia, and social/emotional issues that are present for an individual with Parkinson’s Disease.

Answer 5

Parkinson’s disease- (Becky Farley)

PRIMARY SYMPTOMS

• Resting tremor
• Bradykinesia
• Rigidity
• Impaired postural reflexes

SECONDARY SYMPTOMS

• Autonomic dysfunction
• Excess sweating
• Greasy skin
• Flushed skin
• Bladder problems
• Cardiopulmonary problems
• Nutritional issues
• Impotence
• Shallow breathing

SECONDARY SYMPTOMS

• Muscle atrophy
• Decreased flexibility & contracture
  
  • Kyphosis
  • Scoliosis
• Akathisia—restless feeling
• Decreased coordination
• Low, monotone voice
• Sensory changes – Numbness, Tingling
• Visual perceptual difficulties

Postural abnormalities

• Flexed, stooped
• Head forward
• Flexion at knees and hips

Balance

• Reactions compromised
• Righting and equilibrium reactions decreased
• Leads to increased falls ​

Daily Exercise Routine

• Full ROM
• Short exercise program 5-10 minutes daily
• Postural flexibility exercises, especially trunk extension
• Relaxation techniques and controlled breathing
• Rhythmic auditory stimulation with accentuated first beat
• Dancing
• Rocking motion to initiate movements ​

Daily Activities

• Time with medication
• On-off periods ​

ADL

• Tremors
• Compensation for postural instability
• Clothing Management
  
  • -Slip-on Shoes
  • -Velcro Closures
• Time and energy required for task

Environment and Task Modification ​

• Decrease impact of tremors
• Built-up handles for eating and writing
• Perform tasks that require handwriting after taking medication
• ​Remove throw rugs
• Place furniture close to wall
• Chairs with armrests
• Bath and toilet railings and elevated toilet seats
• Environmental Control Units (ECU’s) in late stages that utilize switch plates for light touch

Fatigue

• Energy Conservation Techniques•
• Frequent Rest Breaks Throughout Day
• Habits and Routines
• Role Delegation

Cognition

• Higher order cognitive deficits
• Decreased shifting of attention among various stimuli
• Easier to process simultaneous information with sequential processing ​

External Cues

• Improve speed and sequential performance of novel motor tasks
• Visual Cues
• Verbal Prompts
• Rehearsal of Movements
• ​Time Management

Dysphagia

• Drooling may cause social embarrassment
• Oral motor exercises
• Alter food consistencies

SECONDARY SYMPTOMS

• Depression
• Anxiety
• Behavioral & personality changes ​

Client and Family Education

• Disease process
• Community Resources
• Support Groups
• Community Mobility ​
• Disease process
• Caregiver support groups
• Respite care plans ​

Habits and routines

• Typical Day
• Planner
• Role Delegation
• Energy Conservation and Work Simplification Techniques

Adaptation

• Home Assessment
• Environmental Modification
• Task Modification ​