Neurodegenerative Diseases Flashcards
1
Q
Signs and symptoms of MS
A
- Impaired balance and coordination (ataxia)
- Muscle weakness, spasticity, possibly paralysis of part of body
- fatigue
- Intention tremors
- Dysphagia and dysarthria (motor speech disorder)
- Sensory symptoms: paresthesia (numbness/tingling), pain, vertigo
- Visual symptoms (80% have loss of visual acuity)
- Slurred space or slow enunciation
- Bladder and bowel symptoms (incontinece or urinary retention, urgency, constipation)
- Sexual symptoms
- Cognitive symptoms e.g., judgment, decreased processing speed, memory loss, attention deficits
- Emotional: depression, inappropriate euphoria, mood changes
2
Q
Eval process for MS
A
- Occupational profile including goals and history of symptoms and tx
- Assess pain, review meds, screen for cognitive deficits during questioning
- Ask about dizziness, sensation, FM, incontinence, fatigue, sleep patterns, muscle cramping, falls, balance
- Standardized eval tools
- Eval and therapy should be scheduled when client reports feeling most energized
- Goals should address both exacerbation and remission stages and should be compensatory because of progressive nature of MS
3
Q
Should goals for MS be remedial or compensatory?
A
Compensatory b/c of progressive nature of MS
4
Q
Standardized eval tools for MS
A
- Modified Fatigue Impact Scale
- Beck Depression
- FIM
- Nine-Hole Peg Test or Purdue Pegboard test for manual dexterity and FM coordination
- Semmes-Weinstein monofilament testing for sensation
- Modified Ashworth Scale for spasticity
5
Q
Contraindications to MS interventions
A
- Hot temperatures
- Heat modalities e.g., moist heat or fluidotherapy, increased emotional or physical stress, excessive physical activity or overexertion; alcohol use increases balance deficits and can be dangerous when mixed with meds used to tx symptoms of MS
6
Q
Interventions for Vision changes with MS
A
- Home safety assessment with recommendations to reduce risk of falls
- AE e.g., optical devices, large-print reading material, large-button technology, talking watches, raised-dot markings for technology, audiobooks
- Refer to low vision specialist or ophthalmologist or optometrist as indicated
7
Q
Interventions for sensory disturbances with MS
A
- Sensory reeducation
- Compensatory strategies e.g., rely on visual feedback to observe desensitized limb and testing the temperature of water for dishwashing or bathing using unaffected body part
8
Q
Interventions for urinary incontinence for MS
A
- Bladder training and instruction in self-cath or use of sanitary pads or absorbent underwear to avoid embarrassment with accidents
- Monitor times of days when fluids are consumed to ensure bathrooms are available to minimize incontinence
9
Q
Interventions for Motor weakness and other difficulties with MS
A
- Monitor body mechanics to avoid stressing joints and increasing and increasing musculoskeletal pain
- Yoga and group exercise classes
- Stretch before any exercise to decrease spasticity, improve flexibility and circulation, and prevent injury; warm up and progress to activities with proximal musculature before distal
- Therapeutic exercise with emphasis on RESTING and avoiding fatigue. Submaximal resistance with frequent reps better to avoid overuse
- Aquatic therapy can reduce weakness and provide gentle exercise
- Assistive devices. Possibly WC
10
Q
Interventions for Pain (from spasticity) with MS
A
- Advise on standing home program such as use of standing frame
- Resting splints
- Maintain hips at 90 or more of flexion to reduce extensor tone in LEs
- Focal heat modalities on muscle trigger points
11
Q
Interventions for Fatigue with MS
A
- Educate! Can be from disease process, secondary to sleep or depression/mood changes, from nerve fiber or motor fatigue, from muscle weakness or spasticity, or related to med side effects or infection
- Keep diary card
- Reduce extended standing or mobility (use power mobility when appropriate)
- Equipment e.g., ankle-foot orthosis to overcome weakness
- Ergonomic positioning and equipment use
- Cooling techniques e.g., showers, ice packs, iced beverages
- Energy conservation and fatigue management tips
12
Q
Interventions for Ataxia with MS
A
- Encourage proximal stabilization for improved distal movements
- Modify tasks by promoting hand over hand techniques for FM tasks e.g., dialing phone number
- Use orthoses e.g., wrist splints for tremor
13
Q
Tx for cognitive and emotional disturbances related to MS
A
- Cognitive retrainings, memory enhancement programs, CBT, visual compensation strategies, group therapy
- Eliminate distractions
- External memory aids e.g., planners, electronic devices
- Write step-by-step instructions
- Allow for extra time, delegation, and repetition when learning new ideas and perform difficult mental tasks earlier in the day
- Teach stress management and relaxation techniques
- Explain coping strategies
14
Q
ADL adaptation for MS to compensate for weak muscles and maintain joint integrity
A
-Build-up-handles, reachers, sock donners to compensate for weak muscles and maintain joint integrity
15
Q
ADL adaption for MS to reduce tremors
A
- Weighted utensils for feeding or wrist weights during self-care activities
- To reach lower body during bathing and dressing, recommend use of AE or stool; maintain hip flexion to decrease extensor spasm
16
Q
Signs and symptoms of parkinsons
A
- Resting tremor (increases with stress or cognitive tasks and often absent with voluntary movement)
- Muscle rigidity or stiffness (tone increased, adversely affecting movement)
- Cogwheel motions: jerky, sometimes painful movements. Fatigue b/c takes extra effort to produce vluntary movement
- Bradykinesia: slowness when initiating or performing volitional movements; shuffling gait, trouble with sit to stand, freezing, increased time required for FM tasks like shaving/fastening clothes
- Postural instability: stooped, lack of arm swing, loss of postural reflexes, fall risk, decreased balance
17
Q
The following are secondary symptoms of what condition?
- Gait dysfunction
- FM and bimanual impairments
- Freezing, trouble initiating movement, or overshooting target
- Cognitive deficits
A
Parkensons
18
Q
The following are secondary symptoms of what condition?
- Communication difficulties including small handwriting (micrographia), reduced volume of speech, muffled speech, lack of verbal inflection, reduced facial expression/flat affect, decreased nonverbal communication
- Sensory loss e.g., bowel and bladder, sexual dysfunction
- Dysphagia with increase in saliva and drooling, coughing or choking, slow intentional eating
- Mood and behavior disturbances e.g., depression, apathy, lack of initiative, social isolation
A
Parkensons
19
Q
Stages of parkinsons disease
A
Stage 1: unilateral symptoms, typically resting tremor with no or minimal loss of function
Stage 2: bilateral symptoms; balance not affected, problems with trunk mobility and postural reflexes
Stage 3: Impaired balance secondary to postural instability resulting in mild to mod impairments in function
Stage 4: decrease in postural stability, decrease in function, impaired mobility, need for assistance with ADLs, poor FM and dexterity
Stage 5: Total dependence for mobility and ADLs
20
Q
OT Evaluation for Parkinsons
A
- Review interests, roles, routines
- Set goals to help client maintain participation in life activities
- Interview to obtain brief history and observation of how symptoms such as rigidity, bradykinesia, tremors, and postural instability impair areas of occupational performance
- Assess occupations or preferred activities that have been altered or eliminated
- May need to evaluate person at multiple times in the day to get accurate picture of strengths and deficits (symptoms tend to increase just before next med dose)
- Tool such as COPM establishes client-centered goals and empowers clients and minimizes stress
21
Q
An evaluating OT notices the following symptoms. What condition does he probably have?
- FM or dexterity difficulty that affects ADLs
- Mobility impairments in community and home
- ADL and IADL deficits
- Swallowing or feeding issues
- Sexual dysfunction
- Disrupted sleep patterns
- Social isolation
A
PD
22
Q
OT interventions for PD for safety considerations for functional mobility
A
- Train client in sit-to-stand and bed mobility techniques
- Instruction on managing freezing such as avoiding crowds, turns or corners; reduce distractions and avoid multitasking; eliminate clutter in pathways; avoid rushing to answer phone/door
- Train in use of AD e.g., walker or cain. Evaluate for proper positioning and train client and family in WC use, transport and maintenance
- Use of single auditory cue to help person produce quicker and smoother movements
- Count out load and sing also helps
- Active music therapy for motor skills and emotional health, ADL performance, and QOL
23
Q
Feeding and ADL adaptations for client with PD
A
- Encourage client to modify meals for smaller portions, remove distractions, eat slower, use adaptive equipment e.g., built-up weighted utensils, cups and lids, plate guards, nonslip surfaces
- Educate client and caregiver to allow for increased time for feeding and ADLs; stress from rushing increases symptoms
- Modify clothing to eliminate fasteners or switch to hook and look closures; use button hooks, sock donners, zipper pulls and elastic shoelaces
- Use distal wrist weights if effective in decreasing tremors
- Instruct client to work on self-care activities as close to body as possible and with UE support on table. Using proximal muscles can help stabilize distal joints and muscles, which can reduce tremors
- Install DME, raised toilet seat, grab bars, shower bench, sink chair and use of soap on rope and long-handled sponge
24
Q
Communication adaptations for PD
A
- Use larger paper and large felt-tip pens and rest before writing
- Suggest adaptive techniques if handwriting illegible and affects IADL tasks like financial management e.g., bill pay online or by phone
- Use of speed dial or voice controlled large key telephones, dictation programs, remote control systems for electronics
- Mirror to increase client’s awareness of facial expression
- Instruct client in articulation, speech volume, breaking up sentences; advise family to phrase Qs in way to elicit shorter responses
25
Q
Strategies to address cognition for pt with PD
A
- Use external or visual cues, rhythmic cues, and music to practice with repetition
- Reduce environmental distractions
- Educate caregivers to speak slowly and clearly with simple one step instructions and introduce new concepts one at a time
