Neurological: Conditions Flashcards
Myasthenia Gravis
- Cause
- Signs and symptoms
- Rx
- Acquired autoimmune deficit ofacetylcholine receptor; characterized by the failure at the neuromuscularjunction due to blockage of acetylcholine receptors at the post-synapticmembrane
- S/S: weakness and increased fatigueof facial muscles (often first shows up in eye muscles)- - Rx: Strengthening AFTER administrationof anti-acetylcholinesterase, fatigue mngmt
What causes Duchenne Muscular Dystrophy?
- What is the function of dystrophin?
- What happens to muscle tissue?
Duchenne Muscular Dystrophy (DMD) = disruption of dystrophin gene leading to muscle weakness accompanied by muscle hypertrophy (issue with mm CT, fat infiltration); CK levels high (necrotic mm)
o mutation in single gene on X chromsome –> fail to produce dystrophin protein (dystrophin links sarcolemma to actin) = mm cells replaced by fat and CT progessive symmetric mm wasting
o normally diagnosed by 5, dead by ~20
How does DMD present?
- What are the 2 key signs
- What would be normal on a pulmonary function test/ what would be abnormal
Presentation:
- Key Signs: Gower’s sign (uses hands on leg to stand up) & Calf psuedohypertrophy
- prox mm weakness, pelvic girlde then shoulder; scoliosis
- waddling gait, toe walking, lordosis, freq falls, difficulty standing up and climbing stairs, lower IQ
- On pulmonary function test: Functional Residual Capacity should be normal
• TLC, vital capacity and FEV1 will be decreased
What are the PT goals and roles for the treatment on DMD
PT: work on strength, independence, advocate; keep body flexible, upright and mobile as possible
Goals of PT intervention for a child with DMD are to retard the development of contracture & muscle weakness, which could lead to functional limitations, and thus, disability. The PT would also play a role in determining the appropriate use of assistive devices that could help maintain the child’s mobility such as wheelchairs, walkers & orthoses
What is Amyotrophic lateral sclerosis (ALS) (Lou Gehrig’s) disease?
- Peripheral or proximal onset of symptoms
- What is spared?
- End stage treatment?
A motor neuron disease and gradual deterioration of BOTH UMN and LMN (may have both flaccid and spastic paresis); M>F; stages 1-6
o Characterized by rapidly progressive weakness, muscle atrophy and fasciculations, muscle spasticity, difficulty speaking (dysarthria), difficulty swallowing (dysphagia), and decline in breathing ability.
o Amyotrophy = mm fiber atrophy; lateral= lateral column atrophy; sclerosis= harden/thickening of axons
o Starts peripherally, moves central, mm groups are affected asymmetrically; gradual involvement of all striated muscles, bulbar (oral motor) are major concern; progresses to paralysis w/o remission
o Sparing: sensory system, cognition, bowel and bladder, autonomic
o End stage Rx: help with resp difficulties (chest clearance), treat complications of immobility, symptom relief, facilitate mobility, patient comfort
What are signs and symptoms of ALS
o paresis in a single muscle group
o corresponding muscle groups are asymmetrically affected (patchy distribution)
o fasciculations (twitching)
o metabolic involvement of the skin (papery, fragile, cold)
o gradual involvement of striated muscle (bulbar = major concern)
o progress to permanent paralysis
o flaccidity + spasticity may co-exist
o selective sparing (no ocular or cardiac, urethral & anal sphincter)
What is Parkinsons disease?
- Possible causes?
Chronic neurodegenerative disease in basal ganglia, (M=F), leading to decreased dopamine produced by substantia nigra
o dopamine normally inhibits ACh
o without dopamine = excessive excitatory output
Possible causes: o viral (infection = swelling of brain) o genetic o toxic (drugs) o injury or focal ischemia = can cause PD-like symptoms
Signs and symptoms of Parkinsons disease;
- What are the 4 hallmark signs?
- What other symptoms may present
- S/S (classic)
o bradykinesia = slowness of movement, can result in freezing
o resting tremor
o rigidity = velocity independent resistance to passive stretch
o postural instability
- S/S (other) o loss of automatic movement (ie rolling over in bed) o micrographia o autonomic abnormalities o hypokinesia/akinesia o mask face o depression, dementia o postural hypotension o pain o sleep disturbance (restless leg) o fatigue o decreased fine motor control
What is the pharmacological management and physiotherapy treatment for PD?
Pharmacological
o Levadopa (Sinemet)
Prolonged use can lead to dyskinesias, GI disturbances, restlessness, anxiety, depression
o Selegiline: used in early PD
Adverse effects: nausea, dry mouth, dizziness, anxiety, hallucinations
Physiotherapy
- education (protective effects of exercise)
- functional mobility exercise = FOCUS ON BIG MOVEMENTS
- cueing (tactile, verbal, music)
- Rx for festinating gait: use toe wedge to help displace COG backwards
- address postural changes and cardiorespiratory fitness
- transfers, balance and falls prevention
o prevention of secondary sequelae
o environment safety and checks
o care giver involvement and training
o equipment
What is Huntington’s chorea?
- What causes abnormal movements
- Physiotherapy treatment?
– Progressive, hereditary condition characterized by abnormal movement and mental deterioration; movement is purposeless, involuntary, brief and random; writhing (choreoform) movements including limbs, speech (sound drunk) due to loss of neurotransmitters and GABA
o PT Tx: symptom management, patient safety, maintain enough nutrition
Differentiare between;
- Essential tremor
- Dystonia
- Hemiballismus
- Tardive dyskinesia
- Tourettes syndrome
- Korsokoff syndrome
Essential Tremor: common neurological disorder usually seen as shaking hands evoked by voluntary movements; no other neurologic signs; most frequently seen movement disorder
o Increases with fatigue/nervousness
Dystonia: involuntary, sustained muscle contractions that produce repetitive movements and distorted or abnormal postures; may be action specific or linked to repetitive action
o Tx: adjust movement-related nerve signals, temporarily immobilize target muscles
Hemiballism: exhaustingm violent movements; often resolves in 6-12 months
Tardive Dyskinesia: motor control disorder secondary to use of neuroleptics for control of psychosis; random movements in tongue, lips, jaw
Tourettes Syndrome: repetitive, involuntary, stereotypical movements and utterances (tics)
Korsokoff’s syndrome = genetic metabolic injury due to malnutrition or alcoholism, can’t make new memories, characterized by confabulation; distored memories about one’s self or the world
What is multiple schlerosis?
- What is the typical age onset
- Cause
- What are the signs and symptoms
o Multiple Sclerosis = an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring; unpredictable, chronic, debilitating
o Typical onset 20-40yo; NO known cause; HLA-DR2 may be genetic link
o S&S’s: fatigue, mm weakness, paraesthesia, optic neuritis or diplopia, vertigo, bowel and bladder, impaired cognition/memory, pain, depression
Differentiate between the different types of MS
o Types:
- Relapsing remitting – new symptoms or old symptoms may resurface or worse and it can be full or partial recovery relapses can be days weeks or months recovery can be slow or instantaneous
- Primary progressive- there is a gradual worsening of symptoms overtime may stabilize but no remission
- Secondary progressive – starts off as relapsing remitting then steadily worsens
- Progressive relapsing - there is a steady progression with attacks
What is the physiotherapy treatment for MS
- Treatment considerations
- Contraindication and precautions to exercise
o PT Rx: treat vestibular dysfunction, posture, proprioception, core, stretches, exercise will benefit overall fxn
o Rx program: late morning sessions, aggressive stretching, moderate exercise, energy conservation and stress management techniques
o Contraindications and precautions to exercise: heat, fatigue, pregnancy
- 80% of pts experience increase in neurological S&S with incr in heat
What is meningitis?
- What is there an increased risk of?
- Presentation of symtpoms (time frames)
- Physical tests for meningitis?
Meningitis: infectious disease that causes inflammation of meninges (all 3: pia, arachnoid, dura)
o Info: increased risk of infarctions, cortical veins may develop thomboses, may be block of CSF secondary to scar tissue (can cause hydrocephaly - excess amount of fluid in the brain) which causes headache (the CARDINAL SIGN!)
o Presentation: can present as acute (hrs-days); sub acute (2wks plus); chronic (1mo plus)
o Physical test for meningitis: patient supine, passively flex neck
- Brudzinski’s sign: knees and hips will flex
Treatment considerations for meningitis?
Tx considerations: Avoid undue oblique stress on any bone, maintain activities below the point of fatigue, elevate the patient toward vertical position slowly
o antibiotic (if bacterial) o viral (control of symptoms)
What are the 3 main types of meningitis
Types:
1) aseptic (fungus, virus, parasite, can also get with: herpes syplex 2, ebstien barr, lupus) 2) tuberculosis: abcess or edema 3) bacterial: in child or infant is considered a medical emergency
What is encephalitis?
- Signs and symptoms
- What are the tests for meningitis and encephalitis?
Encephalitis: infection of the brain and SC
o S&S: headache, nausea, vomiting, LOC, coma can last for weeks; can result in focal brain damage
Investigations = EEG, CSF tap, MRI
