Progressive Disorders of the CNS Flashcards
3 nuclei that make up dorsal or sensorimotor basal ganglia
- caudate nucleus
- putamen
- globus pallidus
BGD Symptoms
- problems with controlling speech, movement, and posture
- difficulty starting, stopping, or sustaining movement
- increased muscle tone and rigidity
- memory loss and trouble finding words
Basal Ganglia Disease (BGD) results in difficulty in
- initiating, continuing, or stopping movement.
- muscle tone (rigidity)
- increased involuntary movements (tremor, chorea)
Motor disorders of BG result in disequilibrium between ___ and ____ movement.
inhibitory and excitatory
Cerebellar dysfunctions: Lesions affect which areas?
Lesions are varied and may affect the Neocerebellar (Posterior lobe), Paleocerebellar (anterior lobe), and Archicerebellar (Flocculonodular lobe).
Cerebellar dysfunctions: Signs & symptoms of neocerebellar lesions (posterior lobe)
Ipsilateral ataxia, Ipsilateral hypotonia & hyporeflexia, Dysmetria, Adiadochkinesia, movement decomposition, asthenia, intention tremors, rebound phenomenon, ataxic gait, staccato voice
Cerebellar dysfunctions: Signs & symptoms of paleocerebellar lesions (anterior lobe)
Disturbances in extensor tone (b/c this lobe receives the Spinocerebellar tracts – which when lost result in an ↑ in extensor tone.)
Cerebellar dysfunctions: Signs & symptoms of archicerebellar lesions (flocculonodular lobe)
Uncoordinated trunk movements – ataxia. Balance deficits d/t loss of vestibular input from vestibular nuclei, cuneocerebellar tract, and rostral cerebellar tract
PT/OT management of cerebellar dysfunctions
Added weight to help decrease tremor (but performance declines due to the added weight); Strengthening (help with deconditioning, weakness, or spasticity)
ALS Basic Info
- destruction of UMN and LMN (degeneration of anterior horn cells and descending corticobulbar and corticospinal)
- usually occurs after 50 yrs but can be younger
- Causes weakness and atrophy to the body
- spasticity, hyperreflexia
- affects distal (limbs) to proximal (whole body)
- loss of voluntary control
- one of 1st signs is thenar eminence wasting
Etiology of ALS
- unknown (viral/autoimmune/toxic)
- 5-10% genetic (autosomal dominant)
Stage I of ALS
early disease, mild focal weakness, asymmetrical distribution, symptoms of hand cramping and fasiculations
Stage II of ALS
moderate weakness in groups of muscles, some wasting (atrophy) of muscles; modified independence with assistive devices
Stage III of ALS
severe weakness of specific muscles, increasing fatigue, mild to moderate functional limitations, ambulatory
Stage IV of ALS
severe weakness and wasting of LEs, mild weakness of UEs; moderate assistive and assistive devices, wheelchair user
Stage V of ALS
progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk, spasticity, hyperreflexia, loss of head control, maximal assist
Stage VI of ALS
bedridden, dependent ADLs, FMS; progressive respiratory distress, mimics Locked-In Syndrome
Examination of ALS
- pt must have s/s of both UMN and LMN destruction
- determine stage patient is in using ALS Functional Rating Scale
- MMT
- ROM
- Reflexes
- Purdue Pegboard Test
- Pulmonary function
- Speech evaluation
- Ashworth Spasticity scale
- CN’s; especially VII, IX, X, XI, XII
- Gait: timed test
ALS Functional Rating Scale (ALSFRS)
- assess disease progression and function across 10 functional categories
- Scored 0 (loss of function) to 4 (normal function)
- 40 maximal score
Motor Learning Stage 1 of ALS
- independent of mobility and ADLs
- Active ROM
- Cont. normal activities
- stretching of affected joints
- resistive exercises to unaffected mm
- aerobic activities
Motor Learning Stage 2 of ALS
- moderate weakness in groups of mm
- assess for use of assistive devices
- continue stage 1 activities
- increased need for caregiver assistance
- exercise 2-3 times per day with rest in between
Motor Learning Stage 3 of ALS
- continued ambulation but severe weakness in mm groups
- foot drop or hand weakness
- goals is to keep pt physically independent
- use of splints, orthotics
Motor Learning Stage 4 of ALS
- severe weakness of legs, involvement of arms
- WC
- Cont. AROM and PROM to prevent contractures
- strengthening
- integumentary
Motor Learning Stage 5 of ALS
- progressive weakness of mobility and endurance
- inability to transfer
- pain due to cramping and contracture
- stretching, splinting, STM, orthotic
Motor Learning Stage 6 of ALS
- bed ridden, max assist, hospital bed, frequent repositioning, pain management, postural drainage, coughing techniques, airway clearance
PT Goals for ALS
- maintain respiratory function
- provide for nutritional needs
- prevent indirect impairments
- provide moderate exercise program
- teach energy conservation
- maintain maximal functional independence
- symptomatic treatment
ALS: Respiratory Function
- may require air way clearance techniques
- cough facilitation
- breathing exercises
- chest stretching
- suctioning
- incentive spirometry
- long term mechanical ventilation
ALS Exercise Precautions
- monitor fatigue levels closely
- avoid overwork injury
- limited positions with decreased pulmonary functioning
AIDS: Motor learning and recovery of function
- motor learning is slower in pt’s with HIV
- may have lack of coordination so would want to have adaptive or compensatory mechanisms for them to complete activities
- physical activity is good
- KEEP THEM ACTIVE
Alcoholic Ataxia: Pathogenesis and History
- a loss of coordination in performing voluntary movements associated with peripheral neuritis as a result of alcoholism
- similar form of ataxia may occur with neuritis resulting from other toxic agents
S/S of Alcoholic Ataxia
- wide-footed, unsteady gait
- slurred speech
- clumsiness of their hands
- double vision
- legs often affected pt states “slow legs”
- peripheral neuropathy (especially in feet and legs)
- loss in vibration sense and DTR
Basal Ganglia Disease
- common disorders: Parkinson’s, Huntington Chorea, and dystonias
- affect 1 million people in US
- Impairments in: muscle tone, movement coordination and motor control, postural stability, presence of extraneous movement
What is Parkinson’s Disease (PD)?
Chronic progressive disease of CNS with degeneration of dopaminergic substantia nigra neurons and nigrostriatal pathways
With degeneration of substantia nigra, there is a ___ of dopamine within the BG corpus striatum - With PD
Deficiency
Loss of inhibitory dopamine results in ____ excitatory output from cholinergic system - with PD
excessive
Characteristics of PD
rigidity (leadpipe or cogwheel)
bradykinesia
restring tremor
impaired postural reflexes
its slowly progressive
Tool(s) assessing dynamic balance
Tandem Walking and Four Square Step Test
Cognitive/Behavioral status in pts. with PD
- intellectual impairments/dementia in advance stages
- memory
- bradyphrenia (slowing of thought processes)
- depression
Communication with PD
- Dysarthria
- Hypophonia (decreased volume)
- Mutism in advanced stages
- Mask like face with infrequent blinking and expression
- Writing becomes progressively smaller
Oromotor Control with PD
- Dysphagia
- Problems in chewing and swallowing
ROM, Deformity associated with disuse and inactivity with PD
- Contractures common in flexors, adductors
- Persistent posturing in kyphosis with forward head
- Many patients osteoporotic with high risk of fracture
Sensation/Perceptual Function with PD
- Aching and stiffness
- Abnormal sensations (cramp like sensations)
- Problems in spatial organization
- Perception of vertical
- Extreme restlessness (akathisia)
Vision with PD
- Blurring
- Cogwheeling eye pursuit
- Eye irritation from decreased blinking
- Decreased pupillary reflexes
Lead Pipe rigidity
- smooth resistance to passive movement that is independent of velocity
- can be made more obvious with voluntary movement or mental task
Cogwheel rigidity
ratcheting through ROM due to subtle tremor superimposed on the rigidity
Gait with PD
- Characterized by poverty of movement
- Generalized lack of extension
- Festination is common
- -Abnormal, involuntary increase in the speed of walking, often with forward acceleration, but may occur with backward progression)
Name clinical features of cerebellar dysfunctions.
hypotonia; asthenia; ataxia; truncal ataxia; dysmetria; gait disturbance; movement decomposition; dysdiadochokinesia; slowed speech enunciation w/ a tendency to hesitate at the beginning of a word or syllable; involuntary, rapid oscillation of the eyeballs in a horizontal, vertical, or rotary direction, with the fast component maximal toward the side of the cerebellar lesion
Asthenia
muscles tend to be weaker and get tired than most muscles
Ataxia
disturbances in gait and decomposition of movement, wide-based gait
Truncal ataxia
Oscillations while sitting or standing; falling may occur toward the side of a unilateral lesion
Dysmetria (definition and way to test for it)
Errors in judging distance with body movements, tested by finger-to-nose test, which may result in underestimation (hypometria) or overestimation with transient overshoot (hypermetria)
Describe myasthenia gravis and its etiology.
A neuromuscular junction disorder characterized by progressive muscular weakness and fatigability on exertion. Etiology: autoimmune antibody-mediated attack on acetylcholine receptors at neuromuscular junction.
Characteristics of myasthenia gravis
Muscular strength worse with continuing contraction, improved with rest.
Describe Generalized myasthenia and its course of progression
Usually involves bulbar (extraocular, facial and muscles of mastication) and proximal limb girdle muscles; Course varies: may progress from mild to severe, typically within 18 months
What should be examined in regards to myasthenia gravis?
cranial nerves, respiratory function, muscle strength, functional mobility skills, EMG & repetitive nerve stimulation studies
Muscle strength testing for myasthenia gravis
Muscle strength: proximal more involved than distal, fatigability, repeated muscle use results in rapid weakness
In regards to myasthenia gravis, EMG and repetitive nerve stimulation studies reveal what?
Show abnormal responses to repetitive nerve stimulation (failure of transmission, decreased EMG-recorded responses)
Medical Interventions for myasthenia gravis
Acetylcholinesterase inhibitors: pyridostigmine; Corticosteriods: prednisone, methylprednisolone; Immunosuppressents: azathioprine, IV immunoglobulin ( IVIG); Alternative treatments: plasmapheresis ( removal of blood with filtering and separation of cellular elements from plasma; thymectomy.
S and S of Brain Tumor
Headaches (usually worse in the morning); Nausea and vomiting; Changes in speech, vision, or hearing; Problems balancing or walking; Changes in mood, personality, or ability to concentrate; Problems with memory; Muscle jerking or twitching (seizures or convulsions); Numbness or tingling in the arms or legs
Describe Tumor Grade I
The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.
Describe Tumor Grade II
The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.
Describe Tumor Grade III
The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing.
Describe Tumor Grade IV
The malignant tissue has cells that look most abnormal and tend to grow quickly.
Astrocytoma
The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.
Meningioma
The tumor arises in the meninges. It can be grade I, II, or III. It’s usually benign (grade I) and grows slowly.
Oligodendroglia
The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It’s most common in middle-aged adults. It can be grade II or III.
Medical and Surgical Management for Brain Tumors
General Surgery, Radiation, Radiosurgery, Chemotherapy
causes of encephalitis
herpes; viruses spread by mosquitoes and ticks.