Progressive Neurological Disorders

Question 1

Multiple Sclerosis (MS)

Answer 1

Chronic inflammation and demyelination of the neurons in the CNS
Resulting in scar tissue formation (or plaques) that reduce the axons ability to conduct impulses

Question 2

Common signs and symptoms (MS)

Answer 2

Tactile awareness- numbness, disturbance in pain sensation, hypersensitivity
Motor- spasticity, low energy (fatigue most common), weakness, ataxia like, intention tremor
Visual- earliest signs, (80%)
Cognitive- short term memory loss, (50%)
Psychological- depression or euphoria, impulsivity, lability

Question 3

Course and prognosis MS (4)

Answer 3

Benign- 1-2 episodes of neurological deficits with no residual impairments

Relapse remitting non-progressive- after each exacerbation, person returns to previous level of function

Relapsing remitting progressive- some residual impairments with each readmission (unpredictable)

Progressive pattern- steady decline in function without remissions and exacerbations (15%)

Question 4

MS affect on life expectancy

Answer 4

Does not significantly decrease the persons’ life expectancy

Complications resulting from inactivity or recurring infections can cause premature death

Question 5

Diagnosis

Answer 5

Made when person has episodes of exacerbation and remission and slow or step by step progression over 6 months

Question 6

Medications

Answer 6

Often prescribed to treat the signs of MS include antispasmodics, muscle relaxants, and anticonvulsants

Question 7

Parkinson’s disease (PD)

Answer 7

Identified by the depigmentation of the dopamine producing substantia nigra (located in the basil ganglia)

Decrease in dopamine levels lead to deficits in the speed/quality of motor movements, cognitive skills, and affective expression

Question 8

Signs and symptoms of PD

Major

Answer 8

Resting tremor (hand movement- pill rolling), decrease when resting, increase when under stress
Muscle rigidity
Bradykinesia
Postural instability

Question 9

Secondary symptoms of PD

Answer 9

Gait- shuffling with reduced arm swing
Coordination difficulties
Immobilization 
Small handwriting (micrographia) 
Cognitive- frontal lobe 
Sensory loss
Muffled speech
Frequent swallowing
Sleep
Reduced bowel and bladder

Question 10

Course and prognosis PD

Answer 10

Slow, progressive disorder into three phases

Question 11

Three phases of PD

Answer 11

Preclinical period- neurons begun to degenerate, but no symptoms

Prodromal- months-years, generalized symptoms (depression, anxiety, fibromyalgia, shoulder pain)

Symptomatic- symptoms evident, 5 stages

Question 12

5 stages of symptomatic period

Answer 12

1. One sided
2. Bilateral, balance not impaired
3. Bilateral, balance is impaired
4. Functionally disabling
5. Confined to bed or w/c

Question 13

Progression of PD

Answer 13

Not linear, experiences some periods of improvement scattered through out the progressive loss

Question 14

Diagnosis of PD

Answer 14

At least one of the primary symptoms must be present-
Resting tremor
Rigidity 
Bradykinesia 
Postural instability

Question 15

Surgical procedures of PD

Answer 15

Thalamotomy- destroys thalamus (reduce tremors for over 10 years)

Pallidotomy- destroys globes pallidus (reduce tremors, shuffling gait, rigidity for at least 5 years)

Deep brain stimulation- brain pacemaker,

Question 16

Amyotrophic lateral sclerosis (ALS)

Answer 16

Lou Gehrig’s disease, fatal, progressive, degenerative moron neuron disease

Scars form on the neurons in the corticospinal pathways, motor nuclei (on brainstem), and anterior horn cells of the spinal cord

Question 17

Signs and symptoms ALS

Answer 17

Common initial signs- weakness of hand, asymmetrical foot drop, night cramps (calf)

Progressive, distal to proximal patter

3 areas

Question 18

3 areas of symptoms ALS

Answer 18

Lower motor neuron- focal/ multifocal weakness, atrophy, cramps, muscle twitching

Corticospinal- spasticity and hyper responsive reflexes

Corticobulbar- dysfunction, dysphasia, and dysarthria

Question 19

Course and prognosis ALS

Answer 19

Progressive and rapid, 1-5 years survival mean-3

16-77 years onset, diagnoses 55-75

Younger age, more mild symptoms = longer the course

Question 20

Diagnosis ALS

Answer 20

As with other PNDS tests are run to exclude other causes of presenting symptoms

Question 21

Impact on OT

Answer 21

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