Revisiting Multiple Sclerosis And Parkinson’s Disease Flashcards
What is Multiple Sclerosis
Ms is a chronic demyelination disease of the CNS characterised by an inflammatory process and causing widespread degeneration of the CNS, gradually resulting in severe neurological deficit
What is the pathology of multiple sclerosis?
Disruption of the blood-brain barrier
Leakage of inflammatory cells
Destruction of oligodendrocytes and myelin sheath
Disruption of nerve signals, rate of conduction of nerves is slowing down.
Plaques form throughout the CNS.
‘Sclerosis’ means ‘scarring’ and ‘multiple’ - occur in different places throughout the CNS
What are the different types of MS?
Silent/Benign
Relapsing-Remitting
Secondary progressive
Primary progressive
What are the initial symptoms of MS?
Limb weakness Optic Neuritis Parasthaesia Diplopia Vertigo Micturition problems
What are the signs and symptoms of MS?
Visual problems eg Diplopia - occipital lobe, optic nerve, thalamus
Weakness- motor cortex, descending pathways
Spasticity and hyper reflexic- cerebellum
Ataxia and poor coordination- sensory cortex or ascending pathways
Sensory loss eg parasthesia, tingling and burning
Dizziness and poor balance- Vestibular system or cerebellum
Sexual dysfunction- spinal cord
Sphincter disturbance- spinal cord
Psychiatric, psychological disturbances- limbic system, dopamine system and hypothalamus
Decreased intellectual function- frontal lobe
What is ataxia?
Disorder/ confusion of movement
Types- cerebellar, sensory and vestibular
What are some treatments for ataxia?
Cerebellar- core stability and coordination exercises
Vestibular- cooksey cawthorne exercises
Sensory- sensory stimulation ++
What would some neuro rehab treatments for ataxia include?
Compensatory approach for everyday strategies eg- splints, orthoses, limiting degrees of freedom etc.
Treadmill training
Visually guided stepping
Light touch supplement
Cold therapy- transient effects
Memory guided movement where visual info is unhelpful closed may help feeding in people with strong intention training)
What are some possible causes of fatigue?
Central CNS Endocrine dysfunction Immunological ANS Neuromuscular Hypothyroidism Anaemia Meds Sleep Diet Anaemia
How can fatigue be measured?
VAS-
Fatigue severity scale
What are some outcome measures for MS?
Expanded disability status scale
MSIS-29
MSWS-12
Functional reach test
What is Parkinson’s disease?
PD is a chronic, progressive, neuro degenerative disorder resulting from the degeneration of dopamine producing neurones in the substantia nigra of the basal ganglia. It comprises a group of disorders characterised by tremor and disturbance of voluntary movement, posture and balance.
What is the pathophysiology of Parkinson’s disease?
Susbstantia nigra is the main source of dopamine. Dopamine is a neurotransmitter.
The basal ganglia is part of a series of parallel loops involving the thalamus and cerebral cortex
This classic model proposes two pathways-
Direct pathway- promotes movement
Indirect pathway- inhibits movement
DOPAMINE EXCITES THE DIRECT AND INHIBITS THE INDIRECT PATHWAY IE INHIBITS INHIBITION!
So what happens in Parkinson’s disease in terms of dopamine
Neuro degeneration in the substantia nigra in the basal ganglia leads to a lack of dopamine.
Lack of dopamine leads to a lack of excitement of the direct pathway leading to lack of movement
Lack of inhibition of the indirect pathway leading to lack of movement
What are the primary clinical features or cardinal signs of Parkinson’s disease?
Bradykinesia/Akinesia
Resting tremor
Rigidity
What medication is given to Parkinson’s disease patients?
Madopar and sinemet
Anticholinergics (Arpicoline)
What is the Hohn and Yale scale used for?
It is used to Show at which stage the patient currently presents at
0- no signs
1- unilateral involvement - minimal functional disability
1.5 unilateral involvement also involving the neck and spine
2- bilateral disease but no Impairment of balance
2.5- mild bilateral symptoms with recovery when the pull test is given
What physiotherapy can be done for postural problems?
Assessment Stretches Strengthening exercises Mobility exercises Seating Function Advice
What type of cueing is there?
Kinesthetic
Visual
Auditory
What are the principles of cueing?
Executing movement- primary motor cortex
Executing and planning movement- Premotor area (PMA) and supplementary motor area (SMA)
In PD, the SMA system is impaired, but the PMA system remains intact.
What are the principles of treatment regarding the premotor ares and supplementary motor area in PD?
Premotor area (PMA) is involved in sensory guided movement Supplementary motor area (SMA) is involved in internally generated movement (automatic) Therefore the automatic subconscious basis of posture and movement is lost. (SMA) Abnormalities can often be overcome by voluntary effort (use of PMA)
What does the different types of cueing entail?
Visual- lines on floor, lines on road crossing, steps and stairs
Kinaesthetic- dancing
Auditory- verbal prompts, metronome
What is are the typical PD outcome measures?
Unified Parkinson’s disease rating scale
Get up and go test
What upper motor neuron diseases are there
Spinal cord and brain injuries, CNS
