Shappy Final Flashcards
Parkinson’s Disease
Pathophysiology:
Pathophysiology:
- Degeneration of Substantia Nigra, Locus Ceruleus, dorsal aspect of putamen, and brainstem.
- –Neuroglial cells issues
-
–Lewy bodies ultimately get formed (IMPORTANT to KNOW!)
- •Synuclein Filled
- a chemical marker (an inflametory protein)
- •Synuclein Filled
-
–Lewy bodies ultimately get formed (IMPORTANT to KNOW!)
- –Neuroglial cells issues
Congenital Malforations: Characteristics/Details (3)
•Congenital Malformations
- –Manifest early in life
- –Example: maybe cerebellum maybe just didn’t form)
- –doesn’t progress (won’t get worse)
- –Variety of deficits is possible
What is ALS ?
•Motor neuron disease
- –Degenerative spinal cord, brain, brainstem motor neuron loss.
- –Typically develops in UE first, then progresses to lower
- •One of few conditions where Diplegia is present in UE
What is Motor Control?
Dr Bringman:
Motor control is
- the ability to maintain and change posture and movement
- the result of a complex set of neurological and mechanical process.
Shappy Notes: Motor control
(she said we must have some knowledge of this side beyond this slide and that we got it from Bringman. She did not talk more about it really)
Multiple Sclerosis
Clinical Course (general):
Clinical Course (general):
- May be progressive or not, may have remissions and relapses. Very unpredictable.
- optic nerve, motor and sensory cortex- not limited to these areas.
- symptoms wax and wane which may or may not have an element of progression
what are some good questions to ask yourself when trying to treat movement disorders?
How can I control these movement disorders?
What does society say about what is appropriate or acceptable? (when deciding what to do to help pts with problems)
Multiple Sclerosis
Non-PT Treatment
What about for an exacerbation?
Non PT Treatment:
- Anti-inflammatory (steroid) at first to stop inflammatory response
- may use IVIG to attack anitbodies that are created.
- Oligodendrocytes can be repaired (remyelination can happen).
- Remyelination can stop at any point.
For an Exacerbation:
- Exacerbation (attack): symptoms get worse, treat immediately with anti-inflammatory (steroids), controls edema, after edema goes away the symptoms may also reduce. It is an argument to be as fit as possible before the attack
define hypotonia
flaccidity
define Nystagmus
- –Rapid alternating eye movement (back and forth of the eyes; rapid alt of the eye movements)
- –Involuntary
- –Some people live in this state
Tremor: Basic definition
•Rhythmic alternating oscillatory movements of anything
Describe (or just read) more details about Romberg Test
From Wikipedia:
Romberg’s test or the Romberg maneuver is a test used in an exam of neurological function, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one’s body in space); vestibular function (the ability to know one’s head position in space); and vision (which can be used to monitor [and adjust for] changes in body position).
A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. A loss of balance is interpreted as a positive Romberg’s test.
The Romberg test is a test of the body’s sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord.[1]
The Romberg test is used to investigate the cause of loss of motor coordination (ataxia). A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg’s test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.
It is used as an indicator for possible alcohol or drug impaired driving and neurological decompression sickness.[2][3] When used to test impaired driving, the test is performed with the subject estimating 30 seconds in his head. This is used to gauge the subject’s internal clock and can be an indicator of stimulant or depressant use.
http://en.wikipedia.org/wiki/Romberg%27s_test
what are tremors? (what are some variables of tremors?)
•Tremors; rhythmic, non-rithmic, oscilating, regular
Can you see plaques on an MRI for someone with MS?
Scars plaque can be found anywhere in CNS
characteristics of Secondary Progressive MS: (4)
Secondary Progressive MS:
- •Develops from relaxing remitting
- •However is more progressive
- •Occasional relapses to differentiate it with minor remissions
- •A lot of these people will plateau during the remission period (you will not see them return to full function)
- •pts are older at this age
ALS: prognosis
From onset of symptoms to death: 5-10 years (usually from respiratory problems)
Does ALS affect cognition?
Cognitive function is generally spared for most people, although some (about 5%) also develop frontotemporal dementia.
per wikipedia: http://en.wikipedia.org/wiki/Amyotrophic_lateral_sclerosis#Diagnosis
what is a postural tremor?
A type of Action tremor (happens when body is in movement).
- Postural tremor: maximal when a limb is maintained in a fixed position against gravity.
- large movments
What two ways the neuron can degenerate?
- Something wrong in the synapse
- Problem not in the synapse
Progressive Supranuclear Palsy:
Transmission:
Transmission:
seems to have a genetic component
Progressive Supranuclear Palsy:
Diagnosis: (3)
Diagnosis:
- MRI will not show until severe atrophy.
- so diagnosis must be by symptoms before it is severe
- Has protein depositis like other similar diseases, possibly part of scar tissue while body is trying to heal (so it doesn’t show until that point)
define tremor (brief definition of it generally)
rhythmic ocillatitory movement
- –“another garbage tern”
- –Many types of tremors
- –Rhythmic alternating oscillatory movements of anything
- •Facial twitches
what is the center of motor cordination?
the cerebellum
what can both demyelination and synaptic degeneration lead to?
•Death of neuron
- •Louie bodies
- •Build up of protein and eosinophil
- •Common in Alzheimer’s and Parkinson’s
Parkinson’s Disease
Diagnosis, Non PT: (3)
Diagnosis, Non PT:
- –Looking for levels of dopamine, L-dopa, and markers that is Synuclein in lewy bodies
- –Ultimately, we can see degeneration on CT scan and MRI
- •Degeneration of Substantia Nigra, Locus Ceruleus, brainstem, and dorsal aspect of putamen
- •Results in the motor deficits we define as Parkinsons
- Try treating like parkinsons (L-dopa or other dopamine replacement therapy) to see if it responds
Multiple Sclerosis (everything below, but not detailed types and clinical manifestations):
What is it?
Epidemiology:
Etiology:
Pathophysiology:
Clinical Course (general):
Exacerbating Factors:
Non PT treatment:
PT Treatment:
What is it?
- Chronic inflammatory demyelinating disease of CNS
Epidemiology:
- Adult onset typically 20-40 years old
- Race: white 2x more likely than African Americans
- Sex: Females 2x more likely than males
Etiology:
- Unknown
- Best accepted theory is some sort of underlying viral disorder that causes autoimmune response
- Some have suspected chalmydia, but this has not been proven and is debatable
- Possible geneitc connection (15%)
Pathophysiology:
- Autoimmune resonse sets of Immune system
- •Something crosses BBB and causes demyelination (that can stop at any point)
- attacks to myelin cause inflammation and then scar tissue develops,
- oligodendrocytes are the glial cells that myelinate CNS axons and experience damage
- shappy said they are the ones that are activated to respond (but microglial cells are like the phagocytes of the CNS, so I would think they have a large role in the innflammation and immue response - maybe oligodendrocytes try to regenerate?
- You get inflammation first, then you will get the scar tissue after on the site (treat with inflammatory first)
- •Slows conduction
- •Decreasing transmission
- •Results in weakness
- Sort of like a CNS version of chronic Gillian Barre.
Clinical Course (general):
- May be progressive or not, may have remissions and relapses. Very unpredictable.
- optic nerve, motor and sensory cortex- not limited to these areas.
- symptoms wax and wane which may or may not have an element of progression
Exacerbating Factors:
- –Heat
- –Stress
Non PT Treatment:
- Anti-inflammatory at first to stop inflammatory response
- may use IVIG to attack anitbodies that are created.
- Oligodendrocytes can be repaired (remyelination can happen).
- Remyelination can stop at any point.
- For an Exacerbation:
- Exacerbation (attack): symptoms get worse, treat immediately with anti-inflammatory (steroids), controls edema, after edema goes away the symptoms may also reduce. It is an argument to be as fit as possible before the attack
PT Treatment:
- –Help them avoid exacerbating factors
- –Exercise is okay, but not in hot environments (pools must be cool)
- –May need specialized outcome measures
- Think of things that you can measure to show progress
- Sensations (semmes weinstein, temperature, etc.)
- •Need more research
- •Including more short term and long term outcome measures
- –Insurance companies don’t want to reimburse for maintenance
- •Insurance companies like short term outcome measures
- Think of things that you can measure to show progress
- Work on balanc and overall conditioning
- ”Strategic Weighting” Weighted belt can improve ability to move. There is certain spots for the weights on the belts. (sort of like jackets for scared dogs)
- Don’t forget wound care stuff
what does ALS stand for?
Amyotrophic Lateral Sclerosis
Progressive Supranuclear Palsy:
Treatment: (3)
Treatment:
- does not respond to dopamine replacement like parkinson’s dz
- a fact sheet I found discussed treatment for symptoms (like difficulty swallowing), but said there was no treatment for the actual disease.
- PT’s treat symptoms (I surmise)
What are tics?
•Tics: the urge to do it and the relief felt afterwards. “it” is whatever.
Movement Disorders, non-rhythmic: what is hemiballismus?
•Hemiballismus: non rhythmic rapid movements. Violent, flinging, non-suppressible.
dr Lake taught us that it would be contralateral to the legion, and it is usually the upper extremity. Hemi means one sided, so it would just be one arm. Ballisums also exists, which would be bilateral (make sure you read carefully when taking the exam!)
What are ways neurons can degenerate at the synapse?
why is it important to know what is wrong?
Problems with:
- receptors,
- reuptake,
- neurotransmitter production (amount of neurotransmitters)
if you know what is wrong, then you can give the correct meds to help with the synapse
Fragile X:
Transmission
Transmission:
Carrier is the female (daughters of males who have the disease) . dad can be symptomless, but pass it on to the daughter who will then give to her sons who will show the symptoms
What is Agillity?
- the power of moving quickly and easily; nimbleness (http://dictionary.reference.com/browse/agility)
From Wikipedia, since we didn’t discuss much in class:
Agility or nimbleness is the ability to change the body’s position efficiently, and requires the integration of isolated movement skills using a combination of balance, coordination, speed, reflexes, strength, and endurance. Agility is the ability to change the direction of the body in an efficient and effective manner and to achieve this requires a combination of
balance – the ability to maintain equilibrium when stationary or moving (i.e. not to fall over) through the coordinated actions of our sensory functions (eyes, ears and the proprioceptive organs in our joints);
static balance – the ability to retain the centre of mass above the base of support in a stationary position;
dynamic balance – the ability to maintain balance with body movement; speed - the ability to move all or part of the body quickly; strength - the ability of a muscle or muscle group to overcome a resistance; and lastly,
co-ordination – the ability to control the movement of the body in co-operation with the body’s sensory functions (e.g., in catching a ball [ball, hand and eye co-ordination]).
In sports, agility is often defined in terms of an individual sport, due to it being an integration of many components each used differently (specific to all of sorts of different sports). Sheppard and Young (2006) defined agility as a “rapid whole body movement with change of velocity or direction in response to a stimulus”.[attribution needed]
Agility is also an important attribute in many role playing games, both computer games and as Dungeons and Dragons. Agility may affect the character’s ability to evade an attack or navigate uneven terrain.
http://en.wikipedia.org/wiki/Agility
Movement Disorders: What is a hyperkinetic movement disorder characterizd by?
increased movement
How many categories of MS are there?
6 categories of Primary Progressive MS
Movement Disorders: What are rhythmic movement disorder characterizd by?
–Rhythmic- regular alternating or oscillatory
define Scanning Speech:
- –Slow enunciation and a tendency for hesitation
- •It’s there, but it is slow and interrupted (almost a stutter)
- •Typically more at beginning of word or sylable
(slow speech, interrupted, hesitated)
What are the 5 theories of ALS Etiology?
- •Free radical build up
- –Enzymes whose job it is to elimiate free radicals are dysfunctional (superoxide)
- •Neurotransmitter issues
- –Glutamate is typically elevated
- •Motor neuron degeneration
- •Autoimmune
- •Unscheduled apoptosis++
what is friedreich’s ataxia?
Friedreich’s ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead toscoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000
from wikipedia
Pathologic Tremor: Intention Tremor, two examples of causes/symptoms
- •Cerebellar lesions- low frequency, unilateral, ataxia, dysmetria, dysdiadochokinesia, dysarthria
- •History of drug use- tremor when stopping
Definition of Dysmetria:
–Inability to control ROM (hard to pick up specific objects)
What are Five types of Motor Coordination?
Coordination
- –Dexterity
- –Agility
- –Intra limb coordination
- –Inter limb coordination
- –Visual motor coordination
- •Hand-eye coordination
What does POMA stand for?
–Performance-Oriented Mobility Assessment (POMA)
Movement Disorders: What is a hypokinetic movement disorder characterizd by?
what are some goals for treatment?
–Hypokinetic- decreased or slow
•Treat: speed them up or prevent them from getting slower
Huntington’s Disease
PT role in Treatment:
PT role in Treatment
- we might be the first medical professional to recognize symptoms
- We can teach adaptations
- We can try to slow progression
What is Inter-limb coordination?
From Wikipedia:
Inter-limb coordination concerns how movements are coordinated across limbs. J. A. Scott Kelso and colleagues have proposed that coordination can be modeled as coupled oscillators, a process that can be understood in the HKB (Haken, Kelso, and Bunz) model.[13] The coordination of complex inter-limb tasks is highly reliant on the temporal coordination. An example of such temporal coordination can be observed in the free pointing movement of the eyes, hands, and arms to direct at the same motor target. These coordination signals are sent simultaneously to their effectors. In bimanual tasks (tasks involving two hands), it was found that the functional segments of the two hands are tightly synchronized. One of the postulated theories for this functionality is the existence of a higher, “coordinating schema” that calculates the time it needs to perform each individual task and coordinates it using a feedback mechanism. There are several areas of the brain that are found to contribute to temporal coordination of the limbs needed for bimanual tasks, and these areas include the premotor cortex(PMC), the parietal cortex, the mesial motor cortices, more specifically the supplementary motor area (SMA), the cingulate motor cortex (CMC), the primary motor cortex (M1), and the cerebellum.[14]
http://en.wikipedia.org/wiki/Motor_coordination#Intra-limb
Pontocerebellum (neocerebellum) is composed of which anatomical parts?
Lateral parts of the hemispheres
Picture: Cerebrocerebellum is the same as pontocerebellum
Physical therapy for ALS
from wikipedia
Physical therapy plays a large role in rehabilitation for individuals with ALS. Specifically, physical and occupational therapists can set goals and promote benefits for individuals with ALS by delaying loss of strength, maintaining endurance, limiting pain, preventing complications, and promoting functional independence.
Huntington’s Disease
Cause:
Cause:
gene mutations
What are three parts of the CNS that influence voluntary movement?
- Corticospinal Tract
- Basal Ganglia
- Cerebellum
what is ataxia?
•Ataxia: really wide based gait.
(I think it is broader than just gait, but go with what shappy said)
what is “decomposition of movement”?
-inability to correctly sequence fine coordinated movements/acts
Movement Disorders, non-rhythmic: what are Tics?
Tourette’s is the example. Rapid repetitive non-rhythmic. Pts usually have some urge to do it and get some sort of relief after they do it. There is some thought that urge can be suppressed.
what is chorea?
•Chorea: non-rhythmic jerky rapid movements. Non-suppressible, involuntary. Distal muscles, facial muscles are commonly involved.
ALS Epidemiology
Epidemiology
- –Men more common than women (2:1)
- –10-15% seem to have familial link
- –30K cases in USA (15 diagnosed per day)
Parkinson’s Disease
Treatment: (Non PT and PT)
Treatment:
- Treat even if MRI is negative
- Dopamine replacement therapy (L-dopa is common)
- PT:
- shappy told us about BIG therapy; DO NOT CALL IT “BIG” therapy in your notes unless certified!!!
- Walker with laser beam that can help break akinesia in pt
- Treat symptoms
- Don’t give up, our brains are the limit on treatment options!
Clinical Manifestations of ALS affecting Bulbar tract neurons (4)
- •Face
- voice
- swallowing
- speaking
what is an action tremor?
–Happens when body is in movement. It may or may not change when the target is reached.
there are at least three types
Parkinson’s Disease (everything):
What is it?/Cause/Progression:
Pathophysiology:
S/S:
Diagnosis, Non PT:
DIagnosis, PT:
Treatment:
What is it?/Cause/Progression:
- Idiopathic, slow progressive, degenerative disorder
- Can be caused by drugs, trauma, strokes, lots of stuff. May be a familial connection
Pathophysiology:
- Degeneration of Substantia Nigra, Locus Ceruleus, and brainstem,
- dorsal aspect of putamen is also involved
- –Neuroglial cells issues
-
–Lewy bodies ultimately get formed (IMPORTANT to KNOW!
-
•Synuclein Filled
- a chemical marker (an inflametory protein)
-
•Synuclein Filled
S/S (but not a check-list; pt may not have all symptoms):
- –Festinating gait
- –Resting tremor
- –Pill rolling
- –Stooped posture
- –Bradykinesia
- –No arm swing
- –Rigidity
- –Dementia
- –Akinesia
- –Sleep disorder issues (typically)
- –Flat affect
Diagnosis, Non PT:
- –Looking for levels of dopamine, L-dopa, and markers that is Synuclein in lewy bodies
- –Ultimately, we can see degeneration on CT scan and MRI
- •Degeneration of Substantia Nigra, Locus Ceruleus, brainstem, and dorsal aspect of putamen
- •Results in the motor deficits we define as Parkinsons
- Try treating like parkinsons (L-dopa or other dopamine replacement therapy) to see if it responds
DIagnosis, PT:
- PT tests
- reflexes - positive babinski (so hyperreflexive)
- Speed dependent tone
- •Finger to nose,
- tone and rigidity
- diadodyskenisia
- •Postural reflexes
- •Analyze gait
- balance
- facial expressions (flat affect)
- lack of blinking
- Try treating like parkinson’s to see if it improves condition
Treatment:
- Treat even if MRI is negative
- Dopamine replacement therapy (L-dopa is common)
- PT:
- shappy told us about BIG therapy; DO NOT CALL IT “BIG” therapy in your notes unless certified!!!
- Walker with laser beam that can help break akinesia in pt
- Treat symptoms
- Don’t give up, our brains are the limit on treatment options!
ALS DIagnosis
ALS is a very difficult disease to diagnose. To date, there is no one test or procedure to ultimately establish the diagnosis of ALS. It is through a clinical examination and series of diagnostic tests, often ruling out other diseases that mimic ALS, that a diagnosis can be established. A comprehensive diagnostic workup includes most, if not all, of the following procedures:
- electrodiagnostic tests including electomyography (EMG) and nerve conduction velocity (NCV)
- blood and urine studies including high resolution serum protein electrophoresis, thyroid and parathyroid hormone levels and 24-hour urine collection for heavy metals
- spinal tap
- x-rays, including magnetic resonance imaging (MRI)
- myelogram of cervical spine
- muscle and/or nerve biopsy
- thorough neurological examination
http://www.alsa.org/about-als/diagnosing-als.html
Multiple Sclerosis
Etiology:
Etiology:
- Unknown
- Best accepted theory is some sort of underlying viral disorder that causes autoimmune response
- Some have suspected chalmydia, but this has not been proven and is debatable
- Possible geneitc connection (15%)
- Best accepted theory is some sort of underlying viral disorder that causes autoimmune response
Etiology of Cerebellar Disorders: 3 categories
- Congenital Malformations
- Hereditary Ataxias
- Acquired Conditions
What are three things that an MD considers when making a medical diagnosis for cerebellar disorders?
- •Family history
- •Neuroimaging/MRI
- •Genetic testing
Managment of ALS
- •We usually go straight to power chair with multiple different concepts on how to get it to move, partly because UE goes first
- •Sip and puff and eye devices
- •Computerized technology for speech
- –Lots of very expensive technology for very short period of time
Wikepedia says:
Management of ALS attempts to relieve symptoms and extend life expectancy. This supportive care is best provided by multidisciplinary teams of health care professionals working with the person and their caregivers to keep them as mobile and comfortable as possible
Then lists the following:
- medications
- breathing support
- Therapy
- physical
- occupational
- speech
- nutrition
- pallitiave care (care meant to keep pt comfortable but not improve condition as they approach death)
What are three types of Pathologic Tremors?
- Action or postural tremor
- Resting tremor
- Intention Tremor
Progressive Supranuclear Palsy:
S/S: (8 examples)
S/S:
- bradykinesia,
- rigidity,
- eye movement,
- Cant look down (can look side to side but the eyes can not go down; if the head is moved up and down, the eyes stay forward- compared pt to a doll’s eyes
- progressive,
- pseudo-bulbar palsy (facial),
- dementia,
- From Video: gait is wide and staggering (not like parkinson’s with the shuffling)
- I think they lean backwards too (not forwards like parkinson’s)
- pt seems apethetic to their unsteadyness and “plunges ahead”
- From Video: Characteristic speech pattern: spastic speech in combo with ataxic speech
- strained and slow
- syllables grouped into unnatural groups with unnatural pauses
- this speech pattern occurs in almost no other condition
- The video of the guy in his underwear had Progressive Supranuclear Palsy (“don’t worry about his underwear!”)
what are the defining functions of the pontocerebellum?
quick finely controlled limb movement (mainly UE coordination)
Dr. Shappy spent a lot of time talking about an example of Dystonia, Spasmodic Torticollis. We should probalby watch the videos she posted.
- http://www.youtube.com/watch?v=pfDYLYyoUyw
- http://www.youtube.com/watch?v=28kMNZdNHaw
- http://www.youtube.com/watch?v=P6XhHb90ciQ
- http://www.youtube.com/watch?v=ElSYsIQMJZQ
- httphttp://www.youtube.com/watch?v=u_-UO2upGW8
- http://www.youtube.com/watch?v=I1bD5Dun7Ss
Characteristics of Benign MS? (2)
.Benign MS
- (about 20% of MS
- •Mild disease with full function greater than 15 years)
Fragile X:
Treatment
Treatment:
There are some med that can help, but only slow the progression/ does not fix (behavioral, speech, balance, etc). IEPs fdeveloped for education at school
Vestibulocerebellum (Archicerebellum) is composed of which anatomical parts?
Flocculonodular lobe (flocculus and nodule)
Picture: cerebrocerebellum is the same as pontocerebellum
What are the three main parts of the cerebellum callded by their functional names?
vestibulocerebellum
spinocerebellum
pontocerebellum or cerebrocerebellum
Spinocerebellum (Paleocerebellum) is composed of which anatomical parts?
Vermis and intermediate parts of the hemispheres (“paravermis”)
Picture: the cerebrocerebellum is another name for pontocerebellum
