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Neuro > Test 5-Parkinson’s, Vestibular, CNS Degen. Dz, Etc. > Flashcards

Test 5-Parkinson’s, Vestibular, CNS Degen. Dz, Etc. Flashcards

1
Q

Def: An autoimmune disorder characterized by sclerotic plaques throughout the CNS that block or slow neural transmission resulting in weakness, sensory loss, visual dysfunction and other symptoms depending on where the plaques develop in the CNS. It is a disease of the temperate climates such as zones of North America, Europe, Canada, Australia and New Zealand

A

Multiple Sclerosis

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2
Q

Onset of MS is at ___-___ y.o. with whites at greater risk
Co-existing autoimmune disorders are seen in a majority of patients with MS, such as Hashimoto’s dz, _____, IBS, and RA. ______ infection often precipitates an attack of MS.

A

20-40
Psoriasis
Viral

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3
Q

S&S of MS: -80% have ____ symptoms, often double vision, sometimes develop optic ______ (inflammation of optic nerve)

  • Sensory changes (paresthesias, vibratory sense)
  • Muscle weakness- result of ______
  • Lack of _______ and balance
  • Gait deviations
  • Fatigue!
  • Cognitive impairment & depression
  • Spasticity
A

Visual
Optic neuritis
Demyelination
Coordination

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4
Q

Diagnosis of MS:

  • History
  • Neurological exam
  • _____
  • ______ puncture
A

MRI

Lumbar puncture

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5
Q 
(MS) Management of Acute Relapses:
\_\_\_\_\_\_\_\_\_ therapy (methylprednisolone)- anti inflammatory and immunosuppressive effects \_\_\_\_\_ swelling in CNS and decrease T-cell activation. 
Side effects of meds: Mood changes, elevated \_\_\_\_, fluid retention, hyperglycemia. Chronic use  associated with \_\_\_\_\_\_\_, DM, osteopenia.
A

Corticosteroid

Decrease

BP

HTN

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6
Q

Disease modifying therapeutic agents (MS) : Goal is to prevent future disease activity. Synthetic interferon drugs slow down ______ system response by decreasing inflammation and slowing proliferation of T and B cells.
Side effects- injection site reactions, ___-like symptoms.

A

Immune

Flu-like

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7
Q

Clinical Subtypes of MS:
_____-_____ (85%) : Periods of exacerbations (relapse) followed by full or partial recovery (remission). Periods between relapses- no dz progression.

_____ _____: Relapsing-remitting course followed by progressive, irreversible decline

_____-_____: no discrete attacks, steady progression of disease

A

Relapsing-remitting

Secondary Progressive

Primary-Progressive

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8
Q

Def: Progressive disorder of CNS affecting the basal ganglion (loss of dopamine) Has insidious onset with slow rate of progression.

A

Parkinson’s disease

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9
Q

Motor symptoms from Parkinson’s disease:
Rigidity- increased resistance to passive motion; 2 types:
1) _____- extremity catches
2)_____- stiff
“_______” tremor- seen at rest

A

Cogwheel rigidity
Lead pipe rigidity
“Pill-rolling” tremor

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10
Q

Def: slow to move

motor symptom of Parkinson’s

A

Bradykinesia

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11
Q

Non-motor symptoms of PD:

  • Loss of ____
  • Sleep disturbance
  • Mood disorders
  • Orthostatic ______
  • Bladder dysfunction
  • Difficulty _____/______
  • Confusion, _______
A

Smell

Hypotension

Speaking/swallowing

Dementia

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12
Q

Etiology of PD:

Combination of _____, ______, and ______ influences

A

Genes, environment, and lifestyle influences

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13
Q

Function of basal ganglia:

A

Helps to plan, initiate, and control movements

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14
Q

Potential Protective Factors (PD):

  • Caffeine
  • High _____ acid levels in men
  • _________ drugs
  • Statins
  • Vitamin ___
  • Exercise
A

Uric acid
Anti-inflammatory
Vit D

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15
Q

Early warning signs of PD:

A
  • Tremor or shaking
  • Small handwriting (sudden change)
  • Loss of smell (foods like bananas, dill pickles, licorice)
  • Trouble sleeping (thrashing, falling out of bed)
  • Trouble moving or walking (stiffness, arms don’t swing)
  • Constipation
  • Soft or low voice
  • Masked face (serious/mad looking)
  • Dizziness or fainting (due to low BP)
  • Stooping or hunching
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16
Q

Pharmacology (PD):
_____/_____ (Sinemet) - pt needs to be on a fixed schedule
Benefits: Bradykinesia, rigidity
Side effects: Hallucinations, depression, insomnia
**High ____ diet can alter effects

A

Levodopa/Carbidopa

Protein

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17
Q

Deep Brain Stimulation (for PD):
[Thalamic/Subthalamic stimulation]
Benefits- Helps control _____
Side effects- More difficulty _____

A

Control tremors

Difficulty Walking

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18
Q

Typical cause of death in people with Parkinson’s:

A

Respiratory related

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19
Q

Interventions for PD:
Pg664 pathology

Improving movement-

A
  • Walking sideways
  • Rocking body to generate weight shift
  • Stamping feet, shaking legs
  • Self-talk
  • Stepping over objects (handle of cane, etc)
  • Quick head movements
  • Music
  • Clapping/snapping
  • VR
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20
Q

Interventions for PD:

Big red pg788-789

A

-Simple blocked practice tasks with many repetitions
-Have pt focus on their movements (use mirrors)
Ex. Have patient focus on swinging their arms during gait, or walk fast, or take large steps
-Visual cues important (tape, laser,etc)
- RAS (Rhythmic auditory Stimulation), metronome, music with steady beat; can help improve gait speed, cadence, and stride

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21
Q

Interventions for PD (cont):

Look at of 793-7796 Big Red

A
  • BIG movements with whole body, repetitive, high intensity
  • Flexibility Ex. (PROM & AROM)
  • Additional VC and TC to encourage maximum range
  • Strength training
  • -Functional training (bridging, pelvic tilts, rolling, sit-stands, quadruped-kneeling-half kneeling-standing)
  • Balance training
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22
Q

(Subtype of MS) - First episode of inflammatory demyelinating of CNS that could become MS if additional activity occurs. Not active= no clinical Relapses or new MRI activity
Active= With relapses or new evidence on MRI in which case it becomes relapsing remitting

A

Clinically Isolate Syndrome

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23
Q

Treatment for MS:
-Alternate days, during optimal times such as in the ______ when core body temp is lowest.
-Balance exercise with rest breaks to AVOID _______! Ex. to point of fatigue is a contraindication.
-Group ex valuable motivation
-Strengthening, aerobic 3 days/week (alternate days) walking, _______, swimming
Prevent patient from _________.

A

AVOID OVERWORK
cycling or water aerobics
*also gait training, flexibility, balance, spasticity mgmt

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24
Q

What kind of approach is essential for patients with MS?

A

Team approach!

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25
Q

Def: Terminal progressive disease; loss of motor neurons in lateral spinal cord, brainstem and motor cortex. Onset mid to late 50s; asymmetrical weakness in arm or leg usually begins distally and moves proximally. Weakness of bulbar (facial) muscles, causing dysphagia. Effects extensor mm more than flexors. Fasciculations of muscles (random twitching, muscle cramps)

A

ALS (Amyotrophic Lateral Sclerosis)

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26
Q

Diagnosis of ALS:
Presence of ____ and ____ findings
-weakness, atrophy, fatigue, hyperreflexia
-EMG changes (fibrillations and fasciculations)
Prognosis: Death usually occurs within __-__ years post dx, typically due to _______ complications.

A

UMN and LMN
2-5 yrs
Respiratory complications

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27
Q 
PT for ALS patients:
Early stage ALS- \_\_\_\_\_\_\_ resistance can increase strength in mm grade 3/5 or higher.
Avoid heavy \_\_\_\_\_ exercise.
Avoid heavy \_\_\_\_\_\_ or \_\_\_\_\_ reps.
Review pg. 733 in Big Red
A

Moderate
Eccentric
Heavy Resistance or high reps

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28
Q

Def: Neurodegenerative genetic disorder—autosomal dominant inheritance; fatal disease. Dominated by involuntary, sustained muscle contractions frequently causing twisting and repetitive movements and abnormal postures. Marked loss in brain volume.

A

Huntington’s disease

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29
Q

S&S of Huntington’s:

  • ______ (Jerky, random and uncontrolled movements)
  • Depression
  • _______
  • Psychiatric disorders
A

Chorea

Dementia

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30
Q

Medical Management of Huntington’s Dz:

  • family history, DNA samples, MRI of brain
  • Treating symptoms
  • Pharmacological mgt of chorea available but side effects include pseudoparkinsonism, akinesia, restlessness
A

*prognosis of death on avg 15-20 years post onset. Increasing disability and mental changes

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31
Q

PT interventions (Huntington’s):

A
  • safety
  • gait
  • freezing during gait can occur
  • ADL training
  • DME
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32
Q

4 types of dizziness:
_______: Room is spinning around the patient
______: Woozy, disconnected from environment
_____: Feels unsteady, off-balance
_____: Precursor to fainting, feeling of about to lose consciousness

A

Vertigo
lightheadedness
Disequilibrium
Pre-syncope

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33
Q

2 types of vertigo-associated disorders:

A

Central (Brain, brain stem or cerebellum)

Peripheral (Semicircular canal or vestibular nerve)

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34
Q

Which type of vertigo-associated disorder?
(Central or peripheral)
-Blood vessel disease, MS, seizures, CVA, tumors, vestibular migraine. Meds: Anticonvulsants, ASA, ETOH

A

Central

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35
Q

Which type of vertigo-associated disorder? (Central or peripheral)

  • BPPV
  • Inflammation of vestibular nerve
  • Labyrinthitis
  • Meniere disease
  • Meds: certain Abx, diuretics
A

Peripheral

36
Q

A patient with peripheral hypofunction would have what type of tests done?
*This is typically a result of an infection, patient may report an upper respiratory infection shortly before onset of extreme dizziness for a few days

A

Head thrust test
Dynamic visual acuity test
VNG testing

37
Q

Cervicogenic dizziness- Patient will report they feel like they are moving, not that the room or their surroundings are moving. Often use words like “______” “floating” “funny headed”

A

“Fuzzy”

*Symptoms are usually able to be connected the head movement or position. Reproduction of symptoms with cervical AROM testing, cervical joint mobilization and/or cervical soft tissue palpation

38
Q

Def:Spinning, lasts greater than 60 seconds, associated with changes in position. Nystagmus that corresponds to the tested canal.

A

BPPV

39
Q

What are the tests that are done to diagnose BPPV?

A

*Dix Hallpike
Roll test
Side lying test
Bow and lean

40
Q

What does BPPV stand for?

A

Benign -Doesn’t cause further illness
Paroxysmal-Temporary and sudden onset
Positional -Related to changes in body position
Vertigo-The false sensation of spinning

41
Q

BPPV occurs when calcium crystals/debris called “ear rocks” (otoconia) detach and fall into semicircular canals, usually the posterior canal, when this happens as the patient moves their head the crystals move inside the canal, irritate the hair follicles and nerve endings causing vertigo

A

The more you know

42
Q

Canalithiasis: Created endolymph movement; _____ lasting
Cupulolithiasis: Debris adheres to cupula, causes input conflict between right and left sides; ____ lasting

A

Short <60 sec

Long >60 sec

43
Q

Dix Hall Pike test:
Cervical- ____ deg rotation, ___ deg extension
Avoid gaze fixation
Nystagmus named for fast phase

A

45

30

44
Q

What two symptoms are required for a positive confirmation of BPPV?

A

Vertigo and nystagmus

45
Q

Prior to testing or treatment for BPPV what test should be performed?

A

Vertebral artery clearance test

46
Q

What is the most common treatment for BPPV of the posterior canal?

A

Epley maneuver

*there’s also the half somersault

47
Q

Def:This reflex controls our movements to stabilize images during head movements. As the head moves in one direction, the eyes reflexively move in the other direction

A

Vestibulo-ocular reflex

*Gaze stabilization exercises from lab

48
Q

BPPV treatment includes:

1) Negative vertebral artery test
2) Canolith repositioning (epley)
3) _____-_____ exercises
4) ____ training
5) Pt education- fall prevention

A

Vestibular-ocular

Balance

49
Q

What is the simplest way to address a convergence Impairment (Oculomotor impairment)?

A

Pencil push-ups or thumb push-ups
*Patient is instructed to focus on a pencil or their own thumb at arms length away against an uncluttered background and bring the target closer to their face until it becomes double.

50
Q

Contraindications to vestibular rehab:

  • Patient not appropriate for unstable vestibular disorders such as _______ disease or uncontrolled migraine.
  • Sudden loss of _____
  • Severe ringing in one or both ears
  • Postop patients with fluid discharge from ears or nose which could indicate _____ leak
  • Acute neck injuries
A

Ménière’s disease
Sudden loss of hearing
CSF leak

51
Q

What are the three leading causes of death?

What was third leading cause of death in 2020?

A

Heart disease
Malignant neoplasms
Chronic respiratory disease

COVID-19 duh

52
Q

Name three examples that are modifiable risk factors of aging:

A

Activity
Smoking
Diet

53
Q

As we age articular cartilage changes, loss of ____ content, thinner, impact of obesity.
Functional implications?

A

Water

Decreased range of motion
Less shock absorption
Osteoarthritis
Gait deviations

54
Q

With aging collagen loses water content, loss of elastic fibers, cross-linking of fibers. This results in decreased joint ____, increased joint _____, skin sagging, internal organs not well supported

A

ROM

Stiffness

55
Q

Changes in the spinal column due to aging: intervertebral discs lose water, ______, decreased height> kyphosis and spinal _____.
PT intervention: strengthening, endurance, ________, ______ stability (TA & Multifidus), balance, pain management

A

Compress
Stenosis

Flexibility
Core stability

56
Q

Bones begin to have decreased mineral density in the ___ decade of life.
What sort of exercise is important for this and what is important to consume enough of for prevention?

A

3rd

WB exercise

Calcium, Vit D

57
Q

Treatment of osteoporosis:

  • women over 50 should have ____ mg Ca/day
  • Vit __
  • ____ ____ exercise
  • Emphasize ______
  • Resistive exercise
  • Biphosphonates
A

1200
Vit D
Weight bearing
Extension

58
Q

Def: Age related loss of muscle mass; leads to increased risk of falls, decline in muscle strength, rate of force development (Type II fast twitch fibers atrophy more than slow twitch fibers)

A

Sarcopenia

59
Q

Def: Decrease in systolic blood pressure about 20 mmHg When a patient moves from supine to sit or sit to stand. Causes include adverse effects of medication, dehydration, anemia, arrhythmias, immobility or autonomic dysfunction related to diseases like diabetes, Parkinson’s, and CNS impairments

A

Orthostatic hypotension

60
Q

Respiratory system changes with age: vital capacity decreases, calcification of ribs and costal cartilage, thoracic kyphosis.
Lungs do not empty as well and ______ volume increases.
PT interventions: ______ correction, breathing ex, good hydration, full UE ROM

A

Residual volume

Postural

61
Q

Changes in the nervous system with aging:
Much of the brain mass loss that is seen with aging is due to decrease in _____ _____ and due to loss of ______.

Exercises to help speed reaction time?

A

White matter

Myelin (cerebellum highly myelinated)

Perturbations, ball tossing, etc

62
Q

Structural changes in the skin contribute to decline in ability to detect ______, _______, pain and vibration with aging.

A

Touch, temperature

63
Q

Leading cause of injury-related deaths in elderly:

A

Falls

*Fall cycle: Fall, fear of falling again, less activity, decreased mm strength & balance, increased risk of falling

64
Q

What is the common side effect from many meds that leads to falls?

A

Postural hypotension

65
Q

Delirium or dementia?

: acute onset, usually reversible

: insidious onset, slow progression

A

Delirium

Dementia

66
Q 
Mini-Mental State Exam (MMSE):
Scoring- 
\_\_\_/\_\_\_ normal
23-19/30 mild cognitive impairment 
18-\_\_\_/30 moderate impairment 
\_\_ or less severe impairment
A

24/30 (normal)

23-19/30 (mild)

18-10/30 (moderate)

9 or less (severe)

67
Q

Benefits of Ex. for older adults:

  • Slowing physiological changes of aging
  • Optimizing body composition
  • Supporting psychological and cognitive health
  • Managing chronic disease
  • Minimizing risk of physical disability
A

Yup

68
Q

Multidimensional Plan of Exercise for geriatric patients includes:

A

Aerobic
Flexibility
Balance
Resistance Ex

69
Q

Aerobic exercise for the older adult:
Minimum of ___ min Moderate intensity ___ days/week or ___ min Vigorous intensity __ days/week

“_____ Test” correlates with “moderate” intensity level and only a few words and only a few words without a breath is “vigorous “

A

30 min 5 days/wk (mod intensity)

20 min 3 days/wk (vigorous)

“Talk test”

70
Q

Flexibility and Exercise for older adults:
Low intensity, _____ duration is safest and most effective

Use the newly gained ROM in ADL’s

A

Long duration

71
Q

Resistance Exercise for older adults:

>60% 1 RM x 3 sets for minimum of 12 weeks for benefits

A

You remember everything ever, right?

72
Q

Signs of Elder abuse

4 areas

A

Physical
Psychological
Neglect
Financial

73
Q

Def: Demyelinating, inflammatory polyneuropathy. Lower motor neurons involved- flaccid paralysis. Often preceded by a respiratory or GI illness (campylobacter); good overall prognosis

A

Guillain-Barré syndrome

74
Q

Symptoms of Guillain Barre:

  • Symmetrical muscle weakness begins in _____ and [ascends or descends?]
  • Paresthesias in ______ and ____
  • Absent or depressed ____ ____ reflexes
  • Severe _____ muscles weakness often requiring a ventilator
A

Legs and ascends

Hands and feet

Deep tendon reflexes

Respiratory

75
Q

The main modalities of disease modifying therapy for Gillian Barre are ______ exchange and intravenous immune _____ (IVIG)

A

Plasma

Globulin

76
Q

Pathophysiology of GB:

  • Infection-induced immune response causes _____ to be destroyed.
  • Schwann cells of PNS are destroyed but _____ are intact.
  • Symmetrical ascending Progressive loss of motor function
  • Paresthesia/pain
  • May involve diaphragm requiring mechanical ventilation
  • 2-3 weeks after onset the Schwann cells begin to proliferate and ________ begins
A

Myelin
Axons
Remyelination

77
Q 
PT intervention (GB):
Acute phase- ROM ex. in pain free range, positioning, AVOID \_\_\_\_\_\_ of muscles, supported coughing, monitor changes in muscle strength
A

Avoid Fatigue

78
Q 
PT Intervention (GB):
Plateau Phase- Symptoms stabilize. Lasts up to 4 weeks. Slowly begin getting pt. back to \_\_\_\_\_\_\_ positions, stretching, active ex. Over\_\_\_\_\_\_ or overuse of painful muscles may stall or prevent recovery.
A

Upright

Overstretching

79
Q 
PT intervention (GB):
Recovery phase-
Gradual recovery after plateau phase. Muscle return in \_\_\_\_\_\_ order, WB, tilt table, aquatics, strengthening (avoid fatigue). This phase may last up to 1 year.
A

Reverse order (proximal to distal)

80
Q

Polio: virus attacks anterior horn cells in spinal cord

S&S:

A 
Muscle weakness
Pain
Atrophy
Bulbar (respiratory and swallowing) 
- All of these combined leads to loss of function and difficulty with ADLs
81
Q

Nonfatiguing Exercise protocols:
(Post-polio)
-Target HR, low range, 60-70% (Aerobic), 3x per week, 15-30 min, walking, swimming, stationary bike

-(strengthening) 60-80% of one repetition maximum, 3-5x per week, goal of 5-10 reps, concentric ex

A
  • monitor HR, BP, RPE (“hard”)

* *Avoid overuse of muscles

82
Q

Def: Most common in women over 50, symptoms range from mild to severe facial pain (sharp, “lightning bolt”). Triggered by chewing, speaking, brushing teeth, shaving, washing face, drinking, talking

A

Trigeminal neuralgia

CN V, facial sensation and chewing

83
Q

Medical mgmt for trigeminal neuralgia:

  • Anticonvulsants (tegretol, Dilantin, klonopin)
  • Botox injections
  • Surgical _______ of nerve
  • gamma knife surgery
A

Surgical Decompression

84
Q

Def: Autoimmune disorder which affects the neuromuscular junction and motor endplate. Acetylcholine receptors are decreased in number, without ACh, the nerve impulses fail to cross the neuromuscular junction to stimulate muscle contraction

A

Myasthenia Gravis
*Clinical presentation: Exacerbations in remission of muscle weakness and muscle fatigue. Rest restores activity. Eyelid muscles and muscles of mastication are some of the first to show signs of fatigue. May also have fluctuating weakness in proximal muscles

85
Q

PT intervention for myasthenia gravis:

  • _____ ______ techniques
  • Monitor for signs of fatigue
  • Avoid strenuous exercise, stress and exposure to ________ extremes
A

Energy conservation

Temperature

86
Q

LSVT BIG Exercises:

  • Floor to ceiling
  • Side to side
  • Forward step and reach
  • Sideways step and reach
  • Backwards step and reach
  • Forward rock and reach
  • Sideways rock and reach
A

Big ol boy

Neuro (6 decks)

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