Term
| What is Multiple Sclerosis |
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Definition
| -Chronic disabling demyelinating dz of the CNS |
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Term
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Definition
-multiple neurological signs and symptoms determined by the location of the lesions
-periods of exacerbations and remissions |
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Term
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Definition
| the proliferation of neuroglial tissue within the CNS and results in glial scars(plaques) |
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Term
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Definition
-characterized by relapses with either full recovery or some remaining neurological S&S and residual deficit upon recovery
-the periods between relapses are characterized by lack of dz progression |
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Term
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Definition
| -characterized by dz progression from onset, without plateaus or remissions or without occasional plateaus and temporary minor improvements |
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Term
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Definition
| -characterized by initial relapsing-remitting course, followed by progression at a variable rate that may also include occasional relapses and minor remissions |
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Term
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Definition
-Characterized by progressive dz from onset but without clear acute relapses that may or may not have some recovery or remission
-common in people who develope dz after 40 |
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Term
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Definition
| -characterized by rapid progression leading to significant disability or death within a relatively short time after onset |
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Term
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Definition
-a common sign of posterior column damage in the spinal cord
-flexion of the neck produces an electric shock-like sensation running down the spine and into the LE |
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Term
| What are some general common symptoms of MS |
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Definition
-Sensory impairment
-Pain
-Visual impairment
-Cognitive impairment
-Emotional
-Motor impairment
-Bladder involvement
-sexual dysfunction
-Bowel involvment
-Speech and swallowing dysfunction |
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Term
| What is a exacerbation in MS |
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Definition
| -new and recurrent MS symptoms that last at least 24 hours and are unrelated to another etiology |
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Term
| What is pseudoexacerbation related to MS |
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Definition
-temporary worsening of MS symptoms
-typically comes and goes quickly, usually about 24 hours |
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Term
| What is Uthoff's symptoms |
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Definition
| -an adverse reaction to heat that brings about a pseudo-attack |
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Term
| What factors can cause an exacerbation or pseudoexacerbation |
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Definition
-Uthoff's symptom
-viral or bacterial infection
-dz of major organs
-major life stress events
-hyperventilation, malnutrition, exhaustion, dehydration, sleep deprivation |
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Term
| Examples of Somatosensory impairment in MS |
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Definition
-Paresthesias: pins and needles
-Dysesthesias: abnormal burning or aching
-Hyperpathia: hypersensitivity to minor stimuli
-Trigeminal Neuralgia
-Lhermitte's sign |
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Term
| What are some interventions for sensory impairments in MS |
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Definition
-Substitute with other systems
-Augment with weights, resistance, approximation
-teach skin care and precautions to prevent breakdown
-manage pain |
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Term
| how might you manage the pain in MS |
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Definition
-if musculoskeletal: use seletive stretching or exercise, splinting, US, massage, or other tissue technigues and modalities
-Pressure garments and other means to apply neutral warmth |
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Term
| what are some general visual impairment with MS |
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Definition
-Nystagmus: common with cerebellar or vestibular involvment
-Diplopia occurs with uncoordinated muscle activity
-Optic neuritis: inflamation of the optic nerve; produces an ice-pick like pain behind the eye
-Scotoma: dark spot that may occur in the center of the visual field
-may lead to significant balance deficits |
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Term
| Interventions for visual impairments in MS |
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Definition
-Patching for diplopia can be a temporary solution, especially if working on balance
-compensatory measures to increase safety during movement activities |
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Term
| problems with motor impairments with MS |
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Definition
-Weakness can indicate damage to the corticospinal tracts or motor cortex
-poor motor unit recruitment results in slow, stiff, and weakened movement
-weakness can vary from mild paresis to total paralysis
-prolonged inactivity and disuse can also result in weakness |
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Term
| Common motor impairments of MS |
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Definition
-Weakness
-Fatigue
-Spasticity
-Balance and coordination
-Ambulation and mobility |
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Term
| Strengthening procedures for MS |
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Definition
-Submaximal exercise intensities with increased repititions
-balance exercise with adequate rest
-avoid exercising to the point of fatigue
-exercise at times when the patient is rested and body core temp is lowest
-exercise in a cool environment
-emphasize proximal muscle strengthening
-PNF patterns work well to help reduce increased tone
-light weights may help stabilize a patient with tremor |
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Term
| Characteristics of spasticity in MS |
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Definition
-Very common
-range from mild to severe
-greater in LE than UE
-extensor tone more predominate
-does not diminish during remission
-during advanced MS, can be difficult to manage |
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Term
| Inverventions for spasticity in MS |
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Definition
-Stretching
-Rotation
-Reciprical inhibition with active exercises
-positioning
-other inhibitory techniques |
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Term
| Characteristics of fatigue in MS |
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Definition
-High percentage of pts report fatigue interferes with function
-over half report fatigue as the most serious symptom
-aggravated by heat and emotional distress |
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Term
| Interventions for fatigue in MS |
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Definition
-energy conservation technigues
-pacing activities
-careful application and monitoring of exercise
-assistive devices
-home modifications |
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Term
Coordination/balance impairments in MS
Ataxia |
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Definition
-combination of dysmetria, dyssynergia, and dysdiadochokinesia
-progressive ataxia of the trunk and LE
-Intention tremor and postural tremor can be present
-with lesions in the cerebellum, patient can experience vertigo, nausea, and disequilibrium
-can be somatosensory ataxia |
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Term
| Interventions for coordination/balance in MS |
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Definition
-Improve static control in a variety of weight bearing positions
-progress to dynamic control
-aquatics: provides support but helps slow ataxic movements
-facilitation or inhibition to promote controlled movement
-may treat central vestibular dysfunction |
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Term
| how would you improve static control |
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Definition
-rhythmic stabilization
-joint approximation
-strengthening of proximal muscles |
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Term
| How could you improve dynamic control |
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Definition
-PNF
-functional training
-Frenkel's
-weight shifts
-etc.... |
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Term
| How do you treat for central vestibular dysfunction |
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Definition
-use techniques known to be sucessful with peripheral dysfunction
-may not work as quickly and not as predictably |
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Term
| characteristics of cognitive and behavior problems with MS |
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Definition
-cognitive deficits seen in about 50%, and are related to the location of the lesions
-memory, attention, concentration, reasoning, reaction time, and excutive functions are examples
-emotional dysregulation and bipolar affective disorder in advanced stages
-depression |
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Term
| What are speech problems resulting from MS? |
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Definition
-muscle weakness, spasticity, tremor, or ataxia
affect as mant as 40% |
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Term
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Definition
| -slurred or poorly articulated speech with low volume, unnatrual emphasis, and slow rate |
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Term
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Definition
| changes in vocal quality including harshness, hoarseness, breathiness, or hypernasal sounds |
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Term
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Definition
-difficulty in swallowing
-caused by poor coordination of the tongue and oral muscles |
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Term
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Definition
| -Chronic and progressive dz of the central nervous system |
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Term
| what clinical manifestations is PD characterized by |
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Definition
-Rigidity
-Bradykinesia or akinesia
-Tremor
-Postural instability |
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Term
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Definition
-group of disorders that produce abnormalities of basal ganglia function
-Parkinson's dz = primary parkinsonism |
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Term
| What is secondary Parkinsonism |
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Definition
| -a number of different causes, such as medications, infections, toxins |
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Term
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Definition
-other neurodegenerative dz that affect the basal ganglia in addition to other brain structures
-does not respond to anti-Parkinson meds |
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Term
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Definition
| -control symptoms and slow progression |
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Term
| Pharmacological management of PD |
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Definition
-L-dopa
-Neuroprotective therapy (MAOs)
-dopamine inhibitors
-anticholinergic agents |
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Term
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Definition
-L-dopa
-used to decrease bradykinesia and rigidity
-long term use and increased dosage can result in decreased effectiveness |
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Term
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Definition
-anorexia, nausea, vomiting, constipation
-mental restlessness, over activity, anxiety
-orthostatic hypotension
-dyskinesia
-sleep disturbances |
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Term
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Definition
-Monoamine Oxidase Inhibitors
-improve dopamine metabolism |
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Term
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Definition
-used in combination with L-dopa to improve effectiveness
-reduce rigidity, bradykinesia, and motor fluctuations |
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Term
| Medication impact on treatment |
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Definition
-will have a direct impact on treatment success
-must be monitored |
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Term
| Nutritional management of PD |
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Definition
-high protein diets can block the effectiveness of dopamine replacement
-amino acids compete with L-dopa absorption |
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Term
| Surgical management of PD |
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Definition
-Stereotaxis surgery: surgical lesioning (Pallidotomy, thalamotomy)
-deep brain stimulation: blocks nerve signals that cause the symptoms
-transplantaion of dopamine delivering cells |
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Term
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Definition
-typically unequal in distribution
-progresses proximal to distal
-initially unilateral, progressing to whole body
-Lead pipe
-cogwheel
-can be exacerbated by mental concentration, emotional tension, or active movements |
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Term
| secondary complication of rigidity |
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Definition
-decreased ROM
-postural deformity (kyphosis)
-decreased respiratory capacity
-inability to express postural adjustments for balance
-loss of reciprical gait movements |
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Term
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Definition
-absence of movemnt
-responsible for moments of "freezing" often seen with PD
-directly influenced by degree of rigidity, stage of dz, and drug actions |
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Term
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Definition
-slowness and difficulty maintaining movement, changing speed, and changing direction
-results in prolonged movement times during functional activities and loss of automatic movements
-often the most disabling sign of PD
-leads to increased dependence in ADL |
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Term
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Definition
-described as resting tremor
-less severe when person is rested and/or when occupied
-aggravated by emotional stress and fatigue |
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Term
| postural instability with PD |
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Definition
-1/3 of PD patients experience falls
-1 in 10 fall more than once per week
-patients have increasing difficulty with dynamic destabilizing activities |
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Term
contributing factors
poor cocontraction of trunk muscles during periods of instability |
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Definition
-bradykinesia/akinesia
-weakness
-fatigue |
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Term
contributing factors
-inability to use normal postural balance stategies or delayed manifestation of strategies |
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Definition
-rigidity
-weakness
-fatigue
-bradykinesia/akinesia or hypokinesia |
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Term
contributing factors
-reduced feed-forward adjustments |
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Definition
-rigidity
-weakness
-bradykinesia/akinesia or hypokinesia |
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Term
contributing factors
-loss of trunk extensor strength and postural changes that position the patient closer to anterior LOS |
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Definition
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Term
contributing factors
-inability to adapt movement strategies to a changing sensory environment |
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Definition
| -difficulty processing visual, vestibular, and somatosensory info |
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Term
| What are some other problems with PD |
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Definition
-difficulty sequential tasks
-reduction in control of habitual motor routines
-difficulty integrating two motor plans at the same time
-freezing
-fatigue
-masked face
-bradyphrenia: may have a significant impact on sucess of therapy due to increased time for thought processing
-depression
-swallowing and communication ds
-visual and sensorimotor changes
-musculoskeletal changes
-autonomic dysfunction
-cardiopulmonary dysfunction |
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Term
| visual and sensorimotor changes with PD |
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Definition
-decreased blinking
-decreased eye pursuit
-decreased visual reflex responses |
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Term
| musculoskeletal changes with PD |
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Definition
-decreased flexibilty
-malalignments |
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Term
| Autonomic dysfunction with PD |
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Definition
-excessive sweating
-increased salivation
-bladder dysfunction
-impotence |
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Term
| cardiopulmonary dysfunction with PD |
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Definition
-bradykinetic disorganization of respiratory movements
-decreased chest expansion
-deconditioning |
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Term
| Early stage intervention with PD |
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Definition
| -cognitive strategies or internal cues may be effective |
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Term
| late stage intervention with PD |
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Definition
| -external cues and adapting the environment are more effective |
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Term
| Intervention for rigidity, loss of flexibilty and loss of mobility |
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Definition
-slow, rhythmic vestibular input and rotation for overall relaxation
-respiratory exercises and techniques
-PNF: rhythmic initiation to improve movement initiation
-strengthening to counteract flexed posture
-ROM with emphasis on counteracting the flexed posture |
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Term
| strengthening consideration with PD |
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Definition
| -be cautious when applying resistance so as not to increase tremor and muscle tension |
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Term
| flexed posture and ROM with PD |
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Definition
-positioning: low load, long duration stretch
-PNF to increase ROM: contract-relax to decrease specific joint limitations
-joint mobilization
-emphasize head, trunk, and pelvic rotation |
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Term
| Intervention for bed mobility and transfers with PD |
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Definition
-emphasize safe performance
-if a patient is able, mentally rehearse the action sequence before initiating movement
-decompose movement sequences: break down the movement sequences
-pay attention to the mechanics of a task and the equipment used |
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Term
| Early stage interventions for gait and balance with PD |
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Definition
-conscious attention to the gait pattern
-use of video equipment, cameras, and mirrors to increase patient self awareness of problems, especially alignment
-emphasize increasing gait velocity, step length, and arm swing with focus on heel strike
-use music or a pacing partner to facilitate velocity and reprocation
-activate central pattern generators |
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Term
Later stage intervention for gait and balance with PD
-Freezing episodes |
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Definition
-identify what may trigger the episode
-observe which leg/foot has a greater tendency to freeze
-use visual cues
-rhythmic cues
-tips on other areas
-retropulsion
-propulsion (festination): identify trigger and compensate |
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