Flashcards in Degenerative Neurologic Disorders Deck (51)
Be able to describe, as if speaking to a client, what is causing the symptoms of Multiple Sclerosis
Mayo Clinic: In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged.
Pedretti (pgs. 936-937): MS is a progressive, inflammatory neurologic disease that damages the myelin sheath of the central nervous system (CNS). The myelin sheath is the covering over our nerve fibers.
Be able to describe, as if speaking to a client, what is causing the symptoms of Parkinson's Disease
There is a part of your brain called the substantia nigra and it plays an important role in collaborating with your body to help you move. This part of your brain undergoes significant deterioration as your disease progresses. Lewy bodies, or an accumulation of protein, form in your neurons and can disrupt the signals the nerves are trying to send. The reduction in dopaminergic neurons, or cells that communicate within this portion of your brain, causes a decrease of activity within another area of your brain called the basal ganglia, which is responsible for initiating movement. This process causes a reduction in “spontaneous” movement, which translates to your difficulty to walk or initiate movement, your tremors, and your slowness of movement.
Pedretti (pgs. 940-941): PD is a slowly progressive, degenerative movement disorder, characterized by dysfunction in voluntary & involuntary movements. It is due to the degeneration, or breakdown, of different structures in the brain. One of these brain structures is called the substantia nigra; within the substantia nigra are dopamine neurons – when there is a reduction of these dopamine neurons, there is a decrease in activity within the basal ganglia and an overall reduction in “spontaneous movement.” The basal ganglia is another brain structure associated with movements (repetitive & sub-conscious) along with motor commands, so it makes sense that some of the symptoms of this disease are difficulty initiating movement & slowness in maintaining movement. Not only is there a reduction in dopamine neurons, but Lewy bodies are also found in the brain, within the substantia nigra (abnormal collections of proteins that are found inside the nerve cells)
Be able to describe, as if speaking to a client, what is causing the symptoms of Alzheimer’s Disease
Many of the neurons in your brain die or lose the ability to communicate with other neurons. This is due to the accumulation of plaques, which are clumps of proteins that interfere with neuron communication, and tangles, which disrupt the nutrient transport system within your brain and lead to neuron death.
Be able to describe, as if speaking to a client, what is causing the symptoms of Amyotrophic Lateral Sclerosis (ALS)
While the exact cause of ALS is unknown, we do know that the motor neurons, or neurons that tell your muscles to move, are becoming destroyed in your spinal cord, brainstem, and motor cortex. All of these are areas of the brain that are related to voluntary or involuntary movement.
Be able to describe, as if speaking to a client, what is causing the symptoms of Huntington’s Disease
Degeneration of the areas of the brain that control voluntary and involuntary movement as well as cognitive and emotional functions
Pedretti (pgs. 932-933): HD is degenerative brain disorder that is characterized by progressive deterioration in both voluntary & involuntary movement. There is a structure in the brain called the corpus striatum (the caudate nucleus & the putamen comprise this structure) and it is involved with motor control – when this area deteriorates, chorea (rapid, involuntary, irregular movements) occurs. Degeneration of this brain structure results in decreased production of the neurotransmitter GABA. Emotional & cognitive impairments also occur; progressive loss of tissue actually occurs in these brain areas: frontal cortex, globus pallidus, & thalamus.
What is the typical age(s) of onset for MS?
Age at onset ranges from 15 to 60 yr, typically 20 to 40 yr; women are affected somewhat more often.
Pedretti (pg. 936): between ages of 20-45 years; some studies have found persons younger than 20 displaying MS symptoms
What is the typical age(s) of onset for Parkinson’s Disease?
Prevalence increases with age; 55+ (1.4%); diagnosis most often made after the age of 60; prevalence of PD in men ages 55-74 is higher, but after the age of 74, women show slightly higher prevalence
What is the typical age(s) of onset for Alzheimer’s Disease?
30-40 early onset (uncommon)
What is the typical age(s) of onset for ALS?
between ages of 40-70 (avg. age 55)
What is the typical age(s) of onset for Huntington's Disease?
Pedretti (pg. 933): person usually experiences an onset of symptoms in his/her 30’s or 40’s, but there have been reported cases in teenage years and younger
Cognitive changes play a role in all of these neurological conditions, except which one?
What are the typical symptoms seen in the early stages of MS?
- Visual loss in one eye
- Emotional lability
- Sensory loss in extremities
- Worsening of symptoms when temperature is elevated
- Cognitive deficits in 30-70%
What are the typical symptoms seen in the advanced stages of MS?
- Varying degrees of paralysis (total lower extremity paralysis to involvement of upper extremities)
- Dysarthria, dysphagia
- Severe visual impairment
- Neurogenic bladder
- Impaired cognition
What are some OT assessment strategies for MS?
- Occupational profile
- Interviews, observation
- Home eval
- Instruments to assess occupational performance across SLAPWIRE
- Special attention to: motor/praxis, sensory-perceptual, emotional reg, cognitive, and communication
- The Modified Fatigue Scale
- Fatigue Questionnaire
- Perceptual processing and cognitive status should be reassessed periodically (helps decide how much supervision client needs)
- Evaluation of cultural, social, & physical environment (generally hits “sandwich generation”)
- Assessing performance patterns
What are some typical interventions for MS?
- Educate caregivers and client about disease and supports
- Problem-solving compensatory strategies
- Time & energy management
- Role delegation
- Using adaptive equipment to compensate for motor, sensory, endurance, cognitive, & visual deficits
- Exercise program
What are the typical symptoms seen in the early stages (Stages I-II) of Parkinson's?
I: Unilateral resting tremor, micrographia (tiny handwriting), poor endurance, fatigue
→ No impairment in functional abilities, but fatigue can affect performance
II: Bilateral motor disturbances, mild rigidity reported, difficulties with simultaneous tasks, difficulties with executive function, stooped posture but can ambulate independently
→ Client should think about pros & cons of remaining employed
What are some OT assessment strategies for the early stages (Stages I-II) of Parkinson's?
- Occupational profile to establish goals/priorities
- Home evaluation
- Ergonomic assessment
- Evaluate energy levels as client performs ADLs/IADLs
- Assess ADLs and IADls (Activity analysis)
- Driving assessment
What are some typical interventions for the early stages (Stages I-II) Parkinson's?
- Educate client/ family on course of disease & community resources
- Work simplification for work/home
- Taking rest breaks
- Time management
- Utensils w/ built-up handles
- Energy conservation for ADLs
- Daily flexibility exercises (trunk rotation)
- Alternatives for community mobility
What are the typical symptoms seen in the middle stages (Stages III-IV) of Parkinson's?
III: Balance problems with delayed reactions, difficulties in skilled sequential tasks
→ Safety concerns while standing (showering, meal prep) & walking
IV: Fine motor control severely compromised, oral motor deficits
→ Significant deficits in completing ADLs (esp. dressing, feeding, hygiene)
What are some OT assessment strategies for the middle stages (Stages III-IV) of Parkinson's?
- Home evaluation
- Activity analysis
- Feeding assessment (safety while eating)
- Focus on assessing ADLs
What are some typical interventions for the middle stages (Stages III-IV) of Parkinson's?
- Home mods (raised toilet seat, chairs w/ arms, remove throw rugs)
- Visual cues & supports for sequential tasks
- Rhythmic auditory stimulation, dancing to improve gait
- Community mobility/resources
- ADL adaptations, modifications
- Changes in food textures
- Oral-motor exercises
What are the typical symptoms seen in the late stage (Stage V) of Parkinson's?
V: Client severely compromised motorically, dependent with ADLs
→ Typically confined to w/c or bed, depends on others for most self-care activities
What are some OT assessment strategies for the late stage (Stage V) of Parkinson's?
- Environment analysis
- Talk to caregivers about concerns
What are some typical interventions for the late stage (Stage V) of Parkinson's?
- Use of environmental controls to allow access to environment (ex: switches)
- Support for caregivers
What are the typical symptoms seen in the early stage (Stage I: Very mild cognitive decline) of Alzheimer’s?
- Feels loss of control, less spontaneous; may become more anxious & hostile if confronted with losses
- Mild problems with memory and less initiative; difficulty in word choice, attention, comprehension; repetition; superficial conversations; mild probs with gnosis or praxis
- Seems socially & physically intact except to intimates; decline in job performance
What are the typical symptoms seen in the middle stage (Stage II: Mild to moderate decline/Stage III: Moderate to moderately severe decline, some difficulties involving physical status) of Alzheimer’s?
II: - Denial, anxious, hostile; withdrawal; possible paranoia;
- Moderate memory loss with gaps in personal history and current events; decreased concentration; losing objects; difficulty problem-solving, learning new tasks; visuospatial deficits;
- Inc. need for supervision; decreased sociability; mod. impairment in ADL/IADL; unemployed
III: - Reduced affect; sleep disturbances; hostile behavior; paranoia; delusions, agitation, violence possible;
- Progressive memory loss of well-known material - some past history retained but unaware of recent events; disorientation to time and place; severe deficits in communication; apraxia & agnosia;
- Slowed response; impaired visual and functional spatial orientation
- Unable to perform most IADLs; assistance needed in ADLs; beginning signs of incontinence; wandering
What are the typical symptoms seen in the late stage of Alzheimer’s?
IV: - Memory impairment severe; may forget family member’s names but still recognizes them; confused in familiar surroundings
- Gait & balance disturbances; difficulty negotiating env. barriers; slow-moving
- Communicating is difficult, often grunts or says single word; psychomotor skills deteriorate until unable to walk, eat; completely incontinent; usually client goes to nursing home
What are some OT assessment strategies for the early stage (Stage I: Very mild cognitive decline) of Alzheimer’s?
- Asking caregivers & staff informants to complete rating scales that assess occupational performance/ functional ability (ex: Functional Behavior Profile, Activity profile)
- Interview staff, family members
- Brief screening strategies for mental status (ex:Mini mental status (MMSE), clock drawing), depression, & anxiety
What are some OT assessment strategies for the middle stage (Stage II: Mild to moderate decline/Stage III: Moderate to moderately severe decline, some difficulties involving physical status) of Alzheimer’s?
II & III: Scales to measure ADL/IADLs in relation to cognitive performance:
- Kitchen Task Assessment
- Executive Function Performance Test
- Allen Cognitive Level
- Cognitive Performance Test
- Disability Assessment for Dementia
- Independent Living Scales