Intervention in early, middle, late neurodegenerative conditions

Question 1

Think about the ICF model and all its components: Health condition –> Impairments, Activity + Participation Limitations –> Personal + Env factors

Answer 1

In the ‘Health conditions’ heading, you have degenerative conditions - early, middle, late phases - and acute conditions (stroke, TBI) - acute, chronic phases

Question 2

Describe the early, middle, late stages of MS

Answer 2

Early:
- minimal disability (management of relapses here)

Middle:
- moderate disability (symptomatic management + rehab)

Late:
- severe disability (coordinated care+awareness of end of life issues)

• ALL stages have patient education + self-management

Question 3

What is the evidence for exercise in the management of MS?

Answer 3

• HIGH QUALITY evidence that exercise, PA improves fatigue, quality of life, functional outcomes

Question 4

What is the EDDS and what does it stand for?

Answer 4

Extended Disability Status Scale

• 10 pt scale (increments of 0.5 starting at 1.0)
• used for MS
• 5 pts = severe disability; cant work a full day without special provisions
• 7pts = can’t walk >5m even with aid
• 8.5 = restricted to bed most of the day
• 10 = death d/t MS

Question 5

What is the effect of exercise on walking MS?

Answer 5

• WALKING - can improve 10m walk time by ~2 seconds (Pearson et al, 2015)
• WALKING - can improve 6MWT - can walk 36m more in 6MWT (Pearson et al 2015)
• STRENGTH - small to moderate effect size of exercise on strength but EDDS was not specified (Platta et al 2015)

Question 6

What is the Hoehn + Yahr Stages and what is it used for?

Answer 6

• used of PD
• 5 pt scale (0-5)

0 = Asymptomatic
1 = unilateral involvement
2 -= bilateral involvement
3 = mild to mod involvment; some instability but still independent; needs some assistance to recover from pull test
4 = severe disability; can still walk/stand unassisted
5 = wheelchair bound/bed ridden

Question 7

Relate early, middle, and late PD stages to HR stages and how the interventions differ in these stages

Answer 7

Early = 1-2.5 (promote activity+movement to maintain strength)
Middle = 2-4 (more specific interventions focusing on range of tasks/interventions - transfers, posture, balance, gait)
Late = 5 (maintain vital functions, prevent contractures)

Question 8

Describe the early, middle, and late stages of MND:

Answer 8

Early:

• mild to moderate weakness
• activity limitations towards the end of this stage

Moderate:

• severe weakness in some mm groups
• progressive reduction in mobility
• wheelchair needed for longer distances

Severe:

• severe weakness of ALL mm’s
• restricted to bed+wheelchair
• respiratory compromise

Question 9

What are the AIMS of physio intervention in treating neurodegenerative conditions?

Answer 9

1. Prevent 2º impairments!
   - address the inactivity that causes further deconditioning
2. ## Promote optimum PA
3. Improve QoL
4. Promote + psychosocial adjustment