Management of Patients with Mobility Difficulties and Neurodegenerative disorders Flashcards
(59 cards)
1
Q
What are the prenatal aetiologies of Cerebral Palsy
A
- Prematurity
- Maternal infections: acute (e.g. rubella) or Chronic (e.g. syphilis, herpes)
- Drugs (e.g. alcohol, cocaine)
- Maternal dysfunctions (e.g. diabetes, hypertension)
2
Q
What are the neonatal aetiologies of Cerebral Palsy
A
- Hypoxia (most common)
- Birth injury
- Prolonged/difficult labour
3
Q
What are the postnatal aetiologies of Cerebral Palsy
A
- Trauma
- Brain tumours
- Infections (e.g. encephalitis, meningitis)
- Toxins (e.g. lead, hydrocarbons)
4
Q
What are the common signs and symptoms in patients with cerebral palsy
A
- Epilepsy (30%)
- Oral features
- Hearing and visual impairment
- Speech impairment
- Uncontrolled movements
5
Q
What types of cerebral palsy are there and list them from most common to least common
A
- Spastic
- Athetoid
- Ataxic
6
Q
What are the common symptoms of spastic cerebral palsy
A
- Exaggerated movements
- Increase in muscle tone hyperreflexia
- tendency towards contractures, positioning and movement
- Loud noises can precipitate flexion/extension
7
Q
What are the common symptoms of Athetoid cerebral palsy
A
- Writhing, worm like movements
8
Q
Where are the lesions that form in the brain of someone with athetoid cerebral palsy
A
Lesions are on the basal ganglia
9
Q
What are the common symptoms of Ataxic cerebral palsy
A
- Lack of coordination and balance problems
10
Q
Where are the lesions that form in the brain of someone with Ataxic cerebral palsy
A
Lesions on the cerebellum
11
Q
What are some oral signs and symptoms that can be prevalent in cerebral palsy patients
A
- Malocclusion
- High palatal vaults
- Drooling
- Caries - xerostemia
- Perio diagnosis is 3x higher
- Bruxism
12
Q
What are the 5As of access to healthcare
A
- Availability
- Acceptability
- Accessibility
- Accomodation
- Affordability
13
Q
What causes disease in Multiple Sclerosis
A
- Damage to the myelin sheath of the brain and spinal cord
14
Q
Who is MS most likely to be diagnosed in
A
Women aged 20-40
15
Q
What is the aetiology of MS
A
UNKNOWN
16
Q
What treatment is available for MS
A
- Disease modifying drugs reduces the number of relapses and slows progression of symptoms
- No treatment can slow the progress of primary progressive MS
- Physio treatment
17
Q
There are a shit load of drugs that are used to treat a shit load of symptoms for MS, what are the more common oral side effects of some of these drugs
A
- Dry mouth
- Blood dyscrasias
18
Q
What are the common characteristics of MS
A
- Fatigue
- Oral features
- Visual impairment
- Speech impairment
- Breathing
- Uncontrolled movements and spasticity
19
Q
What types of MS are there
A
- benign MS
- Primary progressive MS
- Relapsing remitting MS
- Secondary progressive MS
20
Q
Describe the course of disease of benign MS
A
Few mild attacks and then complete recovery
21
Q
Describe the course of disease of Primary Progressive
A
- Symptoms worsen over time with remission period
22
Q
Describe the course of disease of Relapsing remitting MS
A
- Symptomatic and symptom free periods eventually secondary progressive after 15 years
23
Q
Describe the course of disease of Secondary Progressive MS
A
- Symptoms worsen over time - this the most common form of MS
24
Q
Name some symptoms of Multiple Sclerosis
A
- Visual disturbances
- Mental changes: decreased concentration, memory loss
- Loss of sensation: tremors, speech impediment
- Depression or Paranoia
- Limb weakness: loss of coordination and balance
- Muscle spasms: fatigue, numbness
- Bladder and bowel dysfunction
25
What are some of the dental implications of Multiple Scelerosis
- Amalgam fillings
- Trigeminal neuralgia
- Cannabis
- Dry mouth
26
What are some of the characteristics of patients with Motor Neurone Disease
- Fatigue
- Tongue wasting
- Difficulty with speech, chewing and swallowing
- Difficulty breathing
- Muscle weakness
- Muscle cramps
- Uncoordinated movement
27
AY BAWS CAN I HABE DE NOTE PLZ
Sensory, Cognitive and Bladder/Bowel is spared even in late disease
28
What types of Motor Neurone Disease are there
- Amyotrophic Lateral Sclerosis (ALS)
- Progressive Muscular Atrophy
- Progressive bulbar palsy
29
What parts of the body are affected first in Amyotrophic Lateral Sclerosis (ALS)
Hands and legs first
30
Describe the progression of Progressive Muscular Atrophy
- Starts in hands and spreads upwards
31
What form of MND has the worst prognosis
Progressive Bulbar Palsy
32
What is the aetiology of MND
UNKNOWN
33
What treatments are there for MND
There no cure but physiotherapy and respiratory support tbh, some tings can delay ALS but you're basically fucked due to respiratory paralysis
34
What treatment changes might be needed in a patient with MND
- Good suction and may need to be treated upright due to aspiration risk
- High risk when using sedation and GA due to respiratory tings
35
What difficulties can MND patients have with oral hygiene
- Motor coordinaton of hands is fooked
| - Poor oral hygiene and aspiration risks = higher risk of pneumonia
36
What kind of genetic disease is Huntingdons disease (dominant or recessive, Autosomal or that other one?)
Autosomal Dominant
37
What are the characteristics of Hungtingdon's disease
- Dementia
- Lack of coordination
- Suicide risk
- Swallowing difficulties
- Mood and cognition changes
- Speech impairment
- Unsteady gait
- Uncoordinated jerky movements
38
What age do symptoms of Huntingdon's Disease start to show up
32-50 years
39
What is the definition of Parkinson's
- The degeneration of dopamine releasing cells in the substantial nigra
40
At what stage of Parkinson's do symptoms occur
When 80% of the dopamine producing cells are destroyed
41
Describe the multi-factorial aetiology of Parkinsons
- Genetics
- Idiopathic
- Drug induced parkinsonism: caused by some neuroleptic drugs such as reserpine and the phenothiazines
- Post viral encephalitis
- Diffuse brain disease causing generalised cerebral damage e.g. alzheimers
42
What treatment options are there for Parkinsons
- Levodopa
- Used concomitantly with an inhibitor of the degradation of enzyme dopa decarboxylase to allow lower dosage but an increased dopamine conc.
- Physio treatment
43
How does Levodopa work as a treatment for Parkinsons
- A precursor of dopamine given to help replenish the depleted dopamine in the basal ganglia
44
What severe side effects can result from using Levodopa as a treatment for parkinsons
- Confusion
- Hallucinations
- Dystonia
- Fluctuations in the ability to perform movements
- Xerostomia
45
What are the characteristics of Parkinsons
- Facial Rigidity
- reduced spontaneous blinking
- Bradykinesia
- Shuffling
- Limb rigidity
- Dyskinesia
- Tremor
- Slurring of speech
- Mask like face
46
What is the definition of a stroke
- Sudden neurological deficit which is vascular in origin and persists for more than 24 hours
47
AY BAWS CAN I HABE DE NOTE PLZ
Stroke is the most common cause of disability in adults
over 80% of strokes occur in people over 64 years old
48
What are some of the risk factors for Stroke
- Diabetes
- Obesity
- Smoking
- Hyperlipidaemia
- Heart Failure
- Carotid Artery stenosis
- Ischaemic heart disease
- Atrial Fibrillation
49
What is a hemorrhagic stroke
Weakened/diseased blood vessels rupture and the blood leaks into the brain tissue
50
What is an ischemic stroke
Blood clots stop the flow of blood to an area of the brain
51
What is the Initial management of a stroke
- Thrombolysis
| - Surgery
52
What prevention options are there for management of a stroke
Anticoagulation
53
What rehabilitation management options are there for a stroke
- SALT: Speech and Language Therapy
- Physio
- OT
54
What complications can arise in patients after a stroke
- Paralysis or weakness of limbs
- Incontinence
- Social Isolation
- Dementia
- Dysphagia
- Agnosia
- Dysathria
- Dyspraxia
- Dysphasia
- Loss of language
55
What Dental Implications can arise as a result of Stroke
- Reduced mobility
- Reduced communication
- Risk of inhalation during treatment
- Increase in sugar intake
- Facial Paralysis
- Xerostomia
- Poor motivation/attendance
56
What is the most common form of Dementia
Alzheimer's
57
What is dementia
A progressive and irreversible impairment of cognitive function
58
What is the aetiology of dementia
UNKNOWN
59
What dental management measures might be needed in patient with moderate dementia
- IV sedation/GA if medically stable and cooperative
| - Slow and careful administration ± clinical holding
