Neuro #6 degenerative disorders Pg 158-

Question 1

What is Multiple Sclerosis?

Answer 1

A chronic progressive, demyelinating disease of the CNS affecting mostly young adults

Question 2

What is the etiology of the CNS?

Answer 2

Unknown; most likely viral, autoimmune (active immune response detected in CSF)

Question 3

6 Characteristics of MS

Answer 3

1. Demyelinating lesions (plaques) impair neural transmission, cause nerves to fatigue rapidly
2. Variable symptoms: lesions scattered in time and place; lesions common in pyramidal tract, dorsal columns and periventricular areas of cerebrum, cerebellar peduncles
3. Variable course with fluctuating periods: exacerbation (worsening of symptoms) and remissions, progressing to permanent dysfunction
4. Precipitating or exacerbating factors: infections, trauma, pregnancy, stress
5. Transient worsening of symptoms: adverse reactions to heat, hyperventilation, dehydration, fatigue
6. Categories of MS - 4

Question 4

What are the 4 categories of MS?

Answer 4

1. Relapsing-remitting MS (RRMS)
2. Primary progressive MS (PPMS)
3. Secondary Progressive MS (SPMS)
4. Progressive-relapsing MS (PRMS)

Question 5

What is Relapsing-remitting MS (RRMS) in MS?

Answer 5

Characterized by relapsing with either full recovery or some remaining neurological S&S and residual deficit on recovery; periods between relapses characterized by lack of disease progression

Question 6

What is Primary-Progressive MS (PPMS) in MS?

Answer 6

Characterized by disease progression from onset, without plateaus or remissions or with occasional plateaus and temp minor improvements

Question 7

What is Secondary-progressive MS (SPMS)

Answer 7

Characterized by initial relapsing-remitting course followed by progression oat a variable rate that may also include occasional relapses and monitor remissions

Question 8

What is Progressive-relapsing MS (PRMS)

Answer 8

Characterized by progressive disease from onset but without clear, acute relapses that may or may not have some recovery or remission; commonly seen in individuals who develop the disease after 40 years of age

Question 9

Diagnostic tests used for MS

Answer 9

• LP/SCE
• Elevated gamma globulin
• CT or MRI
• Myelogram
• ECG

Question 10

Areas that PTs need to examine when working with Parkinson’s disease patients - Pt History

Answer 10

• Symptoms
• Disease progression
• Functional deficits

Question 11

Areas that PTs need to examine when working with Parkinson’s disease patients- Cognitive/behavioral status

Answer 11

Intellectual impairment/dementia may occur in advanced stages. Examine for:

• memory deficits
• Bradyphrenia (slowing of thought process)
• Depression

Question 12

Areas that PTs need to examine when working with Parkinson’s disease patients- Communication

Answer 12

• Dysarthria & Hypophonia (dec volume) are common
• ## Mutism in advanced stages; masslike face with infrequent blinking & expression, writing becomes progressively smaller

Question 13

Areas that PTs need to examine when working with Parkinson’s disease patients- Oromotor control, nutritional status

Answer 13

Dysphagia is common, problems in chewing and swallowing

Question 14

Areas that PTs need to examine when working with Parkinson’s disease patients- Respiratory status

Answer 14

• Breathing patterns
• Vital capacity
• Dec chest expansion common

Question 15

Areas that PTs need to examine when working with Parkinson’s disease patients- ROM, deformities assoc with disuse and inactivity

Answer 15

Contractures common in flexors, adductors; persistent posturing in kyphosis with FHP; many pts osteoporotic with high risk of fracture

Question 16

Areas that PTs need to examine when working with Parkinson’s disease patients- Sensation/ perceptual function

Answer 16

Examine for aching and stiffness, abnormal sensations (cramp-like sensations poorly localized) problems with spatial organization, perception of vertical, extreme restlessness (akathisia)

Question 17

Areas that PTs need to examine when working with Parkinson’s disease patients- Vision

Answer 17

Examine for blurring, cogwheel eye pursuit, eye irritation from decreased blinking, dec pupillary reflexes

Question 18

Areas that PTs need to examine when working with Parkinson’s disease patients- Skin integrity & condition, circulatory changes

Answer 18

Edema may occur in LE, inc sweating (ANS dysfunction); decubitus ulcers in late stages