Test 5-Parkinson’s, Vestibular, CNS Degen. Dz, Etc. Flashcards by Andrea Smith

Def: An autoimmune disorder characterized by sclerotic plaques throughout the CNS that block or slow neural transmission resulting in weakness, sensory loss, visual dysfunction and other symptoms depending on where the plaques develop in the CNS. It is a disease of the temperate climates such as zones of North America, Europe, Canada, Australia and New Zealand

Multiple Sclerosis

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Onset of MS is at ___-___ y.o. with whites at greater risk
Co-existing autoimmune disorders are seen in a majority of patients with MS, such as Hashimoto’s dz, _____, IBS, and RA. ______ infection often precipitates an attack of MS.

20-40
Psoriasis
Viral

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S&S of MS: -80% have ____ symptoms, often double vision, sometimes develop optic ______ (inflammation of optic nerve)

Sensory changes (paresthesias, vibratory sense)
Muscle weakness- result of ______
Lack of _______ and balance
Gait deviations
Fatigue!
Cognitive impairment & depression
Spasticity

Visual
Optic neuritis
Demyelination
Coordination

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Diagnosis of MS:

History
Neurological exam
_____
______ puncture

MRI

Lumbar puncture

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(MS) Management of Acute Relapses:
\_\_\_\_\_\_\_\_\_ therapy (methylprednisolone)- anti inflammatory and immunosuppressive effects \_\_\_\_\_ swelling in CNS and decrease T-cell activation. 
Side effects of meds: Mood changes, elevated \_\_\_\_, fluid retention, hyperglycemia. Chronic use  associated with \_\_\_\_\_\_\_, DM, osteopenia.

Corticosteroid

Decrease

HTN

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Disease modifying therapeutic agents (MS) : Goal is to prevent future disease activity. Synthetic interferon drugs slow down ______ system response by decreasing inflammation and slowing proliferation of T and B cells.
Side effects- injection site reactions, ___-like symptoms.

Immune

Flu-like

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Clinical Subtypes of MS:
_____-_____ (85%) : Periods of exacerbations (relapse) followed by full or partial recovery (remission). Periods between relapses- no dz progression.

_____ _____: Relapsing-remitting course followed by progressive, irreversible decline

_____-_____: no discrete attacks, steady progression of disease

Relapsing-remitting

Secondary Progressive

Primary-Progressive

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Def: Progressive disorder of CNS affecting the basal ganglion (loss of dopamine) Has insidious onset with slow rate of progression.

Parkinson’s disease

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Motor symptoms from Parkinson’s disease:
Rigidity- increased resistance to passive motion; 2 types:
1) _____- extremity catches
2)_____- stiff
“_______” tremor- seen at rest

Cogwheel rigidity
Lead pipe rigidity
“Pill-rolling” tremor

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Def: slow to move

motor symptom of Parkinson’s

Bradykinesia

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Non-motor symptoms of PD:

Loss of ____
Sleep disturbance
Mood disorders
Orthostatic ______
Bladder dysfunction
Difficulty _____/______
Confusion, _______

Smell

Hypotension

Speaking/swallowing

Dementia

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Etiology of PD:

Combination of _____, ______, and ______ influences

Genes, environment, and lifestyle influences

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Function of basal ganglia:

Helps to plan, initiate, and control movements

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Potential Protective Factors (PD):

Caffeine
High _____ acid levels in men
_________ drugs
Statins
Vitamin ___
Exercise

Uric acid
Anti-inflammatory
Vit D

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Early warning signs of PD:

Tremor or shaking
Small handwriting (sudden change)
Loss of smell (foods like bananas, dill pickles, licorice)
Trouble sleeping (thrashing, falling out of bed)
Trouble moving or walking (stiffness, arms don’t swing)
Constipation
Soft or low voice
Masked face (serious/mad looking)
Dizziness or fainting (due to low BP)
Stooping or hunching

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Pharmacology (PD):
_____/_____ (Sinemet) - pt needs to be on a fixed schedule
Benefits: Bradykinesia, rigidity
Side effects: Hallucinations, depression, insomnia
**High ____ diet can alter effects

Levodopa/Carbidopa

Protein

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Deep Brain Stimulation (for PD):
[Thalamic/Subthalamic stimulation]
Benefits- Helps control _____
Side effects- More difficulty _____

Control tremors

Difficulty Walking

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Typical cause of death in people with Parkinson’s:

Respiratory related

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Interventions for PD:
Pg664 pathology

Improving movement-

Walking sideways
Rocking body to generate weight shift
Stamping feet, shaking legs
Self-talk
Stepping over objects (handle of cane, etc)
Quick head movements
Music
Clapping/snapping
VR

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Interventions for PD:

Big red pg788-789

-Simple blocked practice tasks with many repetitions
-Have pt focus on their movements (use mirrors)
Ex. Have patient focus on swinging their arms during gait, or walk fast, or take large steps
-Visual cues important (tape, laser,etc)
- RAS (Rhythmic auditory Stimulation), metronome, music with steady beat; can help improve gait speed, cadence, and stride

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Interventions for PD (cont):

Look at of 793-7796 Big Red

BIG movements with whole body, repetitive, high intensity
Flexibility Ex. (PROM & AROM)
Additional VC and TC to encourage maximum range
Strength training
-Functional training (bridging, pelvic tilts, rolling, sit-stands, quadruped-kneeling-half kneeling-standing)
Balance training

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(Subtype of MS) - First episode of inflammatory demyelinating of CNS that could become MS if additional activity occurs. Not active= no clinical Relapses or new MRI activity
Active= With relapses or new evidence on MRI in which case it becomes relapsing remitting

Clinically Isolate Syndrome

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Treatment for MS:
-Alternate days, during optimal times such as in the ______ when core body temp is lowest.
-Balance exercise with rest breaks to AVOID _______! Ex. to point of fatigue is a contraindication.
-Group ex valuable motivation
-Strengthening, aerobic 3 days/week (alternate days) walking, _______, swimming
Prevent patient from _________.

AVOID OVERWORK
cycling or water aerobics
*also gait training, flexibility, balance, spasticity mgmt

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What kind of approach is essential for patients with MS?

Team approach!

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Def: Terminal progressive disease; loss of motor neurons in lateral spinal cord, brainstem and motor cortex. Onset mid to late 50s; asymmetrical weakness in arm or leg usually begins distally and moves proximally. Weakness of bulbar (facial) muscles, causing dysphagia. Effects extensor mm more than flexors. Fasciculations of muscles (random twitching, muscle cramps)

ALS (Amyotrophic Lateral Sclerosis)

Diagnosis of ALS: Presence of ____ and ____ findings -weakness, atrophy, fatigue, hyperreflexia -EMG changes (fibrillations and fasciculations) Prognosis: Death usually occurs within __-__ years post dx, typically due to _______ complications.

UMN and LMN 2-5 yrs Respiratory complications

``` PT for ALS patients: Early stage ALS- _______ resistance can increase strength in mm grade 3/5 or higher. Avoid heavy _____ exercise. Avoid heavy ______ or _____ reps. Review pg. 733 in Big Red ```

Moderate Eccentric Heavy Resistance or high reps

Def: Neurodegenerative genetic disorder—autosomal dominant inheritance; fatal disease. Dominated by involuntary, sustained muscle contractions frequently causing twisting and repetitive movements and abnormal postures. Marked loss in brain volume.

Huntington’s disease

S&S of Huntington’s: - ______ (Jerky, random and uncontrolled movements) - Depression - _______ - Psychiatric disorders

Chorea Dementia

Medical Management of Huntington’s Dz: - family history, DNA samples, MRI of brain - Treating symptoms - Pharmacological mgt of chorea available but side effects include pseudoparkinsonism, akinesia, restlessness

*prognosis of death on avg 15-20 years post onset. Increasing disability and mental changes

PT interventions (Huntington’s):

- safety - gait - freezing during gait can occur - ADL training - DME

4 types of dizziness: _______: Room is spinning around the patient ______: Woozy, disconnected from environment _____: Feels unsteady, off-balance _____: Precursor to fainting, feeling of about to lose consciousness

Vertigo lightheadedness Disequilibrium Pre-syncope

2 types of vertigo-associated disorders:

Central (Brain, brain stem or cerebellum) Peripheral (Semicircular canal or vestibular nerve)

Which type of vertigo-associated disorder? (Central or peripheral) -Blood vessel disease, MS, seizures, CVA, tumors, vestibular migraine. Meds: Anticonvulsants, ASA, ETOH

Central

Which type of vertigo-associated disorder? (Central or peripheral) - BPPV - Inflammation of vestibular nerve - Labyrinthitis - Meniere disease - Meds: certain Abx, diuretics

Peripheral

A patient with peripheral hypofunction would have what type of tests done? *This is typically a result of an infection, patient may report an upper respiratory infection shortly before onset of extreme dizziness for a few days

Head thrust test Dynamic visual acuity test VNG testing

Cervicogenic dizziness- Patient will report they feel like they are moving, not that the room or their surroundings are moving. Often use words like “______” “floating” “funny headed”

“Fuzzy” *Symptoms are usually able to be connected the head movement or position. Reproduction of symptoms with cervical AROM testing, cervical joint mobilization and/or cervical soft tissue palpation

Def:Spinning, lasts greater than 60 seconds, associated with changes in position. Nystagmus that corresponds to the tested canal.

BPPV

What are the tests that are done to diagnose BPPV?

*Dix Hallpike Roll test Side lying test Bow and lean

What does BPPV stand for?

Benign -Doesn’t cause further illness Paroxysmal-Temporary and sudden onset Positional -Related to changes in body position Vertigo-The false sensation of spinning

BPPV occurs when calcium crystals/debris called “ear rocks” (otoconia) detach and fall into semicircular canals, usually the posterior canal, when this happens as the patient moves their head the crystals move inside the canal, irritate the hair follicles and nerve endings causing vertigo

The more you know

Canalithiasis: Created endolymph movement; _____ lasting Cupulolithiasis: Debris adheres to cupula, causes input conflict between right and left sides; ____ lasting

Short <60 sec Long >60 sec

Dix Hall Pike test: Cervical- ____ deg rotation, ___ deg extension Avoid gaze fixation Nystagmus named for fast phase

45 | 30

What two symptoms are required for a positive confirmation of BPPV?

Vertigo and nystagmus

Prior to testing or treatment for BPPV what test should be performed?

Vertebral artery clearance test

What is the most common treatment for BPPV of the posterior canal?

Epley maneuver *there’s also the half somersault

Def:This reflex controls our movements to stabilize images during head movements. As the head moves in one direction, the eyes reflexively move in the other direction

Vestibulo-ocular reflex *Gaze stabilization exercises from lab

BPPV treatment includes: 1) Negative vertebral artery test 2) Canolith repositioning (epley) 3) _____-_____ exercises 4) ____ training 5) Pt education- fall prevention

Vestibular-ocular Balance

What is the simplest way to address a convergence Impairment (Oculomotor impairment)?

Pencil push-ups or thumb push-ups *Patient is instructed to focus on a pencil or their own thumb at arms length away against an uncluttered background and bring the target closer to their face until it becomes double.

Contraindications to vestibular rehab: - Patient not appropriate for unstable vestibular disorders such as _______ disease or uncontrolled migraine. - Sudden loss of _____ - Severe ringing in one or both ears - Postop patients with fluid discharge from ears or nose which could indicate _____ leak - Acute neck injuries

Ménière’s disease Sudden loss of hearing CSF leak

What are the three leading causes of death? | What was third leading cause of death in 2020?

Heart disease Malignant neoplasms Chronic respiratory disease COVID-19 duh

Name three examples that are modifiable risk factors of aging:

Activity Smoking Diet

As we age articular cartilage changes, loss of ____ content, thinner, impact of obesity. Functional implications?

Water Decreased range of motion Less shock absorption Osteoarthritis Gait deviations

With aging collagen loses water content, loss of elastic fibers, cross-linking of fibers. This results in decreased joint ____, increased joint _____, skin sagging, internal organs not well supported

ROM | Stiffness

Changes in the spinal column due to aging: intervertebral discs lose water, ______, decreased height> kyphosis and spinal _____. PT intervention: strengthening, endurance, ________, ______ stability (TA & Multifidus), balance, pain management

Compress Stenosis Flexibility Core stability

Bones begin to have decreased mineral density in the ___ decade of life. What sort of exercise is important for this and what is important to consume enough of for prevention?

3rd WB exercise Calcium, Vit D

Treatment of osteoporosis: - women over 50 should have ____ mg Ca/day - Vit __ - ____ ____ exercise - Emphasize ______ - Resistive exercise - Biphosphonates

1200 Vit D Weight bearing Extension

Def: Age related loss of muscle mass; leads to increased risk of falls, decline in muscle strength, rate of force development (Type II fast twitch fibers atrophy more than slow twitch fibers)

Sarcopenia

Def: Decrease in systolic blood pressure about 20 mmHg When a patient moves from supine to sit or sit to stand. Causes include adverse effects of medication, dehydration, anemia, arrhythmias, immobility or autonomic dysfunction related to diseases like diabetes, Parkinson’s, and CNS impairments

Orthostatic hypotension

Respiratory system changes with age: vital capacity decreases, calcification of ribs and costal cartilage, thoracic kyphosis. Lungs do not empty as well and ______ volume increases. PT interventions: ______ correction, breathing ex, good hydration, full UE ROM

Residual volume Postural

Changes in the nervous system with aging: Much of the brain mass loss that is seen with aging is due to decrease in _____ _____ and due to loss of ______. Exercises to help speed reaction time?

White matter Myelin (cerebellum highly myelinated) Perturbations, ball tossing, etc

Structural changes in the skin contribute to decline in ability to detect ______, _______, pain and vibration with aging.

Touch, temperature

Leading cause of injury-related deaths in elderly:

Falls *Fall cycle: Fall, fear of falling again, less activity, decreased mm strength & balance, increased risk of falling

What is the common side effect from many meds that leads to falls?

Postural hypotension

Delirium or dementia? : acute onset, usually reversible : insidious onset, slow progression

Delirium | Dementia

``` Mini-Mental State Exam (MMSE): Scoring- ___/___ normal 23-19/30 mild cognitive impairment 18-___/30 moderate impairment __ or less severe impairment ```

24/30 (normal) 23-19/30 (mild) 18-10/30 (moderate) 9 or less (severe)

Benefits of Ex. for older adults: - Slowing physiological changes of aging - Optimizing body composition - Supporting psychological and cognitive health - Managing chronic disease - Minimizing risk of physical disability

Yup

Multidimensional Plan of Exercise for geriatric patients includes:

Aerobic Flexibility Balance Resistance Ex

Aerobic exercise for the older adult: Minimum of ___ min Moderate intensity ___ days/week or ___ min Vigorous intensity __ days/week “_____ Test” correlates with “moderate” intensity level and only a few words and only a few words without a breath is “vigorous “

30 min 5 days/wk (mod intensity) 20 min 3 days/wk (vigorous) “Talk test”

Flexibility and Exercise for older adults: Low intensity, _____ duration is safest and most effective Use the newly gained ROM in ADL’s

Long duration

Resistance Exercise for older adults: | >60% 1 RM x 3 sets for minimum of 12 weeks for benefits

You remember everything ever, right?

Signs of Elder abuse | 4 areas

Physical Psychological Neglect Financial

Def: Demyelinating, inflammatory polyneuropathy. Lower motor neurons involved- flaccid paralysis. Often preceded by a respiratory or GI illness (campylobacter); good overall prognosis

Guillain-Barré syndrome

Symptoms of Guillain Barre: - Symmetrical muscle weakness begins in _____ and [ascends or descends?] - Paresthesias in ______ and ____ - Absent or depressed ____ ____ reflexes - Severe _____ muscles weakness often requiring a ventilator

Legs and ascends Hands and feet Deep tendon reflexes Respiratory

The main modalities of disease modifying therapy for Gillian Barre are ______ exchange and intravenous immune _____ (IVIG)

Plasma Globulin

Pathophysiology of GB: - Infection-induced immune response causes _____ to be destroyed. - Schwann cells of PNS are destroyed but _____ are intact. - Symmetrical ascending Progressive loss of motor function - Paresthesia/pain - May involve diaphragm requiring mechanical ventilation - 2-3 weeks after onset the Schwann cells begin to proliferate and ________ begins

Myelin Axons Remyelination

``` PT intervention (GB): Acute phase- ROM ex. in pain free range, positioning, AVOID ______ of muscles, supported coughing, monitor changes in muscle strength ```

Avoid Fatigue

``` PT Intervention (GB): Plateau Phase- Symptoms stabilize. Lasts up to 4 weeks. Slowly begin getting pt. back to _______ positions, stretching, active ex. Over______ or overuse of painful muscles may stall or prevent recovery. ```

Upright Overstretching

``` PT intervention (GB): Recovery phase- Gradual recovery after plateau phase. Muscle return in ______ order, WB, tilt table, aquatics, strengthening (avoid fatigue). This phase may last up to 1 year. ```

Reverse order (proximal to distal)

Polio: virus attacks anterior horn cells in spinal cord | S&S:

``` Muscle weakness Pain Atrophy Bulbar (respiratory and swallowing) - All of these combined leads to loss of function and difficulty with ADLs ```

Nonfatiguing Exercise protocols: (Post-polio) -Target HR, low range, 60-70% (Aerobic), 3x per week, 15-30 min, walking, swimming, stationary bike -(strengthening) 60-80% of one repetition maximum, 3-5x per week, goal of 5-10 reps, concentric ex

* monitor HR, BP, RPE (“hard”) | * *Avoid overuse of muscles

Def: Most common in women over 50, symptoms range from mild to severe facial pain (sharp, “lightning bolt”). Triggered by chewing, speaking, brushing teeth, shaving, washing face, drinking, talking

Trigeminal neuralgia | CN V, facial sensation and chewing

Medical mgmt for trigeminal neuralgia: - Anticonvulsants (tegretol, Dilantin, klonopin) - Botox injections - Surgical _______ of nerve - gamma knife surgery

Surgical Decompression

Def: Autoimmune disorder which affects the neuromuscular junction and motor endplate. Acetylcholine receptors are decreased in number, without ACh, the nerve impulses fail to cross the neuromuscular junction to stimulate muscle contraction

Myasthenia Gravis *Clinical presentation: Exacerbations in remission of muscle weakness and muscle fatigue. Rest restores activity. Eyelid muscles and muscles of mastication are some of the first to show signs of fatigue. May also have fluctuating weakness in proximal muscles

PT intervention for myasthenia gravis: - _____ ______ techniques - Monitor for signs of fatigue - Avoid strenuous exercise, stress and exposure to ________ extremes

Energy conservation Temperature

LSVT BIG Exercises: - Floor to ceiling - Side to side - Forward step and reach - Sideways step and reach - Backwards step and reach - Forward rock and reach - Sideways rock and reach

Big ol boy

Test 5-Parkinson’s, Vestibular, CNS Degen. Dz, Etc. Flashcards

(86 cards)