Neurodegenerative Diseases

paresthesia

-"pins and needles" -numbness and tingling because of sensory nerve changes

MS OVERALL SYMPTOMS

-fatigue -numb/weak -partial or incomplete vision loss -double/blurry vision -tingling/pain in body parts -tremor -lack of coordination -slurred speech -dizzy -problems with bowel/bladder

Relapse-remitting MS

-fluctuating course of relapses with associated neurologic deficits, followed by periods of relative quiet

Secondary progressive with relapses MS

-fluctuation with relapses and deterioration between relapses

contraindications for OT intervention for MS

-hot temperatures -heat modalities -excessive physical activity

Parkinson's stage 3

-impaired balance -mild to moderate impairments in function

Akinesia

-impairment of voluntary and spontaneous movement *loss of voluntary movement

MS Bladder and bowel symptoms

-incontinence -increased urgency or frequency -constipation

OT evaluation for Parkinson's

-interview -observation of how symptoms impair occupations may notice the following during evaluation: -FM difficulties -mobility impairments -ADL/IADL deficits -swallowing or feeding issues -sexual dysfunction -disrupted sleeping patterns -social isolation

Fasciculation

-involuntary muscle contraction and relaxation *muscle twitch

teaching compensatory strategies

-minimize distraction and interruptions during task completion -use problem solving techniques -use memory aids -use written instructions -minimize multitasking -allow increased time to complete tasks

standard evaluations for MS

-modified fatigue impact scale -beck depression inventory -FIM -nine hole peg test or purdue pegboard test (FM, dexterity) -semmes-weinstein monofilament testing (sensory) -modified ashworth scale (spasticity)

ALS S&S

-move distal to proximal -weakness of the small muscles of the hand or an asymmetrical foot drop (dropping things/tripping) -difficulty breathing (SOB) -slurred speech -impaired swallowing -muscle atrophy -cramping, usually in the calves -twitching of muscles -spasticity -hyperactive muscles -dysphagia(difficulty swallowing) -dysarthria(difficulty with speech) -people usually develop all the symptoms, becoming progressively weak and immobile *cognition, sensation, vision, hearing and bowel and bladder control are not usually affected

rigidity

-muscle stiffness that impairs movement

OT evaluation for ALS

-obtain specific level of function -obtain clients goals -write goals that focus on minimizing symptoms -as ALS progresses the goals switch from the persons performance to the physical and social environment TOOLS: -ALS functional rating scale -Purdue pegboard -fatigue inventory -dysphagia screening and testing

GBS 3 phases

-onset and acute inflammatory phase -plateau phase -recovery phase

amyotrophic lateral sclerosis (ALS)

Lou Gehrig's disease -cause is unknown -progressive, degenerative disease -motor neurons in the brain, spinal cord and peripheral system are destroyed and replaced by scar tissue -plaque leads to progressive muscle atrophy

MS sexual symptoms

Men: erectile dysfunction Women: decreased libido(sex drive), inorgasmia

MS OT evaluation

**minimize the severity, amount and length of exacerbation in order to improve function! -profile -history of symptoms -pain -motor/praxis deficits -sensory deficits -emotional deficits -communication deficits -cognitive deficits *it is important to see actual occupational performance! ASK THEM ABOUT: -dizziness -sensation -FM skills -incontinence -sleep patterns -muscle cramping -falls -balance issues

OT Intervention for Parkinson's

*compensatory strategies *education *environmental modification *task modification -energy conservation -caregiver training -support groups -home exercise program (AROM and walking) -sit to stand techniques -rocking motion to begin movement -manage freezing by avoiding crowds, corners, distractions, multitasking, rushing, eliminating clutter -walker or cane use -w/c positioning -use of single auditory cue can help produce quick and smooth movements -smaller portions for eating -remove distractions -eat slow -use weighted or built up handles -cups with lids -plate guards -nonslip surfaces -allow increased time for eating -alter food constancy -modify clothing to eliminate fasteners use sock aide, zipper pull, elastic shoelaces -use dial weights to decrease tremors -raised toilet seat, grab bars, shower bench, sink chair -use of speed dial or voice control, large key telephone -online bill paying -voiding schedule for bowel and bladder -train to use external or visual cues, rhythmic cues to practice repetition -reduce environment distractions -educate caregiver to speak slowly and clearly with simple one step instructions -group therapy -stress reduction and relaxation techniques (visualization, mediation, deep breathing) -home evaluation (eliminate throw rugs, lighting, HORIZONTAL strips of contrasting tape on floor where freezing occurs) -use heat, stretch, gentle ROM (CAUTION: masked face for pain perception) -splints (antispasticity, dynamic or static progressive)

OT Intervention for ALS

-COMPENSATORY *adapting the disability and preventing secondary complications *keeping the person as active and independent as possible for as long as possible -home evaluations and home safety assessments -positioning -transfers -skin integrity -communication equipment -equipment and environmental modification(ex: first floor) -therapeutic exercise (ROM, strength, endurance, stretch, breathing) -select adaptive equipment and technology (universal cuff, mobility aids, wheelchair, voice operated hands free technology) -techniques to address dysphagia(minimize distractions at mealtime, adapt food consistency(thicken liquids, soft foods), use manual swallowing, allow sufficient time to eat) *IDEAL W/C: high back, recline, lightweight, turns in small spaces, offers head, turn, extremity support OR powered w/c with adaptable controls with tilt or recline

MS motor symptoms

-FATIGUE: most common complaint & debilitating symptom (especially in LE) -ataxia (impaired balance & coordination) -partial or complete paralysis of part of body -muscle spasticity especially in the LE -muscle weakness -intention tremors (occurs when person attempts to engage in meaningful activity) -dysphagia (difficulty swallowing)

Festinating gait

-SMALL RAPID shuffling steps resulting from a forward-tilted head and trunk posture

provide training in activity strategies and energy conservation

-alternate periods of rest with periods of activity -complete higher priority tasks in the morning -use appropriate equipment to minimize energy use (w/c, orthotics) -use ergonomic adaptations for head and arm support

Parkinson's stage 2

-bilateral symptoms -ADLs are do-able -IADLs might need modification

OT intervention for MS(ADL adaptations)

-built up handles sreachers -sock aid -use weighted utensils for feeding -wrist weights during self care to reduce tremors -AE for lower body dressing and bathing

Guillain-Barre syndrome (GBS)

-cause unknown (infection, surgery, immunization) -inflammatory disease that causes demyelination of axons in peripheral nerves

MS dx

-cerebrospinal fluid analysis -nerve conduction studies -brain imaging (CAT or MRI) -the person must have episodes of exacerbation and remission and slow or step by step progression over six months -also must have evidence of lesions in more than one site in the white matter and no other neurological explanation

Secondary Progressive MS

-cessation of fluctuations with slow deterioration

OT intervention for MS(cognitive and emotional disturbances)

-cognitive retraining -memory enhancement program -cognitive behavioral therapy -group therapy -eliminate distractions -use external memory aids (day planner) -write step to step instructions -allow for increased time -delegation -repetition when learning new ideas and perform tasks earlier in the day -teach stress management and relaxation -explain coping strategies

OT intervention for MS (dysphagia and dysarthria)

-collaborate with SPT to enhance intervention strategies and maximize carryover -routinely screen for signs of choking, aspiration or swallowing dysfunction because people with MS are asymptomatic

Parkinson's stage 4

-decrease in postural stability -impaired mobility -need for assistance with ADLs -poor fine motor and dexterity -oral motor deficits

Dysmetria

-decreased coordination of movements

MS emotional symptoms

-depression -inappropriate euphoria (extreme happiness) -lability (frequent mood changes)

Primary Progressive MS

-deterioration from beginning

MS visual symptoms

-diplopia (double vision) -optic neuritis (sudden loss of vision with pain in or behind the eye) -partial loss of vision (scotoma) -nystagmus -loss of visual acuity

OT intervention for MS(vocational adaptations)

-educate client in self pace -perform higher intense activities when energy levels are higher -rest breaks -breaking tasks down -simplifying work -adapting work hours -ergonomic workstation to minimize pain and fatigue

OT intervention for MS (fatigue)

-educate clients on types of fatigue -dairy card during day to monitor activity level and identify occupations thht result in fatigue then find modifications -reduce standing -educate on ergonomics -energy conservation techniques

OT intervention for MS (ataxia)

-encourage proximal stabilization for improved distal movements -modify tasks by promoting hand over hand techniques for FM tasks (using unaffected extremity over the hand with tremor when dialing a phone) -use orthoses

Parkinson's Stage 2 OT Intervention

-energy conservation for ADLs -home exercise program for flexibility -alternative for community mobility

Parkinson's Stage 5 OT Intervention

-environmental controls

Parkinson's Stage 4 OT Intervention

-environmental modifications for self care -changes in food textures

Parkinson's Stage 3 OT Intervention

-environmental modifications in home -visual cues for sequential tasks

Parkinson's disease etiology

-exact cause is unknown -progressive -major degenerative changes occur in the basal ganglia, the grey matter that contributes to complex movements -the production of dopamine is affected (neurotransmitter that influences the speed and accuracy of motor skills, postural stability, cognition and affect and expression) -the loss and reduction of dopamine leads to disabling symptoms -associated with heredity and environment, 50% have a relative that is also affected so genetic

multiple sclerosis etiology

-exact cause is unknown, -chronic, often progressive demyelinating disease of the central nervous system -persons own body attacks the myelin sheath that covers the neurons of the brain and spinal cord -the demyelination produces scar tissue or plaque in the myelin sheath of nerve fibers that interferes with the axons ability to conduct impulses -result is impaired nerve conduction and inflammation, which causes neurological dysfunction

GBS S&S

-pain, MOSTLY LE! -fatigue/weakness of bilateral extremities from distal to proximal -sensory loss in hands and legs -edema -absence of deep tendon reflexes -dysfunction of cranial nerves -bladder dysfunction -autonomic nervous system involvement that can result in postural hypotenstion, arrhythmia, facial flushing, diarrhea, impotence, urinary retention and increased sweating -if progresses can experience problems with breathing, speaking, swallowing

MS sensory symptoms

-paresthesia (numbness or tingling) -impaired pain, touch and temperature sensations -vertigo -pain

What diagnosis are included in this?

-parkinsons -MS -guillain-barre -huntingtons -dementia

OT intervention for MS(vision)

-perform home safety assessment and make recommendation to reduce risk of falls (remove clutter, clear paths, using bright light) -AE for vision (optical devices, large print reading material, large button technology, talking watches, raised dot markings, audio books)

ALS stage I

-person can walk -I with ADLs -some weakness/clumsy

ALS stage II

-person can walk -has moderate weakness

ALS stage III

-person can walk -has severe weakness (ankles, wrist, hands) -muscle function loss *environmental adaptations (moving frequent used items close) *strengthening is no longer beneficial *focus= AAROM and PROM

ALS stage VI

-person confined to bed (ulcer prevention!!!) -dependent for ADLs -PAIN!

ALS stage IV

-person requires W/C for mobility -has severe weakness in the legs -needs some assistance with ADLs due to fatigue

ALS stage V

-person requires w/c for mobility -has severe weakness in arms and legs -dependent for ADLs -PAIN!

MS overall OT intervention

-problem solving compensatory strategies -fatigue management -role delegation -AE for motor, sensory, endurance, cognitive, vision

OT Evaluation for Neurodegenerative Diseases

-profile -occupational performance, daily habits, routines -observation -interview for PLOF -motor and praxis ability -sensory-perceptual skills -emotional regulation -cognitive ability -communication skills

ALS prognosis

-progresses rapidly -fatal disease that often ends in respiratory failure due to degeneration of motor neurons of diaphragm

Neurodegenerative Diseases

-progressive and usually chronic conditions resulting from damage to the CNS, PNS, or both

Progressive-relapsing MS

-progressive with relapses

OT intervention for MS(muscle weakness)

-proper body mechanics -therapeutic exercise (REST BREAKS) -stretch -aquatic therapy -W/C: provide seating and positioning

OT intervention for MS(urinary incontinence)

-provide bladder training -provide instruction in self cathetertization -monitor times of days when fluids are consumed to ensure availability of bathrooms

OT intervention for MS(sensory disturbances)

-provide sensory re-education -introduce compensatory strategies (rely on vision)

MS categories

-relapse-remitting -secondary progressive -secondary progressive with relapses -primary progressive -progressive relapsing

MS cognitive symptoms

-short-term memory loss -attention deficits -decreased processing speed -impaired visuospatial ability -impaired executive functioning

bradykinesia

-slow motor movement

MS communication symptoms

-slurred speech -scanning speech (slow enunciation with frequent hesitations)

OT Intervention for Neurodegenerative Diseases

-teach compensatory strategies -provide training in activity strategies and energy conservation -help the client delegate roles -environmental modifications and AE training for home -exercise programs that promote balance and rest periods

Parkinson's stage 5

-total dependence for mobility -total dependence for ADLs -w/c confined

Parkinson's stage 1

-unilateral/resting tremor -no functional impairment

MS course and prognosis

-unpredictable -no cure or treatment

OT intervention for MS (pain from spasticity) *spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity

-use resting splint -heat on muscle trigger points

MS initial S&S

-visual disturbances -dizzy -weakness *symptoms worsen (exacerbation) at times and at other times improve (remission)

Parkinson's Stage 1 OT Intervention

-work evaluation -work simplification -rest breaks -use AE for eating and handwriting (enlarged/built up handles) -medication management

Parkinsons has 5 Stages

1-5

ALS has 6 stages

1-6

Parkinson's S&S

3 CLASSICAL SYMPTOMS: *1) resting tremor *2) muscle rigidity (stiffness, tone is increased, cogwheel motions-jerky) *3) bradykinesia (extreme slow, rapid movements, shuffling gaits, increased time for FM, freezing) -postural instability -gait dysfunction (festinating gait: stride length decreases but speed increases, shuffling) -FM impairments -freezing to initiate -cognitive deficits -communication difficulties (micrographia(small handwriting), hypophonia(reduced speech volume), muffled speech, masked face) -sensory loss -sexual dysfunction -dysphagia(difficulty swallowing) -mood disturbances

A client with Stage 1 Parkinson's disease (PD) identifies grocery shopping as a valued occupation but lists fatigue as a barrier and states that occasional tremors can be embarrassing. What intervention approach would be meaningful as the OTR® prepares to accompany the client to the store for an occupation-based treatment session? A. Creating a list of needed items and making a route to navigate the store efficiently B. Providing the client with psychosocial support to focus on reducing the anxiety or shame associated with symptoms C. Having the client don wrist weights to reduce tremors while reaching for items to put in the shopping cart D. Instructing the client in the use of a rollator to take seated rest breaks or one of the store's power chairs to save energy

A is the simplest approach; organizing a grocery list and planning the most efficient route through the store to obtain the needed items is an energy conservation technique that maintains dignity. C: Donning wrist weights may help some clients with PD reduce tremors, but adding weights might increase fatigue and may also draw attention to the disability

A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? A. Educate about timing social activities when medication is most effective. B. Train in facial exercises to improve speech quality and communication. C. Provide utensils with built-up handles during mealtimes to decrease spills. D. Suggest a community support group to provide a social outlet.

A. Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance. D: A community support group may be an effective intervention once the motor impairment and communication difficulty issues are addressed.

Results from a manual muscle test indicate that a client who is in Stage II of amyotrophic lateral sclerosis has Good Minus (4/5) strength of the intrinsic muscles. The client reports that by the end of a meal, it becomes extremely difficult to hold and manipulate eating utensils. Which assistive device will be MOST EFFECTIVE for the client to use during self-feeding at this stage of the disease process? A. Foam tubing to build up handles of eating utensils B. Standard universal cuff with elasticized strap C. Lightweight plastic eating utensils with contoured grip D.Wrist support with palmar pocket for inserting utensils

A. Built-up utensils will allow the client to use less grasp strength throughout the meal and will be effective in compensating for the decreased intrinsic muscle strength. C: Decreasing the weight of the utensil would decrease the muscle strength needed to lift the utensil; however, the client is still required to use prolonged grasp strength to hold the utensil and would still fatigue with the task.

For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities? A.Schedule demanding tasks at intervals throughout the day B.Simplify daily tasks to conserve energy C.Modify the environment to decrease clutter D.Decrease visual stimulation to promote focused attention

A. Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks. B: Simplifying tasks conserves energy but does not directly address the cognitive demands of task performance. C: Organizing the environment decreases the energy required to complete tasks but does not directly address the cognitive demands of task performance. D: Decreasing visual stimulation may improve visual attention but would not improve the client's ability to focus attention, which is a cognitive skill.

A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus? A. Positioning, to ensure proximal support on a lap tray B. ROM exercises, to enable the patient to adequately reach the device C. Trunk strengthening, to enable upright sitting during use of the device D. Adapting the device with larger buttons and controls, to enable independent use

A. The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair.

A client has severe intention tremors secondary to multiple sclerosis. Which adaptive strategy would be MOST BENEFICIAL for this client to use when eating? A. Placing plastic eating utensils in a universal cuff B. Stabilizing both arms on a counter or table top C. Using a mobile arm support or suspended sling D. Fastening a 5-lb (2.27-kg) weight on each forearm

B. Intention tremors occur during voluntary movement, and providing proximal stabilization may be effective in decreasing the intensity of the tremor with eating. A: A universal cuff is used when grasp ability is diminished and would not be beneficial to decrease tremor. C: Mobile arm supports or slings are used to improve mobility of the upper extremity during activities and would not be beneficial to decrease tremor. D: Use of weighted utensils may lessen tremors, but the added weight of the utensil may contribute to a person's fatigue.

A client with multiple sclerosis (MS) presents with extensor tone in the bilateral lower extremities, which interferes with work tasks completed at a desk. The OTR® performs a worksite evaluation. What would the OTR® recommend to decrease spasticity? A. Trialing moist heat pads B. Positioning the hips into 90° or more of flexion. C. Taking frequent rest breaks to stretch D. Using a reclining chair to open the hips

B. SIMPLEST, Maintaining at least 90° of hip flexion will help reduce spasticity and can be achieved by adjusting the height of the chair or using a small stool for the feet. C: Although stretching may help decrease spasticity, if the client states that the pain interferes with function, this approach may not be sufficient; moreover, frequent standing rest breaks may increase fatigue and draw attention.

A client in the late stage of Parkinson's disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see? A. Resting tremor, spasticity, tingling sensations B. Resting tremor, rigidity, oral motor deficits C. Spasticity, paralysis, decorticate posture D. Spasticity, rigidity, impaired respiratory muscles

B. Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages.

An OTR® is performing caregiver training for a client with Stage 3 Parkinson's disease (PD) and family members because of the client's emerging need for increased assistance with ADLs and mobility. Which instruction would MOST appropriately help family members deal with a freezing episode? A. Educate the family to have the client silently count each step while walking. B. Recommend that the family use a rhythmic beat to each step as they walk with the client. C. Advise the family to place vertical strips on the floor where freezing episodes are likely to occur at home. D. Encourage the family to give the client tactile cues to promote weight shifting to resume walking.

B: External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated. C: Strips on the floor or carpet where freezing occurs is one intervention approach, but the strips should be horizontal, not vertical.

Both standardized and nonstandardized assessments are included as part of an evaluation for a client with multiple sclerosis. Which standardized assessment would be MOST effective in assessing a client's endurance? A. Nine-Hole Peg Test B. Sleep Questionnaire C. Modified Fatigue Scale D. Multiple Sclerosis Functional Composite

C A: The Nine-Hole Peg Test does not assess fatigue. B: The Sleep Questionnaire is not a standardized assessment. D: The Multiple Sclerosis Functional Composite measures short-distance walking, hand function, and cognition but does not directly assess fatigue.

An OTR® performs an evaluation on a client who has a new diagnosis of Parkinson's disease (PD), Stage 1. The client's goal is to maintain employment as an administrative assistant in a moderate-paced law firm. With which intervention would the OTR® BEST begin treatment? A. Instruct the client in adaptive equipment such as large-button telephones and distal wrist weights. B. Develop a home exercise program for the client to maximize balance and strength. C. Plan the client's work day so that the most difficult tasks align with the time when medications are at optimal effect. D. Advise the client to alert superiors and coworkers to the new diagnosis to gain support and help modify work tasks.

C. A client with Stage 1 PD may present with a resting tremor, a typical first symptom; a resting tremor will make fine motor tasks more difficult. Most people with PD experience their worst symptoms just before the next medication dosage. Timing more difficult fine motor tasks with medication is the most nonintrusive intervention A: A client with Stage 1 PD is unlikely to require adaptive equipment, because symptoms are beginning to emerge and likely do not greatly interfere with occupational performance. ADL tasks do not typically become difficult until Stage 2 or 3, when symptoms make coordinated, smooth movements more challenging. B: A home exercise program to improve balance and strength is a relevant intervention approach, but it does not meet the work demands of an administrative assistant whose job requires more fine motor tasks. D: A new diagnosis of PD can be emotional; a client in this position may want time to work with the interdisciplinary team to consider the implications and how the disease affects the client physically and mentally from day to day before making any public announcements.

An OTR® is performing family training with a client with Stage VI amyotrophic lateral sclerosis (ALS) who is preparing for discharge home. Which points are MOST IMPORTANT for the OTR® will address? A. Adaptive equipment for ADLs and how to set up the client with ALS to perform as independently as possible B. Energy conservation for the client with ALS, as well as caregiver support resources to prevent burnout C. Positioning to prevent skin breakdown, a ROM home program, and safe bed mobility and transfers D. Therapeutic exercises for the client with ALS and how caregivers can use proper body mechanics

C. A client with end-stage ALS would likely be totally dependent for all ADL and mobility, thus requiring major caregiver assistance for bed mobility and transfers. An OTR® instructing family members in these techniques would educate them on body mechanics. Positioning and ROM at this stage are important to prevent discomfort, contractures, and skin breakdown.

An OTR® is working with a client with amyotrophic lateral sclerosis to address interosseous muscle wasting and atrophy in the dominant hand and to promote self-feeding. Which compensatory strategy would be MOST beneficial? A.Weighted utensils B.Built-up foam grip C.Universal cuff with a D-ring D.Hands-free option

C. A universal cuff compensates for loss of finger extension and facilitates grip to allow the client to hold utensils. A: The client's progressive loss of upper-extremity and grip strength indicates that weighted utensils would be too difficult to use during self-feeding. B: A built-up foam grip would require the client to grasp and release the utensils, but atrophy of the hand muscles would not allow the client to grip the foam, even if it is built up.

An OTR® is evaluating a client with multiple sclerosis (MS). What main evaluation finding related to neuromusculoskeletal function can the OTR anticipate? A.Slowed movement of the extremities B.Uniform resistance to passive movement C.Tremor when moving the extremities to reach D.Inability to initiate movement in the extremities

C. Intention tremor is commonly seen in people with MS.

A client with multiple sclerosis (MS) experiences ataxic movements when performing fine motor self-care tasks. During treatment addressing oral hygiene, what might the OTR® FIRST do? A. Instruct the client in weighted adaptive equipment to reduce tremors B. Have the client trial a static wrist splint to reduce the number of joints needed to stabilize and perform motor tasks C. Position the client's trunk and upper extremities to provide proximal support for the shoulders and elbows D. Massage the client's trigger points to release muscular tension

C. Proximal support of the trunk, shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned to lean against a table and prop the elbows on it, which may provide enough support to allow for improved control of the hands while performing oral hygiene. A, B: Adaptive equipment and splinting may be effective but are more involved interventions that may be trialed if positioning is not sufficient. D: Massaging trigger points may help reduce pain associated with MS but is unlikely to affect ataxic symptoms or tremors.

An OTR® is performing a home evaluation for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the OTR®'s recommendations MOST LIKELY focus? A. Modifications to keep the client's lifestyle as close as possible to occupations preferred before diagnosis B. Environmental adaptations such as moving frequently used items to easy-to-reach and nearby areas C. Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment D. Technology changes such as a motorized stair lift

C. Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible first-floor setup is the best option; the patient and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores. A: ALS is progressive, and the client will need to change his or her lifestyle to adapt to increasing disability. B: Environmental adaptations may be appropriate for the earlier stages of ALS, when a client is more mobile. D: A stair lift would not be the best option for a client at this advanced stage because a family member would be required to carry the wheelchair to the opposite end of the stairs.

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is MOST likely to be the priority for this client in the acute care setting? A.Maximize the client's participation in IADLs B.Identify appropriate positioning for the client in bed C.Guide the caregiver in assisting the client with ADLs D.Facilitate increased strength to maximize abilities

C. The caregiver should be trained in skills for assisting the client with ADLs because the client will require greater assistance for tasks as symptoms progress. A: Focusing on maintaining the client's participation in ADLs would be more appropriate than promoting independence in IADLs given the progressive nature of ALS. B: Instruction on positioning in bed is not indicated at this time given the client's ability to be mobile and participate in ADLs. D: The client's strength should be optimized to maintain abilities as long as possible, but increasing strength should not be a focus of intervention because of the progressive nature of ALS.

A client with amyotrophic lateral sclerosis requires significant assistance with ADLs because of limited upper-extremity function and fatigue. The client reports an increase in shoulder pain, and the OTR® observes edema in the hand. The client uses a wheelchair, and during the occupational therapy evaluation the OTR observes the client's arm hanging at the side of the wheelchair. Which intervention is BEST to address the shoulder pain and hand edema? A.Train the caregiver in PROM for the arm and hand B.Advise the client to continue normal activities using the arm as tolerated to provide active motion C.Fit the client with an adaptive device for grasp, such as a universal cuff D.Provide appropriate arm support using a sling or wheelchair device

D. Because of the client's dependence on wheelchair positioning and loss of upper-extremity function, external arm support may be needed to facilitate proper positioning while in wheelchair and thereby minimize shoulder pain and hand edema.

A client with secondary progressive multiple sclerosis (MS) is recovering from a recent relapse and seeks occupational therapy to manage anxiety associated with the disease and its effect on occupational performance. What strategy might the OTR® suggest? A.Participation in a cognitive retraining group B. Implementation of a home exercise plan that incorporates deep breathing C. Relaxation, such as taking a hot bath and yoga D. Using coping strategies for self-identified difficult tasks or situations

D. Emotional stress may exacerbate symptoms in clients with MS, especially relapse-related anxiety. This strategy is client centered and will empower the client with MS to problem solve and handle difficult tasks.

An OTR® is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities? A.Pain management B.Decubitus ulcer prevention C.Strengthening activities D.Caregiver assistance with ADLs

D. Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue. A: Pain is not a significant factor until later stages of the disease, particularly Stages V and VI. B: Ulcer prevention is needed in Stages V and VI, when clients are confined to a wheelchair and have limited independence with bed mobility. C: Stage III of the disease is characterized by muscle function loss, and strengthening is no longer beneficial. The focus in Stage III is on active assistive and passive range of motion.

A client with multiple sclerosis (MS) is experiencing memory deficits that are hindering the client's ability to take medications accurately. Which intervention is the MOST appropriate to support performance in medication management for this client? A.Simplify the task steps in managing medications B.Change the time when the client takes medications C.Have the client use a timer to take medication at designated times D.Provide the client with written directions for medication management

D. The use of memory aids, such as written directions, has been shown to improve cognitive function for clients with MS. Providing written directions can promote independence and accuracy in managing medications. A: Simplifying task steps addresses the cognitive deficit of sequencing and is an energy conservation strategy to manage fatigue; however, this intervention does not provide support for memory. B: Changing the time when the client takes medications would require the involvement of the physician, and there may be little flexibility in the medication schedule. C: If the client is experiencing memory deficts that interfere with taking medications, the client will likely not remember to use a timer.

An OTR® is evaluating a client with Stage 4 Parkinson's disease (PD). During ROM and manual muscle testing, the client presents with cogwheel motions and is mostly quiet with an occasional moan. What would be the BEST action for the OTR® to take? A. Continue testing, then apply heat or ice (to the client's preference) to reduce pain associated with stiffness. B. Study the client's facial expressions and body language to determine which specific movements elicit a pain response. C. Discontinue the manual muscle testing and assess at a later time. D. Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response.

D. client with advanced PD would likely experience common symptoms such as muscle rigidity, which may be exacerbated by ROM or manual muscle testing. "Cogwheeling, common in clients with Parkinson's disease, is identified by jerky movements and is considered rigidity superimposed on tremor. Rigidity often is associated with musculoskeletal pain" (Cooper, 2008, p. 477). The client may not be able to tell the OTR® that he or she is experiencing pain; it is critical that the OTR® help the client feel comfortable with hands-on techniques and assess verbally in clear, concise language, with close-ended questions A: The OTR® must further evaluate the pain before intervening with a modality; although moist heat is a modality that may lessen the pain from rigidity, ice may worsen symptoms. B: A common symptom of PD is a masklike facial expression; the flat affect and lack of nonverbal communication makes it necessary to assess pain by other means. C: For a thorough evaluation, it would not be best to fully discontinue the ROM and manual muscle testing without further measuring the client's movements and pain.

Parkinson's DX

at least one primary symptom must be present -autopsy confirms dx -no cure!