OTS 422 EXAM 3

Why do individuals with post polio have a hard time trusting medical professionals?

the initial experience of the disease

What medication given long term to individuals with schizophrenia can cause Parkinson-like symptoms?

thorazine or antipsychotic medications

At what point in the condition of ALS, is a ventilator necessary?

when breathing is difficult and oxygen saturation is not high enough

What subtype of MS has significant deterioration from the beginning of the disease?

Primary Progressive

When individuals with MS experience difficulty with coordination and balance this is called

Ataxia

Individuals with multiple sclerosis have increased susceptibility to complications from ___________.

Infectious conditions

What causes secondary Parkinsonism?

Ingestion of certain drugs

What is the body part most affected by polio?

Legs

What part of the body is most often affected by poliomyelitis?

Legs

What medication is most often used in Parkinson's disease?

Levadopa (L-dopa)

What medication is most often used in management of Parkinson's disease?

Levodopa (L-dopa)

What is amyotrophic lateral sclerosis (ALS) sometimes referred to?

Lou Gehrig's Disease

What symptom interferes with a person with Parkinson's disease facial expression?

Masked Facies

What medical condition refers to an inflammation of the membranes surrounding the brain and spinal cord and the cerebrospinal fluid?

Meningitis

Individuals with ALS maintain are able to maintain what ability throughout their illness?

Mental alertness

Onset of multiple sclerosis

Most individuals with MS are young adults who have lived through the formative years of childhood and adolescence as relatively healthy individuals. -Individuals may be relieved when MS is identified because of the apprehension experienced prior to having an explanation for the manifestations provided.

Lyme Disease

Multisystem inflammatory condition that affects the nervous system as well as joints and muscles.

A common manifestation of post-polio syndrome is ___________________.

Muscle Atrophy

Manifestations of ALS

Muscle weakness of an extremity, awkwardness or stumbling when walking, difficulty with manual dexterity, or slurring of speech. -Dysarthria, dysphagia, hyperreflexia, spasticity, dyspnea (difficulty w/ breathing) -As the condition progresses, ind. become increasingly weak and immobile.

When the poliovirus affects the brain stem (bulbar polio) what affects does this have on the body?

Muscles that control breathing and swallowing are affected.

A _______________ is a fatty, protective sheath that surrounds and insulates the axon in the brain and spinal cord and promotes rapid transmission of nerve impulses.

Myelin

An individual has an uncontrollable tendency to fall asleep inappropriately during the day, despite sufficient sleep the prior night. What medical condition manifests in this way?

Narcolepsy

Poliomyelitis targets what cells in the body?

Nerve cells hat control muscles

Identification of Huntington's Disease

- Based on individual's manifestations, family history, and genetic testing

Management of Parkinson's Disease

- There is no cure -Progressive debilitation -Slow progression -Levodopa (L-dopa) is most often used in the management of Parkinson's disease as the condition progresses. Levodopa increases the level of the neurotransmitter dopamine in the brain. -Deep brain stimulation: Implanting an electrode into a target area of the brain.

Secondary Parkinsonism

- When manifestations stem from another condition -Can be associated with ingestion of certain drugs or exposure to toxic substances -Examples of other conditions that can cause secondary Parkinsonism 1. Alzheimer's disease 2. Encephalitis 3. Brain Tumor 4. Head trauma 5. Huntington's disease

Vision affected with MS

-Any portion of the visual system can be affected by MS *Diplopia: Double vision *Nystagmus: repetitive back and fourth eye movement

Motor Manifestations with MS

-Ataxia: Difficulty with coordination and balance -Vertigo: Dizziness -Intention Tremor: Tremor of hands -Spasticity: Muscle spasms

Speech and swallowing with MS

-Dysphagia: Difficulty swallowing -Dysarthria: slurred speech/unclear articulation with words -Dysphonia: Changes in voice quality

Alzheimer's Disease

-Most prevalent type of dementia. - No clear cause of alzheimer's disease has been discovered. -Prevalence increases with age -Risk factors include family history, diabetes, hypertension, cardiovascular conditions, and head injury

Bowel and Bladder with MS

-Neurogenic bladder -Urinary retention: inability to empty bladder of urine -Incontinence: Loss of control of bowel and bladder -Most frequent bowel manifestation is constipation

Identification & Confirmation of MS

-No definitive laboratory test -Diagnosis based on clinical history, manifestations, and the results of a full neurological examination

Identification of Parkinson's Disease

-There is no single test that can be used to identify Parkinson's disease. -Parkinson's disease is usually based on the presence of tremor, stiffness, and slow movement and ruling out other causes of Parkinsonism.

Manifestations of Parkinson's disease

1. Bradykinesia (slowness of movement) or akinesia - Slowness in initiating or maintaining movements. May walk with small, shuffling steps (shuffling gait) and may have difficulty in rising from a chair or bed. May find it difficult to initiate stop. 2. Muscle rigidity - May blink less frequently and develop a mask-like expressionless face. -Dysphagia -Holds food in mouth, can cause aspiration or choking. -Hypophonia (volume of speech decreases) -Micrographia (handwriting gradually becomes smaller and smaller) 3. Postural disturbance - Posture becomes stooped, and ind. arms fail to swing with their stride when they are walking. -Risk of falling becomes greater due to loss of postural reflexes. -May quicken their steps to "catch up" with their center of gravity 4. Tremor - Most noticeable in hands

Manifestations of Huntington's Disease

1. Cognitive deficits 2. Motor consequences 3. Behavioral changes -Dementia -Bradykinesia

Infections of the nervous system includes:

1. Meningitis: inflammation of the meninges 2. Encephalitis: an inflammation of the brain itself, due to direct invasion of an organism (west nile virus)

Central Sleep Apena

1. Obstructive sleep apnea 2. Central Sleep apnea: occurs when the brain fails to appropriately communicate with muscles needed for breathing to initiate respiration. Apnea= Cessation n breathing

What are the 3 types of Multiple Sclerosis?

1. Relapsing-Remitting: Fluctuating course of relapses with associated neurologic deficits, followed by periods of total recovery after * 90% of ind. with MS experience this stage *Progress to Secondary Progressive 20-40 yrs. later. 2. Secondary Progressive: Characterized by cessation of fluctuations with slow deterioration and progression 3. Primary Progressive: Deterioration from the beginning.

What is multiple sclerosis?

A chronic progressive CNS disease that demye linates the nerves and leaves sclerotic lesions. -An inflammatory, demylinating condition of the CNS that affects nearly twice as many women as men and is the second to only trauma as the most incapacitating neurologic condition affecting young children. - Multiple areas of scaring of myelin surrounding here fibers in the brain and spinal cord are destroyed -Life long condition

Narcolepsy

A complex neurological sleep condition causing impairment of the sleep-wake cycle and resulting in excessive daytime sleepiness with sudden involuntary attacks of sleep lasting from a few seconds to several minutes.

Manifestations of Post-Polio Syndrome

A noncontiguous neurological disorder that produces a variety of manifestations in individuals who experienced acute polio infection years earlier. It is a progressive disease. -Slowly progressive muscle weakness -Generalized and muscular fatigue -Gradual decrease in muscle size (atrophy) -Muscle pain (myalgia) and joint pain -Increasing skeletal changes such as curvature of the spine (scoliosis) -Respiratory muscle weakness -Difficulty swallowing (dysphagia)

Huntington's Disease

A progressive, genetic condition of the CNS in which neurons of the brain degenerate. -Characterized by disorders of movement, cognition, and behavior -Develop manifestations between the ages of 30 to 50 yrs. -Condition advances slowly and progressively -Can result in death after 15 to 20 years

Parkinson's Disease

A slowly progressive neurodegenerative condition of the CNS that leads to progressive loss of motor function -Cause remains unknown - Involves extensive degenerative changes in the basal ganglia and the loss of or decreases in levels of dopamine in the basal ganglia -Can be caused by herbicides, pesticides, CO2, manganese and mercury toxins, head injury. -Most are diagnosed at age 50-70

In what condition does sensation and cognition remain intact throughout the course of the disease?

ALS

What condition has the worst prognosis of the neuromuscular degenerative conditions?

ALS

What are neuromuscular conditions?

Affects the nerves or muscles, which results in degeneration of motor neurons in the areas of the central and peripheral nervous systems, leading to muscle weakness and atrophy(shrinkage) of muscle.

Over 25% of individuals with Parkinson's disease are also diagnosed with what other condition?

Alzheimers Disease

Guillain-Barre syndrome

An acquired inflammatory condition of the peripheral nerves. -Unknown cause but appears to be an immune-mediated condition.

What is poliomyelitis?

An acute infectious viral condition that was prevalent in the U.S. in the first half of the 20th century. -Not progressive

Myasthenia Gravis

An autoimmune neuromuscular condition in which there is an interruption in transmission of nerve impulses to muscle at the point at which nerves initiate contraction of a muscle can occur at any age.

Sudden partial or complete paralysis of one side of the face is characteristic of ____________.

Bell's Palsy

At what age does Duchenne's muscular dystrophy affect males?

Between 3 and 5 years of age

An individual with Parkinson's disease is having difficulty shaving and buttoning his clothes. What condition do these difficulties exhibit?

Bradykinesia

What are neurodegenerative conditions?

Consist of number of conditions that may either be inherited or acquired and that show progressive deterioration of the CNS over time. They may progress slowly or rapidly, and the cause is unknown. 1. Parkinsonism 2. Huntington's Disease 3. Alzheimer's disease

What is a common bowel problem associated with multiple sclerosis?

Constipation

What is the main manifestation of Alzheimer's disease?

Dementia

The primary progressive category of multiple sclerosis indicates what type of progression?

Deterioration from beginning

Cognitive Changes with MS

Difficulties with attention, conceptualization, memory, or new learning

Individuals with multiple sclerosis may experience ataxia, which is (are) ____________.

Difficulty with coordination and balance

The presence of what 2 symptoms that occur in 2 different parts of the body are often used to diagnose MS?

Diplopia and Urinary Tract Infection problems

Some individuals experience visual disturbances, such as diplopia, due to weakness of ocular muscles. What is the definition of diplopia?

Double vision

What condition affects males, beginning at 3-5 years of age

Duchenne's muscular dystrophy

Slurred speech is called

Dysarthria

What does your textbook say is a common symptom with most people who have MS?

Fatigue

Which of the following condition is common in individuals with multiple sclerosis?

Fatigue

Symptoms of Multiple Sclerosis

Fatigue, slight muscle weakness, difficulty with vision, heat sensitivity. *At first, these may be overlooked by the ind. because the often resolve

Amyotrohpic Lateral Sclerosis (ALS)/ Lou Gehrig's Disease

Gradual degeneration of motor neurons, the nerve cells that convey impulses to the voluntary muscles. When upper and lower motor neurons are damaged, the muscles are unable to function and control over voluntary motion is lost. -The exact cause of ALS is unknown -Risk factors appear to include: Increasing age, male gender, and genetic susceptibility.

Muscular Dystrophy

Group of inherited muscle conditions characterized by weakness and progressive degeneration of skeletal muscle. It features fiber degeneration with atypical muscle regeneration (dystrophy), usually consisting of fat and CT that replaces muscle fiber. Examples of muscular dystrophy 1. Ducheen's MD: Most common inherited MD. Seen in boys ages 2-5. (Scoliosis by late adolescence) 2. Becker MD: Milder form of Duchess's MD, identified in boys after age 5. 3. Facioscapulohumeral MD: Affects both male and females. Progressive muscle weakness in feet (foot drop), face, shoulders, arms, abdomen. 4. Limb-gridle MD: affects the hips and shoulders first, then progresses to arms and legs. 5. Myotonic MD: Can be identified in childhood, progresses slowly and is characterized by weakening of muscles in the arm and legs, as well as muscles of the head, neck, and facial muscles.

What condition can occur after a stomach virus or surgery ?

Gullian Barre'

What condition is acute, progressive and ascends usually from legs to trunk, then arms?

Gullian Barre'

When neurons in the basal ganglia of the brain degenerate, what inherited disease is manifested?

Huntington's Disease

Guillain-Barré syndrome is an inflammatory condition of the ______________.

Peripheral nerves

Chronic Lyme disease is characterized by which of the following?

Persistent pain and cognitive difficulties

Which of the following is a major component of the management program for individuals with Huntington's disease?

Physical therapy

The four basic manifestations of Parkinsonism are tremors, akinesia, postural disturbances, and ________________.

Rigidity

Which of the following sensitivities are experienced in many individuals with multiple sclerosis?

Sensitivity to heat

What are the five stages of Parkinson's Disease?

Stage 1: Mild, one side only, hand tremor, stiff neck and leg, also on HO. Stage 2: Symptoms bilateral, stooped posture, hard to start/stop gait, no arm swing, excessive sweating, oily skin, hot/cold flashes Stage 3: Slow shuffling, festinating gait, frequent falls, posture unstable, pill-rolling, cog-wheel rigidity, masked faces. micrographia Stage 4: Dysphagia, drooling, monotone voice with low volume, loss of bowel/bladder control, 1/2 depression, 1/4 dementia Stage 5: Unable to walk, stand, unable to move, 24 hour care

What drugs are sometimes used, especially in acute phases of exacerbations, to suppress the manifestations of multiple sclerosis?

Steroids

Bell's Palsy

Sudden partial or complete paralysis of one side of the face. -Occurs when a nerve running from the brain to the face becomes inflamed. -Steroids is a form of treatment -Most ind. recover

Parkinsonism

Term to describe a condition in which four basic manifestations occur: 1. Tremor 2. Rigidity 3. Akinesia (Absence of movement) 4. Postural Disturbance

Management of ALS

There is no cure for ALS -Forestalling complications such as respiratory infections and decubitus ulcers. -ROM and stretching exercises can help reduce spasticity and prevent contractors. -PT, OT, and speech

Management of Muscular Dystrophy

There is no cure for MD. -Management interventions are directed toward preventing complications and maintaining mobility function and long as possible. -PT, OT, Speech

Management of Huntington's Disease

There is no intervention known to slow the progression of or cure the disease -PT, Speech, OT can help manage the disease -Medications help alleviate or control behavior manifestations

Identification of ALS

There is no specific diagnostic test to detect the presence of ALS

What type of tremors do individuals with Parkinson's disease have at the beginning?

Unilateral Resting Tremors

Manifestations of Guillain-Barre syndrome

Weakness is the most common initial manifestation -Muscular weakness begins in lower extremities and spreads upward (ascending paralysis) -Hospital stay, PT, OT, Speech needed in management -Individuals experience a slow spontaneous recovery over a period of weeks or months

In the United States, what is the most common cause of epidemic encephalitis?

West Nile Virus

Which condition is an inflammatory condition of the peripheral nerves?

What is Gullian Barre

In what condition, does implantation of a deep brain stimulator help control symptoms?

What is Parkinson's Disease

What is the best time to install a feeding tube for a person with has ALS?

When lung capacity is still 75%

Which of the following is the definition of exacerbations?

When manifestations become worse

Why would you advise a person with MS to avoid hot tubs?

a sensitivity to heat that can cause permanent damage to nerves?

Manifestations of Myasthenia Gravis

initial manifestation is usually painless muscle weakness that increases with muscle use and decreases after rest of the muscle.

People with MS fall due to what 2 body changes?

leg weakness and decreased sensation in the feet and legs

Name 3 adjectives that can describe the gait of persons with Parkinson's disease.

shuffling, festinating, and retropulsive