Test 4: PD, GBS, MG

Parkinson's Disease

common progressive neurological disturbance of motor function

after age 55

PD is often diagnosed _________

10 to greater than 400 per 100,000

PD prevalence...

increases with age

the prevalence of PD...

basal ganglia;

dopamine; serotonin; norepinephrine

PD is a disease of the _____________, resulting in decreased ____________, _______________, and _______________.

- festinating gait

- stooped forward posture

- mask-like face

- thought processes

- speech slowed

- swallowing difficulty

- depression

What are some characteristics of PD?

- not definitively established

- Familial and Sporadic

- History; not a genetic marker

- Environment and Diet; genetic mutations

The Etiology of PD:

- ....

- ____________ and ______________ forms of PD

- Family ___________ is a risk but NOT a _________ marker.

- ______________ and ____________ may play a part in PD, but NOT as strongly as ________________________.

- tremor

- cogwheel rigidity

- bradykinesia

- impaired postural mechanisms

What are 4 motor dysfunctions associated with PD?

Tremor

involuntary rhythmic movement (1st clinical symptom), "pin-rolling" of the thumb and finger

Cogwheel Rigidity

increased resistance to passive movement, release is ratchetlike

Bradykinesia

slowness of movement, difficulty initiating and executing voluntary movement, difficulty from one pattern to another

Impaired postural mechanisms

anticipatory reflexes, righting reactions, and protective responses are lost, proprioception, ability to maintain upright position, and balance are impaired, causing frequent falls.

TRAP

T- tremor: shaking, usually starting on one side

R- rigidity: stiffness of the limbs, neck, or trunk

A- akinesia: loss or impairment in power of voluntary movement

P- posture and balance

what is the acronym for the motor dysfunction portion of PD

- depression

- akinesia: masked face

- psychosis: hallucinations, delusions

- cognitive issues: processing skills, visual-spatial perception, sequencing tasks

- dysphagia

- bowel and bladder problems

- orthostatic hypotension

- abnormal tolerance to temperature

Non-motor dysfunctions of PD...

- neurotransmitter replacement therapy (levodopa) helps control symptoms

- LSVT big

- physical activity

- yoga

- tai chi

- non-contact boxing

Parkinson's Disease Treatment

decreases; increase

PD

After 4-8 years, the effectiveness of drugs ___________, and side effects ___________.

- depends on the stage

- compensatory strategies

- pt/family education

- environmental modifications

- community involvement

PD OT intervention

Stage 1

PD stage _______

- tremors on one side of the body

- mild clumsiness

- stiffness in posture

- slowed facial expressions and movement

Stage 2

PD stage _______

- tremor, rigidity and other movement symptoms affect both sides of the body

- walking, bathing, and changing clothes take a longer time to complete

- stiff trunk muscles

Stage 3

PD stage ________

- loss of balance and slowed movement

- falls become more common

- daily activities of living are hindered, but patient is mostly still independent

Stage 4

PD stage __________

- movement is limited

- patient requires assistive devices like walking canes or wheelchairs

- needs help with daily activities of living

Stage 5

PD stage _________

- difficult or unable to stand

- bed ridden or requires a wheelchair to move about

- difficulty swallowing

- requires around the clock care

Guillain Barre Syndrome

results in axonal demyelination of peripheral nerves

Acute Inflammatory Demyelinating Polyneuropathy

what is another name for guillain barre syndrome....

- quickly progressing

- symmetrical ascending paralysis starting with the FEET

- pain in the legs

what are characteristics of GBS?

deep tendon reflexes

mild sensory loss

cranial nerve dysfunction

GBS characteristics

- ABSENCE of __________________________

- _________________ in glove and stocking distribution

- ________________________ with possible facial palsy and swallowing problems

- postural hypertension

- tachycardia

- respiratory muscle paralysis

- pain

- fatigue

- and urinary dysfunction

What is the ANS's response to GBS?

cognition

what remains intact with cognition?

respiratory muscles

what muscles may be involved with GBS and may require ventilator support

- rapid loss of muscle function

which stage of GBS occurs at 2-4 weeks

- a stable or plateau phase period

which stage of GBS occurs a few days to a few weeks

- a progressive recovery period

which stage of GBS can last up to two years but generally around 12 weeks

a few weeks to months; residual weakness

most cases of GBS recover within ________________; may have some _____________.

- autoimmune

- antibodies are released that damage the myelin sheath

what is the etiology of GBS...

- hospitalization

- high dose immunoglobulin

- immunosuppressive drugs

what are the treatment options for GBS

1 to 10% of cases

symptoms of GBS range from so mild that medical attention is unlikely to severe disease that may cause death in ____________ cases

- cause is unclear

- 1.3 - 2 per 100,000

what is the cause of GBS?

what is the prevalence per 100,000?

men;

adults 20-24 and 70-74 years

GBS is 1.5 times more common in _________ and occurs in adults ____________ and ____________ years.

- paraesthesia

- pain

- tenderness of muscles

- weakness

- decreased deep tendon reflexes

what are characteristics of the rapid onset of GBS?

- flaccid paralysis of limbs

- sensory loss

- muscle atrophy

what does GBS progress to?

- history;

physical;

neurological examination;

nerve-conduction tests;

cerebral spinal fluid analysis

Diagnosis of GBs entails a _______ of symptoms and a ________ and _________________________ that includes ____________________ and _________________ analysis.

- lessen the severity but does not cure the disease;

- breathing;

- stabilized

Medical intervention for GBS is to _________________ but does not __________________ such that upon initial diagnosis, patients are admitted to the hospital to monitor ___________ and other functions until the GBS has _________.

- occupational profile

- revisions to the intervention plan may be necessary

- PROM/AROM, monitoring strength

- pt/caregiver education- energy conservation/work simplification

- ADLs/IADLs/leisure activities

GBS OT interventions....

Myasthenia Gravis (MG)

the most common chronic disease involving a disorder of chemical transmission at the nerve-muscle synapse or neuromuscular junction

grave muscle weakness

what does MG mean?

autoimmune;

nicotinic acetylcholine;

synaptic

MG is caused by an ______________ response in which antibodies are produced that block, alter, or destroy the ______________ receptors on the post-synaptic membrane and interfere with ___________ transmission at the nerve-muscle junction.

- weak and easily fatigued

- 14/100,000

- undiagnosed

- ptosis and diplopia

with MG muscles become _________ and _________________.

what is the incidence in the US?

May be _____________ especially in older persons.

Oculomotor muscle weakness resulting in ________ and ________.

- muscle weakness

- fatigue

- droopy eyelids

- blurry or double vision

- limited facial expressions

- trouble walking

- difficulty speaking, swallowing or chewing

what are the symptoms of myasthenia gravis

chewing and swallowing and speaking

Oropharyngeal muscle weakness resulting in difficulty with _________, _________, and __________ is seen in some clients.

AM

MG clients are stronger in the _________.

thymus gland; thymic tumors

removal of gland...

MG clients have abnormalities of the ____________ and some have _____________.

what is standard therapy?

limb weakness

_______________ is not an initial stage but happens later in the disease.

progressive;

years

MG

- course of disease fluctuates but is usually ___________.

- prognosis for most patients is good living normal or nearly normal lives.

- remissions or decrease in symptoms can last for ________.

- depends on the outcome of the OT eval

- interventions should not cause fatigue

- must be aware of medications, activity tolerance, best time of day

- stress reduction, pacing activities, emphasis on rest/sleep

- pt/caregiver education

- work simplification/energy conservation

- assistive/adaptive devices

- eating/swallowing evaluation

- home evaluation

MG OT Interventions...