Neuro Diagnoses/Journal Review Exam 1

Multiple Sclerosis

Multiple Sclerosis

CNS Demeylination: signal transmission is slowed or blocked Autoimmune Disease (progressive) Common in 20-40 y/o women Causes: environmental and genetic factors SXS: Impaired motor function, vision, speech, memory

What can OT do for MS?

-Maintain or improve function where possible -Slow disease progression: fatigue/stress management, regular exercise -Independence of ADLs and energy conservation (adaptive equipment or environment) -Avoid high temperatures and excessive exertion

Guillain-Barre Syndrome

PNS Demyelination Autoimmune disease; attacks motor and sensory nerves Occurs 2-3 wks post mild infection Rapid onset followed with a plateau and then gradual recovery 80% report severe fatigue and 20% cannot walk after GBS. 3-10% die from cardiac/respiratory failure

What can OT do for GBS?

Training of ADLs and IADLs Exercises for ROM, muscle strengthening, movement coordination

Epilepsy

Over abundant neural activity simultaneously; decrease in GABA (inhibitory), increase in glutamate (Excitatory), focal v. generalized (location) Dx: >2 seizures, more than 24 hours between seizures,

Causes of Epilepsy

Causes: (Symptomatic) inflammation of brains, tumors, strokes, infectious disease or injuries, (genetics) abnormal gene mutations affecting ion-gated channels, (triggers) Strobe lights, lack of sleep, fevers, and brain hypoxia, (unknown) most common

Generalized Seizures

Absence seizures- blank and unresponsive

Tonic-Clonic seizures- unconscious, rhythmic contractures

Myoclonic seizures- conscious, muscle jerks, after waking up

Focal Seizures

Focal Aware Seizures: conscious, symptoms depend on affected brain area, a warning for a bigger seizure

Focal impaired aware seizures: consciousness affected, hear but not understand or respond (Easily aggravated)

Focal to bilateral tonic-clonic seizure: similar to tonic-clonic one spot---> whole brain

What can OT do for Epilepsy?

Rehab post-injury Energy conservation Learn healthy habits Adapt environment for safety Mental health considerations

Which of the following is NOT true of an epileptic seizure? A. The symptoms of the seizure depend on what area of the brain is affected. B. It originates in the brain where there are too many signals firing at different times C. Neural firing can occur in rhythmic oscillatory patterns D. Absence seizures may go unnoticed.

B. It originates in the brain where there are too many signals firing at different times

During your therapy session with Mike, he suddenly stops what he is doing and stares blankly ahead. What type of seizure might he be having? A. Tonic-Clonic B. Focal Aware C. Absence D. Myoclonic

C. Absence Seizure

Jane has epilepsy. She is 50 years old and lives alone. What is NOT a way she could modify her environment to make it safer? A. Remove lock on bathroom door B. Put rugs over tile/hardwood floors C. Cook with an open flame D. Install temperature timer in shower

C. Cook with an open flame

Why would Jane be prescribed an antagonist drug? A. To prevent the release of neurotransmitters B. To activate receptors C. To open ion channels D. To increase blood flow

A. to prevent the release of neurotransmitters

Tetanus

An infectious disease caused by clostridium tetani bacteria, enters the nervous system through lower motor neurons and travels to the spinal cord and brain stem. Can lead to lockjaw, dysphagia, opisthotonus, muscle spasms and more.

Blocks the release of neurotransmitters (GABA/Glycine) that inhibit excitatory impulses leading to uncontrollable muscle contraction.

Tetanus Pathophysiology

-Inhibitory neurons secrete GABA/Glycine neurotransmitters ---> -toxin enters the neuromuscular junction and goes to the CNS ---> -toxin moves through nervous system trans-synaptically ---> -Toxin enters presynaptic area at the inhibitory neuron terminals ---> -Reaches presynaptic area and prevents the release of neurotransmitters, allows motor neurons to send a high frequency of impulses to the muscle cells and leads to sustained contractions and other symptoms.

Opisthotonus

Arching of the back, neck, and head

Risus Sardonicus

sustained facial muscle spasm

What can OT do for tetanus?

Primary treatment: wound debridement and cleaning, antibiotic treatments, early administration of antibodies (human tetanus immunoglobulin)

OT Goals: ROM work, Preventing muscle atrophy and joint stiffness, possible wound care treatment/management, possible cardiopulmonary work to manage/help respiratory issues.

Which of the following is an inhibitory neurotransmitter that is blocked by the tetanus toxin? A. Acetylcholine B. Histamine C. GABA D. Dopamine

C. GABA

T./F: Sustained muscle contractions due to tetanus occur because the motor neurons send too many excitatory impulses to the muscle cells.

True

Which of the following would not be considered a treatment goal in a case with a tetanus patient? A. Wound care/management B. Prevention of atrophy in muscles C. Early mobilization D. Swallow therapy

C. Early mobilization

T/F Opisthotonos causes facial muscles to spasm, as well as the neck to fall into the chest.

False, arches back, neck, and hand

Myasthenia Gravis

Neuromuscular autoimmune disease: patients immune system generates antibodies to block the receptors on the muscles, making them unable to contract. Few ACh receptors are available for ACh binding. Onset in women 20-30 y/o and 60-70 y/o in men.

symptoms of myasthenia gravis

Muscles that contract frequently become weak: eye movement/eyelid muscles, muscles control facial expression, swallowing, proximal limb muscles, and respiratory muscles.

Symptoms usually improve with rest.

What can OT do for Myasthenia Gravis?

Energy conservation technique, maintain or improve independence of ADL (assistive tech, environmental mods), ergonomics), decrease risk of falling (balance training), exercises for ROM, muscle strengthening, mvmnt coordination.

Which of the following is NOT a goal of long-term management of stable myasthenia gravis? A. To identify relapses B. To guide patients in practicing exercise C. To help patients return to work and school D. To reduce the risk of complications E. To cure disease

E. To cure disease

Which of the following is most likely the reason why the topic of 'the role of physical training/exercise in MG' was excluded from the international consensus guidance for management of MG published in 2020? A. There is not evidence that physical training/exercise is beneficial for patients with MG B. There is no evidence that physical training/exercise is harmful for patients with MG C. There is not enough high-quality evidence on the topic D. The topic was not considered to be a priority

C. There is not enough high-quality evidence on the topic

Which of the following is the best way to develop data-driven decision support platforms for MG management? A. Leverage artificial intelligence (AI) B. Collect a large amount of data from patients C. Use machine learning to analyze the data D. All of the above

D. All of the above

Hydrocephalus

Imbalance of CSF in the bloodstream Progress over time, increasing the amount of pressure and overall stretching the tissue within the brain. If not relieved tissue death, interferes with normal brain activity, and potentially permanent brain damage.

Hydrocephalus pathophysiology

Caused by neurological build up of CSF or improper drainage on the ventricles of the brain causing them to enlarge. Fluid causes ventricles to widen, putting pressure on surrounding tissue of the brain --> leading to tissue death

Hydrocephalus causes

Mostly congenital (unknown cause) developing in the third trimester. Can be due to premature birth, intraventricular/subarachnoid hemorrhage (Causes scarring within fluids pathways), meningitis, brain tumor or lesion, SCI or tumor (block normal pathways for fluid), traumatic head injury, spina bifida, blockage (stops the flow from flowing as it should)

Hydrocephalus Symptoms

Infant: rapid increase in head size, prominent scalp veins, vomiting, irritability, bulging fontal, sunset sign

Children: problems with balance/coordination, trouble remembering and focusing, developmental delays also severe headaches, loss of bladder control

Adults: Short-term memory loss, problems with balance and coordination, feeling fatigued, headaches, nausea and vomiting, vision problems

Older Adults: mild dementia, gait disturbances, forgetfulness, loss of bladder control/frequent urination, general slowing of movements, poor coordination and balance

What can OT do for hydrocephalus?

Increasing independence, helping to plan and execute movements, improve balance, help with ADLs, fine motor skill training, helping to adapt their environment/tasks, use equipment or assistive tech

Spina Bifida

Edges of the neural groove don't fulling meet, leaving an opening where the nerves of the spinal cord can protrude. Can be caused by folic acid deficiency, genetics, and anti-seizure meds

Symptoms of Spina Bifida

Occulta: lump discoloration, dimple on lower back (rare) Meningocele: issues with bowel and bladder function Myelomeningocele: Issues with bowel and bladder fxn, problems with sexual fxn, muscle weakness, paralysis and/or lack of sensation below lesion level, cognitive difficulties, chiari malformation

Comorbidities of Spina Bifida

Mobility issues Musculoskeletal malformations (scoliosis, contractures) Hydrocephalus Tethered spinal cord Skin problems (unhealed wounds) Latex Allergy Meningitis Sleep disorders

What can OT do for Spina Bifidia?

Bowel and bladder program Assistive devices Transfer training/education (Weight shifting/skin care) Wound care management

Which of the following is not a type of Spina Bifida? A. Occulta B. Myelomeningocele C. Myelomeningocculta D. Meningocele

C. Myelomeningocculta

T/F: Spina Bifida is a progressive condition characterized by a neural tube defect at birth

False, neural groove not meeting together

T/F: In Spina bifida, the edges of the neural groove fully meet together

False

What is a type of SB clients do OTs typically see? A. Occulta B. Myelomeningocele C. Myelomenigocculta D. Meningocele

B. Myelomeningocele

What is an example of something not recommended to do for a client that has spina bifida? A. Teach proper form for wheelchair transfers B. Wear latex gloves while helping with bowel and bladder program C. Wound care management

B. Wear latex gloves while helping with bowel and bladder program.

What are the interventions we can do to positively impact neuroplasticity in our spinal cord after injury?

blocking of 5-H2C receptors

T/F: hyperreflexia is caused by a lack of motor current input.

False

Why does unchecked sprouting of afferent fibers occur after SCI?

motor neurons below the location of injury lose connection to the brain