Week 4- Neurological Conditions

What is the epidemiology of Multiple Sclerosis?

900,000 in the US

2.3 million worldwide

When is it generally common for someone to be diagnosed with MS?

Young adulthood

Who is MS usually more common in?

Women

Caucasians

What is the cause of MS?

It is unknown

What is the only thing affected in MS?

UMN

What are signs and symptoms of MS?

Fatigue

Sleep/depression

Weakness

Cognition

Pain

Spasticity

Tremor and ataxia

Dysphasia

Sensation changes

Bladder dysfunction

Visual changes and vertigo

Difficulty with speech and swallowing

What are the structures impacted in MS?

Myelin within the CNS (of the UMNs)

What is the disease progression of MS?

Characterized by periods of exacerbation and remission, as the disease progresses, remission periods are shorter with less improvements

What is MS’s impact on occupational performance?

Interference with ADLs, IADLs, and other occupations

Can impact AROM, strength, coordination

What are examples of activities that are difficult for those with MS?

Medication management

Money management

Self-care

Sexual function/activity

Functional transfers

What is anatomy of MS?

Plaques or lesions form in different parts of the brain; deficits are dependent on where the lesion forms. The lesions are due to the immune system mistakenly attacking the myelin on axons. The damaged neurons struggle with transporting signals (through UMN)

What is the OT’s role in MS?

Self maintenance roles, self advancement roles, self enhancement roles

Activity strategies and energy conservation

Adaptive equipment

Behavioral and environmental modifications

Exercise

Spasticity interventions

Cognitive compensations

Pain management strategies

Tremor and ataxia intervention

Employment modifications

What is the epidemiology of Parkinson’s disease?

Progressive, variable, common movement disorder

What is the age of onset of Parkinson’s disease?

65-70 years

What gender is more commonly affected by Parkinson’s disease?

Men

What is the pathogenesis of Parkinson’s disease?

Loss of dopaminergic neurons of the substantia nigra interrupts input to the corpus striatum and motor pathways to the thalamus and motor cortex

What is the prognosis of Parkinson’s disease?

5 stages

Based on symptoms, function, response to meds

What are the symptoms of Parkinson’s disease?

Hypertonicity

Cogwheel rigidity

Bradykinesia

Masklike face

Tremors at rest

Cunctation-festinating gait

Decreased or no arm-swinging while walking

I paired postural reflexes

Micrographia

What is true regarding Parkinson’s disease and mental health?

About 50% of those diagnosed experience anxiety and/or depression

About 30% of those diagnosed develop dementia

What are the structures impacted with PD?

Damage to the nigrostriatal pathway between the substantia nigra and basal ganglia- the pathway utilized by dopamine

Substantia nigra degenerates due to dopaminergice neuron death which leads to a decrease of dopamine in the basal ganglia

What does a decrease of dopamine cause?

A decrease in speed of movement and mental functions

What is Parkinson’s disease impact on occupational performance?

Impaired coordination and motor control interferes with ADLs, IADLs, and other occupations

Medication and money management

Meal preparation

Safety awareness

Increased risk of falls

What is the direct pathway (excitatory) of dopamine? (Goes in a loop)

Signal starts in the motor cortex

Goes to the striatum

Then to the globus pallidus internal

Then to the thalamus where it says movement is a go

And finally back to the motor cortex to initiate movement

What is the indirect pathway (inhibitory) of dopamine? (Goes in a loop)

Signal to move begins at the motor cortex

Goes to the striatum

Then to the globus pallidus external

Then to the subthalamic nuclei (which says to not move)

The signal then goes to the globus pallidus internal

The it is sent to the thalamus where it is inhibited

The signal then returns to the motor cortex to inhibit movement

What is stage 1 of Parkinson’s disease?

Slight tremors on one side of the body, symptoms are often mild and include changes in walking, posture, and facial expressions

What is stage 2 of Parkinson’s disease?

Symptoms worsen and affect both sides of the body, changes in walking and moving make daily tasks become more difficult

What is stage 3 of Parkinson’s disease?

Loss of balance and slowness of movement makes falls more common, symptoms significantly impaired ADLs

What is stage 4 of Parkinson’s disease?

Symptoms are severe and limit the ability to live alone, walkers or other aides are used daily to help support limited mobility

What is stage 5 of Parkinson’s disease?

Confined to a wheelchair or bed, a 24-hour caregiver is required, and many experience hallucinations and other non-motor symptoms

What is the ages of onset for amyotrophic lateral sclerosis?

40-70

What is affected in ALS?

UMN and LMN in the brain stem and spinal cord

What is the prognosis of ALS?

Often fatal 20-48 months after diagnosis

What is the cause of ALS?

No known cause

What gender is ALS more common in?

Males

What occurs in ALS?

Oligodendrocytes degeneration

Neuroinflammation

Mitochondrial impairment- axonal retraction and cell denervation

what are the symptoms of ALS?

Muscle atrophy and spasticity globally

Sensory and cognitive functions remain intact

Dysphasia, dysarthria, dysphasia

What are specific UMN of ALS?

Muscle weakness

Spasticity

Loss of fine motor control

What are early symptoms of ALS?

Muscle cramps in distal legs

Slow, progressive weakness and atrophy of distal muscle groups and one UE

What are LMN specific symptoms of ALS?

Fasciculations

Muscle weakness

Muscle atrophy

Hyporeflexia- loss of reflexes

What are the structures impacted in ALS?

UMN in the cerebral cortex and LMNs of ventral horn of spinal cord

Impacts the CNS and PNS

What is the progression of ALS?

Very progressive

Death commonly occurs from denervation of respiratory muscles

What impact does ALS have on occupational performance?

All occupations are significantly impacted

Early stages- IADLs, work, leisure can be impacted due to weakness and atrophy

What is the age onsets for Gillian-Barre syndrome?

20-24 and 70-74

What is the cause of GBS?

There is no know cause but it often follows and infection

What is the pathogenesis of GBS?

Acute inflammatory demyelination g polyneuropathy- the infection attacking the myelin temporarily leading to axonal demyelination of the PNS

GBS has a ___________ progression

Quick

What is the prognosis of GBS?

Progressive weakness, the condition worsens, and demyelination occurs but some level of disability remains

What are the 3 phases of GBS?

Onset

Plateau

Recovery

What are GBS symptoms?

Progressive ascending muscular weakness of the limbs- stocking and glove neuropathy

Flaccid paralysis with symmetric pattern

Parenthesis and numbness often accompanied by loss of motor function

Complete tendon a reflex is

ANS involvement in GBS can cause…

Orthostatic hypotension

Arrhythmias

Facial flushing

Diarrhea

Erectile dysfunction

Urinary retention

Increased sweating

What are the structures impacted by GBS?

Swelling and demyelination of peripheral spinal roots

ANS can be impacted

What is the progression of the stages of GBS?

Insert of symptoms with 2 weeks of worsening symptoms

Plateau of symptoms around 4 weeks

Recovery period begins; typically lasts 6 to 12 months but can last up to 3 years

What is the impact of GBS on occupational performance?

ADLs, IADLs, leisure, work, education, etc. due to loss of motor function, the impact varies based on the severity of the symptoms and what stage the person is in

What is the epidemiology of Huntington’s disease?

Genetically inherited

50% chance of getting the gene if a parent is affected

What ages does Huntington’s disease become apparent?

Between 30-50

Early onset before 20

What score is Huntington’s disease development based on?

CAG- score 40 or more and the person will typically develop symptoms

What causes huntington’s disease?

Damages to nerve cells in the brain, typically the basal ganglia is heavily impacted

What is the prognosis of Huntington’s Disease?

There is no treatment or cure, death occurs 10-30 years of symptom onset

What is common in the end stage of Huntington‘s disease?

Injuries from falls and pneumonia

What are symptoms that occur in HD?

Affects judgement, behavior, and emotions

Affects movement and posture

Hallucinations, delusions, and violent outbursts occur

What is HD’s impact on occupational performance?

Movements and posture can impact various occupations

Behavioral and emotional changes can interfere with social participation, work/education, and leisure

What are ways a person can manage Huntington’s disease?

Implement physical safety protocols

Use a calendar to stay organized

Stick to a daily routine to avoid stress

Monitor medication side effects

Choose therapy made for your specific symptoms

Consider Botox

What is epilepsy?

An umbrella term for many different disorders that have caused 2 or more seizures

When is a seizure not considered linked to epilepsy?

Isolated seizure, sometimes due to fever or drugs

What causes epilepsy?

Dysfunction of electrical activity in the brain

What are symptoms of epilepsy?

Unusual behavior, sensation, or loss of awareness

Starting, twitching, confusion, stiff muscles, loss of consciousness

What is the prognosis of epilepsy?

Can be treated with medication

Some cases may require surgery

Treatment with alternative methods- ketogenic diet, deep brain stimulation, VNS

Some may outgrow seizures and others may receive severe brain damage and loss of function

How does epilepsy impact occupational performance?

depends on the severity but it can impact IADLs, social participation, leisure, work, education, and safety

What is a focal seizure?

A seizure that occurs in a specific spot in the brain

What is a generalized seizure?

A seizure that impacts all of the brain

What is the leading cause of senile dementia?

Alzheimer’s

How many in the US are affected with Dementia and Alzheimer’s?

4 million

What is the ages of onset for dementia and Alzheimer’s?

After 80 years old

Early onset is 40-60

What is the percent of genetic connections to the development of Alzheimer’s or dementia?

50%

What causes Alzheimer’s and dementia?

Cortical atrophy

Broadening of the sulci

Decrease in the size of the gyri

Widening of ventricular cavities

Loss of brain matter/neurons

What is the prognosis of Alzheimer’s and dementia?

Degenerative and progressive

Early onset is more severe and rapid

3 stages

What are the symptoms of Alzheimer’s and dementia?

Memory loss

Loss of cognitive functions

Related symptoms- depression, difficulty communication, loss of bowel and bladder control, personality change, severe mood swings

What is a potential link to Alzheimer’s?

Diabetes- when blood sugar is poorly controlled

Alzheimer’s is suggested to be a ________ syndrome that causes neurodegeneration via brain insulin resistance, accumulation of neurotoxins, and neuronal stress

Metabolic

What are the structures impacted in Alzheimer’s ?

Hippocampus

ACh shortage

What is the impact of Alzheimer’s on occupational performance?

Impact increases with the progression of the disease

Safety awareness

Difficulty to carry out ADLs that were once easily mastered

What are things that can help someone with Alzheimer’s?

Providing memory aids

Compensatory strategies

Caregiver training

Environmental modification

Men have slightly ______ brain cells and brain tissue

Mole

Women typically have more _____________ _____________

Dendritic connections

Men have a larger inferior __________ lobe and ___________

Parietal, amygdala

Women have more extensive ________ ________ indicating a potential for more integration of both hemispheres

Corpus collosum

Women have a larger ________ area

Broca’s

Fine motor skills appear to mature earlier in…

Females

Women have larger _____ within the frontal cortex

Regions