PT 536 Neurodegenerative Conditions PT Implications

AD

most common form of dementia as people age

memory, cognition, mood, language/understanding, movement, sleep

6 specific things which AD impacts, clinical symptoms

memory loss disrupting daily life, problem solving issues, difficulty completing home tasks, confusion with time or place, trouble with visual images or spacial relationships, speaking or writing, misplace items and inability to retrace steps, poor judgement and health concerns, withdraw socially, mood and personality

early warning signs of AD

decline in several cognitive domains

1st way to diagnose alzheimer's disease

false

true or false? short term memory loss is enough for a AD diagnosis

CSF, genetics, PiB, PET w/ FDG

possible testing available to diagnose AD

PiB

compound that binds to extracellular amyloid to visualize plaques in a person's brain while they are still alive

Mini-Mental State Examination

A tool used to determine the level of awareness of current events and recall of past events to screen for orientation or dementia

Cholinesterase Inhibitors

treatment for AD that prevents degradation of ACh

AD causes cholinergic neurons to die which causes poor learning and memory

why take cholinesterase inhibitors?

those with mild to moderate AD

what patients would be better candidates for cholinesterase inhibitors?

Memantine

AD treatment that is an NMDA receptor antagonist

prevents glutamate toxicity

Why take memantine?

those with moderate to severe AD

what patients would be better candidates for memantine?

7-11 years

prognosis of AD

4th

AD is the ____ leading cause of death in older adults

dehydration, infection

death in patients wit AD is often secondary to what two things?

Exercise (physical health & depression), family training, home modification

Main concerns for PT plan of care for patients with AD

hand-over-hand, mirroring, task break-down

what cueing or body language techniques can be helpful when communicating with your patients with AD?

low fat, high omega 3 oils

what kind of diet modifications prove to be neuroprotective in patients with AD and dementia?

Amyotrophic Lateral Sclerosis

What does ALS stand for?

False (both UMN and LMN)

True or False? ALS involves LMN deficits only

weakness, preserved eye movements, cognitive impairment

primary clinical symptoms of ALS

unilaterally

weakness typically begins unilaterally or bilaterally with ALS?

UMN

degeneration of the cortex will cause UMN or LMN symptoms?

LMN

degeneration of the spinal cord or brainstem will cause UMN or LMN symptoms?

limb onset ALS

initial involvement in extremities; affects 70-80% of ALS pts

bulbar onset

ALS which initially affects the muscles controlling speech and swallowing

pseudobulbar palsy, progressive bulbar palsy, primary lateral sclerosis, progressive spinal muscle atrophy

4 major groups of ALS symptoms

pseudobulbar palsy

Dysfunction in the UMN that innervate cranial nerves; patient will experience spasticity in speech and swallowing muscles

progressive bulbar palsy

degeneration of motor neurons of cranial nerves and nuclei in the brainstem; results in difficulty speaking, swallowing, and managing saliva. May complain of drooling

primary lateral sclerosis

degeneration of corticospinal tract; causing muscle weakness and inability to control movements; NOT muscle atrophy

Progressive spinal muscle atrophy

Loss of LMN in anterior horn cells of the spinal cord, resulting in muscle weakness and atrophy

clinical signs/symptoms, EMG

methods of diagnosing ALS

weakness & muscle wasting, speech or swallowing issues, respiratory decline

Common clinical signs and symptoms of ALS

fibrillations and fasciculations

what will an EMG show in a patient with ALS?

LMN

are fasciculations UMN or LMN signs?

LMN signs, UMN signs, progressive spread of signs (with the absence of other disease processes)

what criteria MUST be present in order to diagnose ALS (could be suspected or definite)?

LMN signs, UMN signs, progressive spread into 3+ regions

what criteria MUST be present in order to definitively diagnose ALS

Relyvrio, Radicava, Rilutek

Disease modifying medications available for treatment of ALS

prevents motor neuron death

How does Relyvrio assist in the treatment of ALS?

eliminated reactive oxygen species

How does Radicava assist in the treatment of ALS?

inhibits glutamatergic neuron activity

How does Rilutek assist in the treatment of ALS?

False (does not increase quality of life)

true or false? Rilutek improves survival time in ALS patients and increases quality of life

2-5 years from symptom onset

Prognosis of ALS

near total paralysis

mobility prognosis of ALS

bulbar onset

what type of ALS indicates a faster decline and a prognosis of less than 2 years?

muscle cramps, atrophy, fatigue, asymmetric weakness

What characterizes the early stage of ALS?

hand (weak grip), ankles (decline in mobility)

common place of first weakness in early stage of ALS

difficulty speaking, chewing, swallowing

what does bulbar onset ALS start with?

decreased mobility (wheelchair long distances), ADLs continue to decline, falls, increased reliance on family

what is the middle stage of ALS characterized by?

dependency in ADLs/mobility, dysarthria, dysphagia, respiratory compromise, may need articifical nutrition

what is the late stage of ALS characterized by?

low-moderate intensity exercise, stretching routines, strengthenings, avoid fatigue, (independent) family training, support (dependent)

PT POC for ALS

muscles with MMT grade 3 or higher

what muscles can we work on strengthening for those with ALS?

maintenance of typical weight (weight loss = poor prognosis)

What is a large goal to educate patients with ALS on?

BIPAP

Between CPAP and BIPAP, which offers a greater amount of assistance in breathing?

CPAP, BIPAP

Non-Invasive ventilation methods for ALS

higher

A ____________ (higher or lower) FVC indicates better respiratory function and is associated with a lower risk of complications with PEF tubce