Comp 2 stuff

What is a neurodegenerative disease?

progressive loss of structure or function of neurons; leads to impaired motor, sensory, and/or cognitive function 

What are examples of neurodegenerative diseases?

Parkinson’s disease (PD)

Amyotrophic Lateral Sclerosis (ALS)

Alzheimer’s disease (AD)

Describe Parkinson’s disease (PD)

chronic, progressive neurodegenerative condition with neuropathological changes. traditionally characterized by a complex set of motor signs including bradykinesia, akinesia, rigidity, tremor, and postural instability, which result in a decline in initiation, speed, and coordination of fine and gross motor function; impaired mobility; and speech and swallowing dysfunction.

Describe Amyotrophic Lateral Sclerosis (ALS) 

also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects the motor neurons in the brain and spinal cord. these neurons control voluntary movements, such as walking, speaking, and breathing. As ALS progresses, most people gradually lose their ability to use their hands and their arms as their muscles weaken. 

Describe Multiple Sclerosis (MS)

causes damage to the central nervous system, and as a result impairs neurological functions, limits daily activities and participation, and compromises quality of life.

What is the C2 myotome mnemonic?

look at your shoe- cervical flexion and extension ^

What is the C3 myotome mnemonic?

a fallen tree - cervical lateral flexion <>

What is the C4 myotome mnemonic?

“im not sure” - shoulder elevation 

What is the C5 myotome mnemonic?

arms out wide - shoulder abduction with elbow flexion

What is C6 myotome mnemonic?

smell your wrist - wrist extension, t and elbow flexion

What is the C7 myotome mnemonic

no zombies in heaven - wrist flexion, elbow extension

What is C8 myotome mnemonic?

youre doing great - thumb extension, ulnar deviation

What is T1 myotome mnemonic 

one and done - finger abduction 

What is bradykinesia 

slowed or decreased movement; the pt’s ability to quickly change movements becomes delayed; switching from 1 motor pattern to another becomes difficult. additionally, it can also manifest as a lack of facial expressions (masked face), monotone speech, and reduced eye movement. 

How to screen for bradykinesia

therapist should note (1) whether the pt can initiate voluntary movement, (2) whether the pt’s voluntary movements are abnormally slow, and (3) whether the pt has difficulty switching from one motor pattern to another. 

• ask the pt to demonstrate different facial expressions- happiness, sadness, anger. is the pt able to exhibit various facial expressions, or is facial expressions mask like? 

• ask the pt to change the inflection of his or her voice to sound anger, sad, happy. can the pt change the inflection of his or her voice, or is speech monotone. 

• present a comb to the pt and ask him or her to comb the hair on the right side of the head. alternatively, provide the pt w hand lotion and ask him or her to rub it into the skin on the opposite arm. observe whether the pt is able to initiate movement and how long initiation of movement takes. 

• ask the pt to comb the hair on the left side of his or her head (or to rub hand location into the opposite arm previously indicated) to determine whether the pt can abruptly change movements. observe if the pt is able to quickly change motor patterns or if changing motor patterns is abnormally delayed. 

How is impairment indicated for bradykinesia?

if the pt’s facial expressions are mask like, if monotone speech is detected (meaning the pt is unable to regulate the rate and inflection of vocal tone), if the pt is unable to voluntarily initiate motor patterns, if voluntarily initiate motor patterns, if voluntary movements are abnormally slowed, or if the pt is unable to change movement patterns in a timely manner when performing functional activities.

What is cunctation-festinating gait?

cunctation means to resist movement; festinating means to hurry. a cunctation-festinating gait is characterized by difficulty both initiating and stopping walking. once the pt is able to begin walking, the movement patterns for walking are hurried. the pt appears to shuffle quickly. reciprocal arm swing is often absent; however, sometimes a pt may demonstrate an exaggerated arm swing to enhance propulsion of movement. the pt is also unable to stop walking once started and often bumps into walls or furniture. changing directions while walking is difficult; pt often are unable to avoid obstacles in their path once they have initiated a particular walking direction.

How to screen for cunctation-festinating gait?

• ask the pt to walk along a straight line (approx. 10 feet)

• observe how long it takes the pt to initiate walking. once the pt begins to walk, observe whether reciprocal arm swing is present. note whether the pt’s gait is hurried. 

• while the pt is walking, ask him or her to alter the speed and direction: “walk faster. turn to the right and keep walking. walk slower. turn to the left and keep walking. march in place.” 

• ask the pt to suddenly stop walking. observe whether the pt is easily able to stop walking or has difficulty. 

• while the pt is standing still, gently displace the pt’s balance. maintain close contact guard w the pt. observe whether they lose balance easily. note whether protective responses are present, decreased, or absent. 

How is impairment indicated for cunctation - festinating gait?

if the pt demonstrates difficulty starting and stopping walking.

if the pt’s gait appears hurried and is characterized by small shuffling steps.

if reciprocal arm swing is absent or exaggerated

if the pt has difficulty altering the speed and direction of walking

if the pt easily loses balance when gently displaced and exhibits impaired or absent protective responses.

How to perform LB dressing for persons with SCI? (paraplegia) 

have pt sit in bed with legs extended, using an O method to get pants on over feet 

How to perform LB dressing for person with C4 SCI or advanced stage ALS?

perform total A LB dressing while instructing client in instructional methods and education for strategies for them to be actively involved in their care

How to instruct PROM for SCI: paraplegia?

shoulder PROM: flexion and extension, abduction and adduction, internal and external rotation; elbow flexion and extension and forearm supination and pronation

*no need to perform PROM of wrist/tenodesis for someone with paraplegia

How to instruct PROM for C6 SCI?

perform shoulder PROM and tenodesis only 

Perform bed positioning for C4 SCI, or advanced stage of ALS

OTS will perform total A bed positioning while instructing client in instructional methods and education for strategies for them to be actively involved in their care.

• supine position, side-lying

instruct client with C6 SCI to perform pressure relief at manual w/c level

• perform all pressure relief strategies in handout, provide education regarding how the w/c pushup method is not most desirable due to risk of carpal tunnel

What are the differences in eating and grooming methods for persons with C5 and C6 NLI 

A person with SCI at C5 will need to use a universal cuff as they don’t have the hand or wrist function to feed without it.