Nuerodegen conditions

ALS (amyotrophic lateral sclerosis)

Progressive degeneration of both upper and lower motor neurons causing muscle weakness, atrophy, fasciculations, spasticity, and eventual respiratory failure

• fatigue and weakness that leads to muscle paralysis that starts distally

• 2-5 year life expectancy after diagnosis some people live longer

ALS sensory and cognitive status

Sensation is intact and the intellect is usually preserved; eye muscles and bowel and bladder control are typically spared

ALS bulbar symptoms

Dysphagia, dysarthria, and drooling due to weakness of the tongue, face, and throat muscles

OT for ALS

Compensatory approach: adaptive equipment, AAC, power mobility, environmental control units, energy conservation, and caregiver training; avoid strengthening to fatigue

MS (multiple sclerosis)

Autoimmune demyelination of the CNS (brain and spinal cord) with relapses and remissions; typically diagnosed in young adults aged 20-40, more common in women

• motor and cognitive deficits skill loss

MS signs and symptoms

Fatigue (most common), optic neuritis and vision changes, ataxia, intention tremor, spasticity, sensory changes, bowel and bladder dysfunction, and cognitive changes

OT for MS

Energy conservation, cooling, fatigue management, pacing, balance and tremor strategies (weighted utensils), cognitive strategies, and avoiding exercise to fatigue

Parkinson’s disease

Progressive degeneration of dopamine-producing neurons in the substantia nigra (basal ganglia), causing movement disorders

Parkinson’s cardinal signs (TRAP)

Tremor (resting, pill-rolling), Rigidity (cogwheel or lead-pipe), Akinesia/bradykinesia, Postural instability

OT for Parkinson’s

Large-amplitude movements (LSVT BIG), external cueing (visual, auditory), weighted utensils, larger-grip tools, fall prevention, and task simplification

Huntington’s disease

Autosomal dominant inherited disorder (CAG repeat on chromosome 4) causing degeneration of the caudate nucleus and basal ganglia; onset usually ages 30-50

Huntington’s triad

Chorea (involuntary, jerky, dance-like movements), cognitive decline leading to dementia, and psychiatric and behavioral changes (depression, irritability)

OT for Huntington’s

Safety and fall prevention, adaptive equipment, weighted items to dampen chorea, consistent routines, dysphagia management, environmental modification, and caregiver training

Alzheimer’s disease

Most common cause of dementia; progressive cortical atrophy with beta-amyloid plaques and tau neurofibrillary tangles; the first sign is short-term memory loss

Alzheimer’s course

Early: short-term memory loss; middle: confusion, wandering, needs ADL assistance; late: loses language and mobility and is fully dependent

OT for Alzheimer’s

Routines, simplified tasks, errorless learning, cueing, environmental safety, and caregiver training; focus on remaining abilities

Dementia

An umbrella syndrome of progressive cognitive decline that interferes with function; not a single disease, and Alzheimer’s is one type

Vascular dementia

Caused by strokes or reduced blood flow; stepwise decline, often with focal neuro deficits