A&A II Neuro Test

multiple sclerosis

autoimmune disease of the brain and spinal cord, causes demyelination and slows/prevents transmission of nerve signals down nerve

relapsing remitting

85% of MS cases, back and forth switch between worsening and improving of symptoms

secondary progressive

50% of MS cases, developed around 10 years of relapsing remitting, progessive worsening of condition

primary progressive

10-15% of MS cases, steady worsening of symptoms without relapses

progressive relapsing

5% of MS cases, steady worsening of symptoms along with occasional relapses

15, 50

overall MS age of onset: between __ and __ years

cardiovascular disease, respiratory diseases, infection

MS comorbidities (3)

2, 1

MS diagnosis criteria:

-damage in at least __ seperate areas

-damage at least __ month apart

-rule out other diagnosis

optic neuritis

MS symptoms: most common visual symptom

myelitis

MS symptoms: numbness, parasthesia, limb weakness, incoordination, spasticity

IADLs

MS symptoms: cognition changes are often not realized by client and causes difficulties with ____

intention

MS symptoms: _____ tremor is common

fatigue

MS treatment: consider _____ during OT assessment process, as it can be severe with MS

patient reported outcome measures

MS OT assessment: _____ _____ _____ are preferred

light exercise

MS OT intervention: ____ _____ for muscle weakness, ergonomic positioning, joint protection

remission, thermal PAMs, pressure sores, fatigue

MS precautions (4)

-______ of symptoms

-avoid ______ ____

-______ _____

-consider ______!!

ALS

progressive degeneration of motor neurons, involves UMNs, LMNs, brainstem, and multiple spinal cord regions

veterans

the exact cause of ALS is unknown, but there is a higher incidence of ALS with _____

late onset, 40-70

ALS age of onset

3, 5

ALS is usually fatal within _ to _ years

location, gradual, unpredictable

type of ALS is named for _____ of onset, but symptoms spread in a ____ and _____ pattern to other areas of the body

exclusion

ALS is a diagnosis of _____, creating a long and frustrating process for diagnosis

fatigue, poor balance, weak grip

ALS symptoms: early stages (3)

choking, eating, driving, fall risk, psuedobulbar

ALS symptoms: middle stages (4)

-_____ and difficulty ____

-_____ is relenquished

-____ ____, may not be able to stand back up alone

-______ effect (uncontrollable laughing and crying)

mobility, respiration, eat/drink, speaking

ALS symptoms: end stages (4)

-_____ is extremely limited

-challenges with _____

-unable to _____ by mouth

-_____ is impacted

AROM and PROM

ALS OT interventions: exercise

muscle strengthening, aspiration/choking, respiratory

ALS precautions (4)

-______ ______ is contraindicated

-______/______

-lowered _______ function

-pressure sores

muscular dystrophy

genetic recessive/dominant disorder or spontaneuous mutation, casues loss of muscle mass and muscle weakness, 9 types, specific muscle groups are affected by different types

55 to 60 years

Parkinsons age of onset

fall risk, dysphagia, facial masking, orthostatic hypertension, dyskinesia

Parkinsons precautions (5)

PDQ-39

Parkinsons questionnaire with domains in mobility, ADLs, emotional well-being, support, cognition, discomfort, etc

functional mobility, balance, strength

5 time sit-to-stand: aspects of occupational performance addressed

longer than 15 seconds indicates higher fall risk

5 time sit-to-stand: what do assessment results indicate?

balance, functional mobility, gait

timed up and go test: aspects of occupational performance addressed

balance, functional mobility

functional reach test: aspects of occupational performance addressed

ALSFRS

assessment for individuals with ALS, assesses functional status and respiratory/swallowing function

Parkinsons

orthostatic hypertension is associated with what NGD?

lowest segment of spinal cord with normal sensory/motor functions on both sides

neurological level of injury (NJI) definiton

absence of sensory and motor function in the lowest sacral segments (S4-S5)

complete SCI definiton

preservation of sensory and/or motor function below neurological level that includes the lowest sacral segments (S4-S5)

incomplete SCI definition

damage to central part of spinal cord, incomplete SCI, affects UE more than LE

central cord syndrome definition

loss of fine movement in hands, bowel/bladder dysfunction, loss of pain/temperature sensations

central cord syndrome symptoms (3)

damage to one side of spinal cord, incomplete SCI

Brown-Sequard syndrome definition

paralysis and motor loss

Brown-Sequard syndrome: ipsilateral symptoms

loss of pain and temperature

Brown-Sequard syndrome: contralateral symptoms

damage to anterior spinal cord, incomplete SCI

anterior cord syndrome definition

motor loss, loss of pain and temperature sensations

anterior cord syndrome symptoms

proprioception and light touch

what sensations/functions are spared with anterior cord syndrome?

compression of sacral spinal nerves

cauda equina syndrome definition

LE paralysis, sensory loss, LMN damage, bowel/bladder dysfunction

cauda equina syndrome symptoms (4)

muscle strength and light touch

ASIA levels/classification of SCI: what is tested?

complete, no motor or sensory below injury

ASIA impairment score: A

incomplete, sensory function but no motor function below injury

ASIA impairment score: B

incomplete, sensory and motor functions below injury preserved, less than 3 key muscles

ASIA impairment score: C

incomplete, sensory and motor functions below injury preserved, more than 3 key muscles

ASIA impairment score: D

normal

ASIA impairment score: E

20, 10

orthostatic hypotension: drop in systolic BP of at least __ mmHg or drop in diastolic BP of at least __ mmHg

lightheadedm pale, dizzy, tachycardia, syncope

orthostatic hypotension

T6, complete

autonomic dysreflexia occurs with SCIs at ___ or above, increased risk the more _____ the injury is

sudden, pounding headache

autonomic dysreflexia: most common symptom

sit patient up, look for and remove cause/stimuli, call 911 if no improvement

autonomic dysreflexia actions

pressure sores, decreased sensation causes hazards with cold, heat, and moisture

SCI: skin related effects

above T12

wjhat injury level would require a bowel program after an SCI?

limited movement of head and neck, total assist

SCI levels: C1-3

usually has head/neck control, total assist for all daily activities/transfers, modified independent for mobility/eating

SCI levels: C4

head/neck control, min assist to total assist for most daily activities, modified independent/set up assist for eating/grooming

SCI levels: C5

more movement in UE, including elbow flexion and wrist extension/tenodesis, more independent with daily activities, still may require some assistance for transfers and bowel management

SCI levels: C6

movement similar to C6 with addition of elbow extension, increased strength and fine motor control, modified independent with most occupations

SCI levels: C7-T1

normal function above chest level, independent with most occupations

SCI levels: T2-T12

normal function above hip level, some motor movement in hips/knees, independent with all occupations

SCI levels: L1-L5

relatively normal function, may see return of voluntary bowel/bladder control, independent with all occupations

SCI levels: S1-S5

postural assessment scale for stroke patients

CVA assessment to examine trunk and postural control

attention,, memory, orientation, executive function, awareness

CVA cognitive impairments (5)

Brocas aphasia

motor functions of speech production affected, comprehension intact

Wernickes aphasia

motor functions of speech not affected, comprehension/fluency of speech affected

global aphasia

receptive and expressive langauge affected

stroke impact scale

assessment tool to assess daily functioning and psychosocial factors after stroke

AROM, Fugl-Meyer, MMT, dynamometer

CVA: assessments/screens for UE weakness

box and blocks, 9-hole peg

CVA: assessments/screens for UE motor control

PROM, Modified Ashworth

CVA: assessments/screens for UE muscle tone

PROM, palpation of subacromia strength

CVA: assessments/screens for UE joint integrity

light touch, sharp/dull, proprioception

CVA: assessments/screens for UE somatosensation

predictable pattern of UE motor recovery, 7 stages, proximal to distal

Brunnstrom stages of UE recovery

evaluates and measures motor recovery in post-stroke hemiplegic patients

Fugl-Meyer UE assessment purpose

measures changes in limb function (grasp, grip, pinch, and gross movement) after stroke

action research arm test purpose

measures unilateral gross manual dexterity and coordination

box and blocks test purpose