GBS
what are the signs and symptoms of GBS
symmetrical ascending paralysis from feet
pain
absence of deep tendon reflexes
glove and stocking distribution of mild sensory loss
cranial nerve problems
postural hypertension and tachycardia
paralysis of respiratory muscles
urinary dysfunction
explain the four types of MS
Clinically isolated syndrome
relapsing-remitting (lesions on the brain)
secondary progressive
primary progressive (lesions on the spinal cord)
what are the 3 categories of pain?
neuropathic- pain caused by a lesion or disease of the somatosensory nervous system
nociplastic pain- no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors
What are the 4 most common Neuromuscular disorders? What are their signs?
Spinal Muscular Atrophy- progressive muscle loss and atrophy
Charcot-Marie-Tooth-Disease- distal muscle weakness and wasting; sensory loss
Myasthenia Gravis- weakness with voluntary muscle activity and fatigue
Muscular Dystrophies
What intervention would you give someone with ALS
primary focus- adaptation and prevention of secondary complications while maintaining max I and positive QoL
Early tx- address symptoms that inhibit occupational performance to maintain highest level of independence as long as possible
Later tx- focus on individual functional needs and physical/social environment (caregiver training and home modifications)
movement programs (ROM, strengthening, endurance, breathing programs)
assistive technology and DME
Dysphagia interventions
what are the similarities and differences between Huntington's and Parkinson's Disease?
Similarities: Neurodegenerative Illness, bradykinesia,
Differences:
Parkinson's- asymmetric onset, officially diagnosed with a DATSCAN, does not have proper amount of dopamine, tremors, bradykinesia, smaller amplitude of movement
Huntington's- hereditary, involuntary movement disorders, voluntary movement disorders (delayed initiation of mvmt, bradykinesia, incoordination, visual changes, posture)
treatments for MCI
Aerobic exercise or resistance training, mental activity/physical activity
use word association, story, mnemonics visual inputs, learning activities, concrete examples, provide feedback, active learning, etc
define delirium
disturbance in attention and awareness
a sudden onset of confusion
dementia diagnosis
Major Neurocognitive Disorder
Deficits in memory and significant cognitive decline in 1+ cognitive domains
independence in daily activities is affected (min requiring assistance with IALDS)
Madison is a 19 year that stepped on a nail but did not feel anything. She also is experiencing midline back pain. What phase of GBS is she in? What intervention would the OT do during this stage?
phase 1: acute inflammatory progressive phase
position for pain management, stability, prevention of secondary complications and function
environmental control- access to nurse call light, TV, lights, phone, etc
communication- picture boards, voice activated devices
range of motion- avoid overwork of denervated muscles
mental wellness- coping with anxiety or depression
swallowing and respiratory care if issues are present
what is the neurophysiologic change?
lesions/plaques in the gray and white matter
spinal cord, optic nerve, brainstem/cerebellum, periventricular white mater, inflammation, demyelination, axonal injury, and cell death
what makes up the Loeser's model of pain?
nociception- tissue damage/irritation
psychological- your unique experience with pain
social- feelings about pain
behavioral- behaviors because of pain
Liam’s parents report that he:
Frequently falls when running, has difficulty climbing stairs, uses furniture or his legs to push himself upright after sitting on the floor, shows increased fatigue after short play periods, has gained weight and appears “clumsy” compared to peers.
what neuromuscular disease does liam have?
Duchenne muscular distrophy
Which one is not tested on the ALDFRS scale?
handwriting, balance, salivation, breathing
balance
How do on and off periods of Parkinson's impact treatment
heavier symptoms return after medications wear off- important for us to know if we are doing treatment because if someone is off, they will have a poor response and less carry over
changes in memory retrieval
slower rate of acquisition
poor processing speed
less divided attention
role of OT an delirium in ICU (evidence based)
OT decreases the incidence and duration of delirium in ICU and improved function outcomes
What are the 3 stages of Alzheimer's Disease?
Pre-clinical Dementia: Brain changes observable on tests no no challenges with memory
Mild Cognitive Impairment due to Alzheimer's Disease: Evidence of Alzheimer's-related biomarker + challenges with cognition compared to peers, problems with memory and thinking that are beyond that of peers but generally able to complete ADL/IADL without assistance
Dementia due to Alzheimer's disease: challenges with memory, tests show evidence of disease, challenges to other areas of thinking that lead to occupational dysfunction
what intervention would you do in the recovery phase?
do not overwork partially innervated muscles, monitor for OH
splinting, increase occupational engagement, safe transferring training, desensitization program, adaptations/modifications, energy conservation, fine motor activity, home assessment
What are the 2 instruments used to measure MS?
Expanded Disability Status Scale (EDSS) and MS Functional Composite.
what does OPQRST stand for?
guide when asking about pain:
O: Origin & Onset- gradual, sudden?
P: Position & Pattern- location of pain? what makes pain better or worse?
Q: Quality- what does the pain feel like (mechanical, chemical, neural, vascular)
R: Radiation- does the pain spread to other areas?
S: Severity
T: Time- how long ago did it start?
What are the 3 types of SMA? How is the onset characterized?
Type 1- most severe; lowest life expectancy
Type 2- proximal muscle weakness, low muscle tone, spinal curvature, and lower limbs more than upper limbs
Type 3- least severe; foot deformities, scoliosis, and respiratory muscle weakness
Characterized by age, the earlier = type 1; later = type 3
How many stages of ALS are there?
Describe each one
1- ambulatory, ind in ADL
2- ambulatory, slightly dec ind
3- ambulatory, inc weakness, introduce adaptive equipment
4- wheel chair, can do ADL with fatigue, ind with PWC
5- dep for wc, inc dep in ADL
6- in bed, dep ADL/max a for mobility
Describe the differences between
Progressive Supra Nuclear Palsy
Multiple System Atrophy
Corticobasilar Degeneration
Lewy Body Dementia
Drug Induced Parkinsonism
Vascular Parkinsonism
PSP- symmetric symptoms, no tremors, vertical gaze palsy (leads to falls), early and sig cog impairments
MSA- multiple systems atrophying quickly, extreme OH, tremors, bradykinesia, rigidity, dec balance, arm swing
CBD- asymmetric motor involvement, apraxia (idea motor, ideation), alien limb syndrome, no cognitive impairment
LBD- cognitive impairments, behavioral symptoms, sig fluctuations in symptoms/functional level
DIP- caused by anti-psychotic drug, can be reversible
VP- multiple small strokes, abrupt onset
what are skills that remain stable with age?
recognition memory, temporal order memory, procedural memory
what intervention would you do with a person who has delirium
continual reassessment, orienting activities, sensory stimulation, modifying the environment to support memory, sleep hygiene, function, integrate family and friends, work in multidisciplinary team
Lisa is a 79 year old who is unable to remember what she ate for breakfast, has impairments in language, wanders around at night, needs help with BADL/IADL, and withdraws socially.
is she in the early, middle, or late stage of dementia?
middle
what intervention would you do in the plateau phase?
continued monitoring and symptoms management
Which type of MS experiences muscle paralysis
Primary Progressive PPMS
Jordan reports:
Pain in the left shoulder when lifting items overhead at work.
Describes pain as “sharp and tight” on elevation and “pulling” on lowering.
Intermittent numbness and tingling along dorsal forearm and thumb when turning his head to the right.
Fatigue and weakness when gripping tools at work.
No recent trauma, but symptoms have worsened over the past month.
is it a joint issue, muscular issue, arthritic issue, or neural issue?
muscular issue and neural issue
what are the 4 categories of CMD?
type 1- hypotonia, generalized muscle weakness, contractures, but no severe intellectual disability
type 2- affects the muscle and brain
type 3/4- affects the muscle, brain, and eye
What stage of ALS should a wheelchair be prescribed
Stage 3, in preparation for Stage 4 (Non Ambulatory)
define chorea, akathisia, and dystonia
are these symptoms found in Parkinson's or Huntington's?
explain how these symptoms impair function
Huntington's
chorea- involuntary jerking/twitching movements
akathisia- motor restlessness
dystonia- sustained abnormal rigidity causing changes in posture
unable to hold onto a walker, unable to stay seated in a wheelchair, contractures, tendons shortening, ADLS, IADLS
What are the 6 neurocognitive domains
1. language
2. learning and memory
3, social cognition
4. complex attention
5. executive function
6. perceptual-motor function
general approaches to treat dementia
enhance occupational performance and quality of life
maintenance, restoration, improvement of capabilities
adaptation of tasks and environment
compensation for declining function
promotion of respite care and support groups for family
education/provision of resources on handling behavioral disturbances and mood liability
(task simplification, environmental modification, remediation, compensation, caregiver training)
Maria reports a 3-month history of persistent fatigue that is “constant,” “not relieved by sleep,” and “making daily tasks feel heavier.” She states that she can get through her workday but crashes immediately after arriving home. She has reduced social engagement and decreased exercise participation.
She denies fever, weight loss, joint pain, depression, anxiety, or night sweats. She has no difficulty initiating sleep and does not snore. She describes her fatigue as mental and physical exhaustion, distinct from sleepiness.
What type of fatigue is this?
primary fatigue