Myasthenia Gravis
What are clinical manifestations of myasthenia gravis?
Fluctuating muscle weakness (more noticeable in proximal muscles)
Fatiguability with repetition that restores with rest
Normal neurological findings
Cranial muscles affected first (double vision and drooping eyelid)
What type of neuropathy is damage to a single peripheral nerve's myelin sheath or axon, resulting in slow nerve conduction?
Mononeuropathy
What is the difference between normal aging and dementia?
Normal aging is decline in only one of 5 domains associated with dementia (memory/learning, attention, thinking, language, visuospatial functioning)
What are the cardinal signs of PD?
Resting tremor
Bradykinesia/hypokinesia
Rigidity
Postural instability
If patient has < 90 degrees hip flexion, how will wheelchair be modified?
Seat to back angle will be greater
What are the signs of a myasthenic crisis?
Increasing muscle weakness
Respiratory distress
Difficulty talking, chewing, or swallowing
What are the pathological changes that occur with peripheral neuropathy?
Sensory loss
Weakness
Pain
Vasomotor symptoms
What kind of dementia presents with: impaired executive functioning, disinhibition, socially inappropriate behavior, less hippocampus involvement, impaired speech production or comprehension?
Frontotemporal dementia
A patient with PD presents with right and left extremity involvement and demonstrates impaired righting reactions during examination. What Hoehn & Yahr stage is this patient?
H&Y 3
Indications for a manual wheelchair.
>3+/5 strength in 2 extremities
Good head control
Fair trunk control
Ability to complete pressure relief
What are some implications for PT?
Deep breathing and coughing exercises
Strength training
Energy conservation education
Education on side effects and toxicity signs of AChE inhibitors
What kind of neuropathy is Guillain-Barre syndrome?
Acute inflammatory polyneuropathy
If a patient scores 20 on the mini mental state examination, what dementia severity do they have?
mild
Which core PD EDGE measure assesses functional balance impairments across 6 contexts of postural control?
BESTest
What are the components of a wheelchair exam?
1. subjective interview and chart review
2. functional assessment (including gait!)
3. mat examination (seated and supine)
4. Patient specific measurements
5. pressure mapping
Characteristics of strength training in patients with myasthenia gravis
Mild-moderate stage of myasthenia gravis
Maximal isometric contractions
Below fatigue level
What neuropathy presents with S/S of acute onset of sensory and motor deficits, foot/wrist drop, facial weakness, and pain?
Name ways to promote motor learning in a patient with dementia.
Errorless learning
Constant practice - repetition
Knowledge of results
Modeling - visual feedback
Spaced retrieval training
Implicit tasks
What 4 disorders present similarly to PD?
Normal Pressure Hydrocephalus
Lewy body Dementia
Cortical-basal ganglionic degeneration
Progressive supra nuclear palsy
What wheelchair components can be added to manage increased tone?
Adductor pads
Decreasing seat to back angle, increasing dump of chair, or adding wedge in anterior part of cushion
Pelvic positioning strap
Calf pads
Why does myasthenia gravis have a guarded prognosis?
Disease course is variable in terms of:
Remissions/exacerbations within 1st year
Symptoms fluctuate in intensity during the day
Longer-term spontaneous relapses
Remissions rarely complete or permanent
What is PT management of inflammatory polyneuropathy?
Maintain ROM
Strengthening
Progressive transfer and gait training
Wheelchair mobility
What are the components of the BIMS?
1. Repetition of 3 words
2. Temporal orientation (year, month, day of week)
2. Recall 3 words
What intervention principles should be incorporated in exercise for PD?
External cues
Functional strengthening
Stretching
Rotational movement
Crossing midlineBalance training with balance reactions
What measurements are taken in supine and what are they used for?
1. Upper leg length (minus 2 inches for seat depth)
2. lower leg length (minus cushion height for floor to seat height)
3. popliteal angle (impacts footrest postion)
4. true hip flexion ROM (seat to back angle)