Akinesia
impairment of voluntary and spontaneous movement initiation resulting in freezing, especially during gait activities
Bradykinesia
slowed motor movements
Dysmetria
decreased coordination of movements
Rigidity
muscle stiffness that impairs movement
Fasiculations
involuntary muscle contraction and relaxation; muscle twitch
Festinating gait
small rapid steps resulting from a forward-tilted head and trunk posture
Paresthesia
numbness and tingling b/c of sensory nerve changes
Evaluation for neurodegenerative diseases
- Occupational profile- Standardized and Non-standardized assessments, observation, interview - Skill assessments (for motor & praxis abilities, sensory perceptual skills, emotional regulation, cognitive ability, and communication skills)
Multiple sclerosis (MS)
disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)
Relapse in MS
appearance of new or worsening of old symptoms and signs lasting at least 24 hours
Remission in MS
improvement of symptoms
Motor symptoms of MS
-Impaired balance and coordination (ataxia)-Partial or complete paralysis of a part of the body -Muscle weakness -Fatigue-Intention tremors -Dysphagia
Sensory symptoms of MS
• Paresthesia (numbness or tingling)• Vertigo• Pain (typically the result of musculoskeletal causes)
Visual symptoms of MS
• Diplopia, or blurred or dimmed vision with or without ocular pain• Optic neuritis
Communication symptoms of MS
• Slurred speech• Scanning speech
Bladder and bowel symptoms of MS
• Incontinence• Urinary retention• Constipation
Sexual symptoms of MS
• Men: erectile dysfunction• Women: decreased libido, lubrication difficulty, and inorgasmia, but ability to conceive and carry pregnance to term remains in tact
Cognitive symptoms of MS
-short-term memory loss-attention deficits-decreased processing speed-impairment in visuospatial ability-impaired executive functioning and judgement
Emotional symptoms of MS
• Depression• Inappropriate euphoria• Lability, likely attributable to lesions in the frontal lobe
Standardized evaluation tools for MS
1. Modified Fatigue Impact Scale2. Beck Depression inventory-18 3. Functional Independence Measure (FIM)4. Nine-Hole Peg Test for dexterity and FM coordination5. Purdue Pegboard Test for dexterity and FM coordination6. Semmes-Weinstein monofilament testing for sensory7. Modified Ashworth Scale for spasticity
Goals for MS should...
address both the exacerbation and remission stages and should be compensatory b/c of the progressive symptoms
Contraindications to OT intervention for MS:
hot temperatures, heat modalities (such as hot packs or flulidotherapy), excessive physical activity or overexertion; increased emotional or physical stress
OT interventions for MS:
1. Vision2. Sensory disturbances3. Urinary incontinence4. Muscle weakness and other motor difficulties5. Pain6. Fatigue7. Ataxia8. Dysphagia and dysarthria9. Cognitive and emotional disturbances 10. ADL adaptation11. Vocational adaptations
Parkinson's disease (PD)
Progressive disorder of the nervous system marked by signs such as tremor, bradykinesia (slow movement), muscular rigidity, and an irregular gait
Secondary Parkinsonism
a condition in which people experience symptoms similar to those of PD, but the cause is related to the ingestion of drugs or other toxic chemicals
Primary symptoms of Parkinson's
resting tremor, muscle rigidity, bradykinesia, and postural instability
Muscle rigidity or stiffness of Parkinson's means
tone is increased and adversely affects movement
Postural instability of Parkinson's
decreased arm swing and loss of postural reflexes*increases fall risk
secondary symptoms of Parkinson's
gait dysfunction, fine motor and bimanual impairments, freezing, cognitive deficits, communication difficulties, sensory loss, dysphagia, mood and behavior disturbances
Stages of PD
1: unilateral disease (i.e. resting tremor)2: bilateral disease (i.e. trunk mobility and postural reflexes)3: mild/mod disease, impaired balance 2/2 postural instability, (I)4: decrease in postural stability, function, mobility, and FM skills - requires assistance for ADLs, standing/walking5: total dependence; confined to bed or w/c
OT eval with a pt with PD
Interview to obtain hx and observation of how symptoms impair occupational performance. COPM is a good tool here.
OT intervention for pts with PD
-energy conservation-caregiver training-support/advocacy groups-HEPs-safety considerations for functional mobility-feeding/ADL adaptations-communication adaptations-sexual routine-bowel & bladder-cognition-recommend group therapy-encourage stress reduction and relaxation techniques-home assessment-address rigidity & associated pain-provide intervention to enable clients to maintain employment
Amytrophic Lateral Sclerosis (ALS)
-"Lou Gehrig's Disease"▪ Rapidly progressive▪ Fatal degenerative neuro disease (respiratory failure)▪ Weakness and wasting of voluntary muscles without accompanying sensory changesleading to eventual paralysis▪ Middle to late adult at diagnosis with average survival at 2-5 yrs. after onset▪ Swallowing, managing secretions, communication, dysfunction of respiratory muscles▪ No cause, no cure, no treatment, no pattern of progression, no method of prevention
Signs and symptoms of ALS are...
progressive and move from distal to proximal
Most typical initial symptom of ALS is...
weakness of the small muscles of the hand or an asymmetrical foot drop with or without night cramps (usually in calves)
Stages of ALS
- Stage I: The person can walk, is independent with ADLs, and has some weakness.- Stage II: The person can walk and has moderate weakness.- Stage III: The person can walk but has severe weakness.- Stage IV: The person requires a wheelchair for mobility, needs some assistance with ADLs, and has severe weakness in the legs.- Stage V: The person requires a wheelchair for mobility, is dependent for ADLs, and has severe weakness in the arms and legs.- Stage VI: The person is confined to bed and dependent for ADLs and most self-care tasks.
Death usually occurs in pts with ALS secondary to
respiratory failure
Tools for OT evaluation of ALS
ALS functioning rating scalePurdue Pegboard TestMultidimensional fatigue inventory Dysphagia screening & testing
Tx approaches for ALS should be ______________.
compensatory
compensatory approach
focusing on adapting to disability and preventing secondary complications - goals center on keeping the person as active and independent as possible for as long as possible
Guillian-Barre Syndrome
inflammatory disease that causes demyelination of axons in peripheral nerves
Phases of Guillian-Barre Syndrome
Onset and acute inflammatory phase: acute weakness occurs in at least two extremities that advances and reaches its maximum in 2-4 weeks; 20-30% of pts with GBS require mechanical ventilation Plateau phase: symptoms are at their most disabling, with little or no change over a few days or weeksRecovery phase: remyelination and axonal regeneration occur over a period as long as 2 yrs. Recovery starts at the head and neck and travel distally. Most people experience significant if not complete return of function - fatigue is a residual symptom
Signs and symptoms of GBS
Rapid progression of symptoms• Symmetrical ascending pattern of flaccid paralysis (typically begins in the feet)• Pain• Fatigue• Edema• Absence of deep tendon reflexes• Mild sensory loss• Dysfunction of cranial nerves• Autonomic nervous system involvement• Bladder dysfunction
Huntington's disease (HD)
a hereditary neurological disorder that leads to severe physical and mental disabilities
Overtime, HD...
causes progressive loss of nerve cells in the brain affecting movement, cognition, emotions, and behavior.
Primary signs and symptoms of huntington's disease
- motor difficulties - deterioration of cognitive and behavioral abilities- slowing of saccadic eye movements and ocular pursuits- dysphagia
Recent memory
Recall of recent events (first type of memory that is affected in dementia)
Procedural memory
recall of information of how to perform a task such as knowing how to ride a bike or write with a pen and paper (REMAINS INTACT with DEMENTIA)
Personal episodic memory
Recall of time related information about one's self, such as where and if one ate breakfast (shows deficits with dementia)
Semantic memory
ability to remember the names of objects (shows deficits with dementia)
Cognitive deficits of dementia
aphasia - difficulty with expressive or receptive language or bothapraxia - loss of skilled, purposeful movementsagnosia - inability to recognize the importance of sensory impressions disturbance in executive functioning
Motor deficits of dementia
-gait disturbances-hyperflexia - overflexion of a limb-paratonia - involuntary resistance -dysphagia - difficulty swallowing