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Multiple Sclerosis
- Patho: progressive demyelinization of neurons
- can involve brian, sc, crainial nerves
- can involve PNS, or ANS also
- Can involve motor and or sensory nerves
- Chararcterized by exacerbation and remissions
- Mild to severe
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MS Causes
- Seems to have a familial tendency
- tends to go with a particular perfectionistic peronality type A
- Environment: climate, geographical clusters
- Viral: immune response
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MS Symptoms
- Early Symptoms
- Optic Neuritis
- Diplopis(double vision) or sclerotoma (spot in visual field)
- Dysarthria
- Weakness in a limb (usually legs First)
- Numbness, burning or tingling in part of the body
- Advandced Symptoms
- Progressive weakness, altered tone
- decreased coordination
- bowel and bladder dysfuncions
- Complications
- Resiratory infecions
- Ducubitus ulcers, contractures
- Depression or euphoria
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MS Cosiderations
- Onset is typically between 20-40
- Consider the activites and goals of the age group
- Difficulites associtaaed witha chronic but unpredictable disease
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MS Diagnosis and Rx
- MRI, IgG levels in CSF, and symptoms
- RX: interferon beta: decrease frequency / severity of exacerbations
- Steroids: ACTH regualtes adrenal funcion
- Avoidance of fagiue, stress, injury and infections
- Management of complications
- Therapy: OT, PT, Speech, Psych
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Parkinsonism
- Patho: progressive degenerative changes in teh basal nuclei especially teh substantia nigra
- Inadequate dopamine
- imblance of exitation and inhibition
- Excess stimulation - increased tone rigidity
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Parkinsonism Diagnosis
- Based on physical manifestations
- MD's are slow to label
- Onset after 60
- Males and females
- Idiopathis: possibel effect of virus or toxin
- Secondary: drug induced - can be reversed
- Phenothiazine
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Early S&S of Parkinson's
- Early
- Slowly spreading tremors, muscle weakness aching fatigue
- Rigidity - cogwheel, leadpipe
- Bradykinesia - difficulty initiating movement
- Orthostatic Hypotension
- Balance and Gait Problems
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Advanced Parkinsons S&S
- increased Rigidity
- Mask like facial expressions, staring eyes
- Mutism, dyarthria, swallowing problems
- Flexed posture with decreased spinal rotation
- Loss of free movement akinesia
- Drolling
- Mutism
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Parkinsonism Rx
- Levodopa: forms of dopamins
- Fetal brain cell transplant
- Surgical Procedures
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Therapy For Parkinsons
- Disease is progressive
- Therapy can help pt stay functional longer
- ROM, postural education
- Adaptive equipment
- Family Education
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Amyotrophic Lateral Sclerosis
- Continuous prgoressive decline in motor funcion, cognition intacts
- Hardening of the lateral corticospinal tracts
- More common in males onset 40-60
- AKA Lou Gehrigs Disease
- Etiology: possibile genitect idopathis
- Distal to Proxiamal
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ALS Patho
- UMN and LMN disease
- Upper: spastic paraplysis, hyperreflexia
- LMN: Flaccis paralysis, decreased tone and reflexes
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ALS S&S
- UE weakness, decreased coordination
- porgesses to LE;s
- Stumbling and Falling
- Eventually to Muscle of swallowing and respiration
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RX for ALS
- Supportive adaptations to maintain funcion
- Team approach
- Focus is to maintain functional independence as long as possibel
- Adaptive devices needed
- Family education and training to allow pt to be cared for in home vs institution
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Myasthenia Gravis
- Authoimmune disorder
- Impairs and eventually destroys receptors for acetylcholine at the myoneural junction therefor messages cannot get where they need to go
- Muscle Weakness and repid fatigue
- S&S: weakness, vison deficits, swallowing and respiration
- Rx: anticholinesterase agents
- Steroids
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Huntingtons Disease
- Inherited but not manifest until midlife
- Progressive atrophy of brain
- degeneration of neurons
- Inadequate neurotransmitters
- S&S reastlessness, choreiform movements, intellectual impairment, rigidity and akinesia, personality changes
- RX: supportive,
- Therapy: reduce choreiform movements, amintain mobility and function for as long as possbile, pt do not recover from this
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