Chronic degenerative Disorders

  1. 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
  2. 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
  3. 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
  4. MS Cosiderations
    • Onset is typically between 20-40
    • Consider the activites and goals of the age group
    • Difficulites associtaaed witha chronic but unpredictable disease
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. Parkinsonism Rx
    • Levodopa: forms of dopamins
    • Fetal brain cell transplant
    • Surgical Procedures
  11. Therapy For Parkinsons
    • Disease is progressive
    • Therapy can help pt stay functional longer
    • ROM, postural education
    • Adaptive equipment
    • Family Education
  12. 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
  13. ALS Patho
    • UMN and LMN disease
    • Upper: spastic paraplysis, hyperreflexia
    • LMN: Flaccis paralysis, decreased tone and reflexes
  14. ALS S&S
    • UE weakness, decreased coordination
    • porgesses to LE;s
    • Stumbling and Falling
    • Eventually to Muscle of swallowing and respiration
  15. 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
  16. 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
  17. 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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Chronic degenerative Disorders