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What is the primary neurological disease of the elderly?
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Primary motor symptoms of Parkinson's disease (4)
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Gerontology Mod10
Neurologic Considerations
| Question | Answer |
|---|---|
| What is the primary neurological disease of the elderly? | Parkinson's disease |
| Primary motor symptoms of Parkinson's disease (4) | Resting tremor Bradykinesia Rigidity Postural instability |
| Hoehn and Yahr Stages of Parkinson's | 1) Unilat involvement, min func disable 2) Bilat/midline without balance impaired 3) Bilateral, mild to moderate disability impaired postural reflex, physically ind 4) Severly disabling, can walk or stand unassisted 5) Confinement to bed or w/c |
| Modified Hoehn and Yahr Stages | 0 = no sign 1 = unilat 1.5 = unilat + axial 2 = bilat without impairment of balance 2.5 = mild bilat, recovery on pull test 3 = mild - moderate bilat; postural instab; physically ind 4 = severe disable; walk or stand ind 5 = w/c or bedridden |
| How do you evaluate rigidity on a Parkinsonian patient? | Test by flexing and extending patient's relaxed wrist Assess relaxed position or wrist drawn into flex, fingers ADD, pronation |
| Functional outcome measures for gait and balance in Parkinson's patients | 2 MWT 6 MWT TUG (TGUG) Sit-to-Stand |
| Parkinson's Disease Rating Scale | 10 listed items Rated 0-3 higher number is more severe involvement |
| Parkinson's Disease Quality of Life Questionnaire | Consists of 4 subscales: 1) Parkinsonian symptoms 2) Systemic symptoms 3) Emotional functioning 4) Social functioning |
| Schenkman's Approach to treating PD | Relaxation/Breathing exercises Passive stretching AROM and Posture alignment Weight shifting Balance responses Gait activities HEP |
| Flewit-Hanford Exercises for PD | Designed to assist gait 1) Long sitting - flex/ext of toes, feet, and knees 2) Hooklying - rocking knees side to side 3) Supine Lying - alternate hip and knee flex/ext 4) Standing - high stepping, alternating DF, weight shifting, standing grapevine |
| Alberts study on Tandem Bicycle for PD | Group forced to pedal at 80-90 RPM had 30% improvement in symptoms vs voluntary group after 8 weeks |
| Music therapy has been shown to be beneficial in increasing gait speed and step length in patients with Parkinson's disease. T/F | True |
| How frequent is recurrent stroke? What is the time frame? | 25% of people who recover from their first stroke will have another within 5 years |
| Signs and Symptoms of Stroke | 1) Decreased level of consciousness 2) Aphasia/Dysarthria 3) Acute onset of hemiparesis/hemisensory loss 4) Monoparesis or Quadriparesis 5) Nystagmus, visual changes 6) Ataxia and vertigo |
| Which type of stroke is more severe hemorrhagic or ischemic? | Hemorrhagic is the most severe |
| Pushers Syndrome (what is it, whos affected, remission) | Patient pushes strongly away from unaffected side towards affected Affects 10% of stroke patients During remission typically disappears first in supine, then sitting, then standing |
| What is affected in pusher syndrome? | Sensory feedback in relationship to posture and gravity leading to misperception of position in space |
| When does recovery of tone generally happen post stroke? | First 7-14 days |
| Left CVA Behaviors (5) | Frequent and severe depression Aware of own deficits Slow cautious behavior Hesitant - may need feedback and support Difficulty learning new tasks |
| Left CVA Motor Programming Deficits (3) | Difficulty completing and initiating sequence of movement Requires increased time for learning Slower movements |
| Left CVA Treatment Strategies (3) | Speak slowly to allow processing of verbal instructions Use visual cues Use one step commands and decrease environmental distractions |
| Right CVA Behaviors (7) | Unrealistic/inappropriate positive emotions Unaware of deficits Tend to be impulsive Decreased information processing Decreased visual spacial perception Decreased mathematical reasoning Poor R vs L discrimination |
| Right CVA Motor Programming Deficits (2) | Difficulty sustaining movement and/or posture Tend to move too fast |
| Right CVA Treatment Strategies (4) | Decrease environmental distractions Maximize verbal cues Keep visual cueing to a minimum Address safety issues, encourage patient to slow down |
| Tripp's Model for Evaluating Stroke Patients | 1) Motor neuron response - eval tone and spastic, abil contract and relax mm 2) Fractioned movement - abil move limb segments 3) Movement consistency - gross motor activity 4) Mental status - abil follow command 5) Funct asses - mobility and UE func |
| Olney and Colbourne's Gait Assessment found 3 problems for stroke patients in last swing phase | 1) Inability to attain full hip flex during swing 2) Inability to ext the knee fully 3) Inability to activate ankle DF |
| 4 Principles of Carr and Shepard's Treatment Approach | 1) Analyze the task 2) Practice the missing component 3) Practice task as a whole 4) Transference of training |
| What common treatment for shoulder problems should be avoided in hemiplegia? | Avoid use of overhead pulley |
| Ranchos Los Amigos Treatment for LE Problems due to Stroke | AFO for DF FES on glutes and quadriceps Prolonged icing to inhibit tone |
| What 2 things are required to treat Pushers Syndrome? | Intact cognition Active patient participation |
| 4 Aspects of PT treatment for Pushers Syndrome | 1) Early resumption of upright posture and transitioning ability 2) Recalibrate perception of an upright posture 3) Utilize tactile and proprioceptive inputs 4) Emphasize stability during early standing |
| Both over-ground gait training and treadmill training are needed to optimize over-ground walking in stroke patients. T/F | True. Both are needed in training sessions to optimize transfer to over-ground walking |
| Explicit information is beneficial for what types of strokes? Which is it detrimental for? | Beneficial: cerebellar damage Detrimental: MCA and Basal Ganglia |
| How frequent should feedback be given for CVA patients? | Less than 50% of trials Summary feedback after several trials is best |
| In patients with CVA guidance has a positive impact on retention of learning. T/F | False. Guidance has a negative impact on retention. NDT |
| Alzheimer's Disease Characterized | Deterioration of memory and other cognitive domains that leads to death within 3 to 9 years after diagnosis |
| 2 markers present in AD | Amyloid clumps Tau neurofibrillary tangles Clumps cause cell death in disease process |
| What part of the brain is affected first by AD? | Nerve cells in the hippocampus |
| What chromosomes are contributors in AD? | Chromosomes 1, 14, 19, 21 |
| Non-Modifiable Risk Factors for AD (6) | Age Genetics Down's Syndrome Gene mutation Head trauma Exposure to metals, infections, toxins |
| Modifiable Risk Factors for AD (5) | HTN Obesity Insulin resistance Smoking Inactivity |
| Stages of Alzheimer's Disease - Early Stage | Forgetfulness, mild memory deficit Difficulty with novel tasks Apathy and social withdrawal |
| Stages of Alzheimer's Disease - Middle Stage | Moderate to severe objective memory deficit Disorientation to time and place Language disturbance, apraxia, personality and behavioral changes |
| Stages of Alzheimer's Disease - Late Stage | Intellectual functions untestable, verbal communication severely limited Incapable of self-care Incontinence of bowel and bladder |
| Stages of Alzheimer's Disease - Terminal Stage | Bedridden Mute Unaware of the environment Joint contracures Myoclonus |
| Neurologic signs such as hyperactive reflexes, increasing primitive tone, and primitive reflexes occur during what stage of AD? | Later stages |
| What is one way to maintain environment when placing a patient with AD in a nursing home? | Use of patients own furniture in the room assists in responsiveness and connectedness with surroundings |
| What factors put patients with AD at risk for falls? | Failing to remember limitations in ADLs Judgment errors and lack of awareness Over-estimation of capacity for safe mobility Refusing/Forgetting use of assistive device |
| What is "sundowning"? | A syndrome characterized by: Restlessness Excitement Increased confusion Hallucination Agitation Seen in late afternoon or early evening Occurs in middle and late stages of AD |
| AD Visual Performance Dysfunction | Restriction of visual fields - loss of peripheral vision, homonymous hemianopia Decrease in visuospatial function, depth perception Loss of contrast sensitivity, agnosia |
| Motor incoordination during gait in AD | Alternating foot pattern is disrupted - pt. takes 2 to 3 steps with one foot without moving the other COG is affected |
| Benefit of habitual exercise for AD | May improve cognitive functioning and reduce falls that result form poor judgment |
| What is the best practice for motor learning for AD? | Constant practice = i.e. practice of all transfers from the same chair Pt.'s were unable to learn new tasks with random practice Learning was impaired with blocked practice |
Created by:
jpwittman
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