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Gerontology Mod10

Neurologic Considerations

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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