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neuro dx and tx Cheat Sheet (DRAFT) by

neuro diagnosis neuro tx

This is a draft cheat sheet. It is a work in progress and is not finished yet.

dx

MS
1. Fatigue – the most common symptom of MS. Primary fatigue – due to cortical damage, -leads to overwh­elming feelings of fatigue -Secondary fatigue- due to decond­iti­oning, respir­atory muscle weakness, pain. 2. Parest­hesias – pins and needles sensat­ions. 3. Sensit­ivity to extreme heat. 4. Pain 5. Vertigo 6. Emotional reactions -lability -euphoria -reactive depression 7. Visual symptoms -diplopia -scotoma -loss of visual acuity -optic neuritis (loss of vision and pain behind the eye, temporary) 8. Motor symptoms -muscle weakness -impaired coordi­nation -impaired balance; ataxia -partial or complete paralysis -spast­icity -intention tremors with movement -impaired bowel and bladder functions; incont­inence -impaired sexual functions 9. Cognitive symptoms -impaired short term memory -word finding problems -diffi­culty attending -slow processing speed -executive function problems
ALS
1. Progre­ssive weakness in hands and feet, moves proximally toward trunk. 2. Loss of fine motor control. 3. Difficulty walking with tripping and falling. 4. Slurred speech, difficulty swallo­wing. 5. Muscle cramps and twitching in arms, shoulders tongue. 6. Difficulty mainta­ining upright posture or holding head up. 7. Cognitive decline charac­terized by person­ality change, irrita­bility, obsess­ions, poor insight, and pervasive deficits in frontal executive tests. Presen­tation consistent with the changes to character, social conduct, and executive function in fronto­tem­poral dementia. 8. Does not affect eye function, bowel and bladder function, sensory or sexual functions.
parkinsons
1. Tremors -resting tremors: occur when the extremity is at rest. -intention tremors: tremors that increase in severity when the person thinks about moving the limb. 2. Muscle rigidity and stiffness. 3. Cogwhe­eling of joints – joint ratchets when moving. 4. Akinesia or Bradyk­inesia – slow movements or inability to initiate movement. 5. Gait disorders -shuffling gait -falling forward -retro­pulsion – walking backwards. 6. Postural Instab­ility 7. Mask-like facial expression 8. Microg­raphia – tendency to write small. 9. Cognitive symptoms -impaired memory, executive function -dementia -depre­ssion 10. Commun­ication and oral motor symptoms -hypop­honia (soft voice) -lack of expression -swall­owing problems -drooling
guillain barre syndrome
1. Tingling sensations in the legs that spread to the arms and upper body. 2. Muscle weakness beginning in the legs and spreading to the arms and upper body. 3. Mild, distal sensory loss. 4. Muscle belly tenderness as diagnostic sign. 5. Fatigue 6. Edema in legs 7. Deep tendon reflexes are absent. 8. Possible facial palsy. 9. Possible autonomic symptoms such as hypote­nsion, diapho­resis, urinary retention. 10. Anxiety
myasthenia gravis
1. Increasing muscle weakness with activity, weakness improves with rest. 2. Drooping eyelid on one side. 3. Impaired facial muscles with slurred speech. 4. Difficulty chewing and swallo­wing. 5. May experience difficulty breathing. 6. End stage – may experience quadri­par­esis, respir­atory failure.
 

occupa­tional therapy tx

dx
tx
precau­tions
MS
Muscle weakness: -gentle therap­eutic exercise -ergonomic positi­oning -education in joint protection techniques Visual impair­ment: -clear walkways in the home -provide contrast at the edges of steps or carpeting (bright or dark electrical tape) -adapt­ations for low vision (large print, large buttons, etc.) Sensory impair­ments: -sensory re-edu­cation -adapt­ations for safety to prevent burns Cognitive impair­ments: -adapt­ations for short term memory, executive functi­oning. -educate family members in how to allow extra time for proces­sing, word finding. Spasti­city: -resting splints, AFOs Dysphagia: -thickened liquids -allow extra time to chew and swallow Fatigue: -educate patient and family in energy conser­vation and work simpli­fic­ation techniques
1. Avoid extreme physical stress -stren­gth­ening should be gradual -allow for rest breaks -plan activities over several sessions. 2. Avoid thermal physical agent modali­ties. 3. Educate patient and family about exacer­bations and remiss­ions. -disease prognosis -exace­rba­tions happen, patient is not faking illness.
ALS
Muscle spasti­city: -AAROM and PROM to prevent contra­ctures -posit­ioning to reduce spasticity -diaph­rag­matic positi­oning to reduce the work of breathing Limited upper extremity movement: -adapt­ations for functional activi­ties, such as built-up handles on eating and grooming utensils or a universal cuff. Limited mobility: -Cane -AFO for foot drop -Walker -Power wheelchair in late stage Dysphagia: -adapt food consis­tencies -allow extra time to eat -reduce distra­ctions during eating Fatigue: -education in energy conser­vation and work simpli­fic­ation techniques Limited Commun­ica­tion: -augme­ntative commun­ication -single switch or eye gaze control Caregiver education: -manag­ement of dysphagia -envir­onm­ental modifi­cations -preve­ntion of skin breakdown
1. Progre­ssive resistive exercise to strengthen muscles may cause cramping, fatigue and is contra­ind­icated 2. Monitor for aspiration and choking – may need suction. 3. Monitor for decreased respir­atory function 4. Monitor for pressure sores. 5. Avoid overwh­elming the patient with adaptive equipment, as the person may not receive adapta­tions well.
parkinsons
Impaired functional mobility: -adapt home to clear pathways -recommend flat shoes, not rubber soled shoes (can stick, cause falls) -avoid tight spaces -encourage group exercise to manage bradyk­inesia, elevate mood Muscle rigidity and pain: -moist heat -gentle ROM -closely monitor pain during exercise Deficits in self care and feeding skills: -distal wrist weights to manage tremors -weighted utensils -thickened liquids -soft food consis­tencies and small portions Problems with commun­ica­tion: -use a mirror for facial awareness -felt tip pen for writing -address vocal responses – volume Employ­ment: -sedentary job with limited need for commun­ication and gross motor movement Family and caregiver training: -use of timed auditory cues to assist patient with initiating and speeding up movements -medic­ation management
1. High risk for falls due to postural instab­ility -keep pathways clear -remove throw rugs 2. Prone to aspiration due to dysphagia. 3. Mask-like face may make it difficult to determine emotions. Closely monitor pain and signs of depres­sion. 4. Medication side effects may cause orthos­tatic hypote­nsion, stomach problems, dystonia.
GBS
Acute Phase: Occupa­tional Therapy evaluation and treatment may not be ordered during this phase. If it is, focus should be on positi­oning and splinting to prevent muscle tightness and contra­cture. PROM may be provided as tolerated but should not be overdone. Plateau Phase: -Symptoms are stabil­izing, OT treatment may begin if it did not during the acute phase. -Decreased trunk control and core stability: provide positi­oning to trunk, head, and upper extrem­ities for stability; adjust for maximum function in sitting and supine. -Decreased UE ROM and strength: provide PROM, especially if strength below grade Fair. -Increased anxiety: focus on providing positi­oning and adapta­tions for comfort and commun­ica­tion, i.e. adapted call button. Recovery Phase: -Proximal to distal recovery of movement: provide adapta­tions for fine motor tasks, such as use of a mobile arm support. -Gradual recovery of gross and fine motor skill: gradually increase the number and complexity of tasks as motor function returns. ADLs and IADLs: assist the patient in resuming prior occupa­tions and roles. -Residual weakness or loss of endurance: train in energy conser­vation and work simpli­fic­ation techni­ques.
Watch for signs of fatigue during treatment, discon­tinue activity if needed to prevent overex­ertion. -Watch for muscle substi­tution patterns during movement ; provide adapta­tions to compensate for weak or fatigued UE muscles to prevent long term pain or contra­cture from substi­tution.
MG
Upper extremity weakness: -exercise and activity to regain muscle power and endurance -adapt­ations for extreme weakness, including overhead slings, mobile arm supports, electronic devices Facial and oral-motor weakness: -educate in adapta­tions to food consis­ten­cies, including thickened liquids, small bites, food consis­tencies -train in self-check of facial muscle status in mirror Fatigue: -educate patient in disease process, fact that muscles fatigue with activity, recover with rest -educate in energy conser­vation techniques -educate in work simpli­fic­ation and adapta­tions to lifestyle -assist patient and family in modifying home to compensate for low endurance and weakness
Attend to and respect the patient’s activity tolerance. 2. Watch for changes in respir­ation and emotional distress during therapy. 3. Use the Borg Scale of Perceived Exertion to monitor the patient’s perceived exertion levels.