Fall Prevention and ALS Overview

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Questions and Answers

What is one of the initial signs and symptoms of botulism after neurotoxin ingestion?

Generalized rash

Blurred and double vision (correct)

Fever and chills

Severe headache

Which treatment is preferred for feeding in patients with botulism?

Oral feeding

Oropharyngeal suctioning

Nasogastric intubation (correct)

IV fluids only

What is the primary medication used for treating Trigeminal Neuralgia?

Topical capsaicin

Intravenous morphine

Oral ibuprofen

Oral carbamazepine (correct)

Which of the following conditions is characterized by sudden attacks of sharp pain?

Trigeminal Neuralgia Signup and view all the answers

What is the role of fibroblasts in wound healing?

Produce collagen and extracellular matrix Signup and view all the answers

What types of patients require wound debridement and parenteral antibiotics?

Patients with wound botulism Signup and view all the answers

What is the significant outcome of severe muscle wasting in botulism patients?

Limits mobility and independence Signup and view all the answers

What constitutes acute inflammation?

Immediately develops and is self-limited Signup and view all the answers

What is the primary characteristic of Tardy Ulnar Palsy?

Atrophy of the first dorsal interosseus muscle Signup and view all the answers

Which test would typically be used to assess the ulnar nerve?

Froment's sign Signup and view all the answers

Which condition is characterized by maximum passive wrist flexion causing paresthesia over the median nerve?

Carpal tunnel syndrome Signup and view all the answers

What does sciatica primarily involve?

Radiculopathy due to nerve root changes Signup and view all the answers

What treatment is preferred for moderate to severe cases of Tardy Ulnar Palsy?

Surgery with decompression Signup and view all the answers

What is a common symptom of Thoracic Outlet Syndrome (TOS)?

Pain at night Signup and view all the answers

Which demographic is particularly at risk for developing sciatica?

People between 40 to 60 years Signup and view all the answers

Which of the following is NOT a common condition of the peripheral nervous system (PNS)?

Spondylolisthesis Signup and view all the answers

What is the primary goal of physical therapy in the context of fall prevention and balance?

To promote function and maintain daily living abilities Signup and view all the answers

Which medication is known for its role in treating ALS symptoms?

Baclofen Signup and view all the answers

What is a common symptom of multiple sclerosis (MS)?

Unsteady gait Signup and view all the answers

Which treatment option is typically used for acute attacks of multiple sclerosis?

Corticosteroids Signup and view all the answers

What type of therapy role does a PTA play in the management of ALS?

Providing gentle, low-impact exercises Signup and view all the answers

How does dystonia primarily manifest in an individual?

Involuntary muscle contractions Signup and view all the answers

Which of the following is NOT a symptom of multiple sclerosis (MS)?

Shutting of eyelids Signup and view all the answers

What type of exercise should be included in the exercise regimen for MS patients?

Core stabilization training Signup and view all the answers

What does Stage 1 of lymphatic stage classification refer to?

Affecting a single lymph node Signup and view all the answers

Which treatment options are common for Hodgkin's lymphoma?

Chemotherapy, radiation, and surgery Signup and view all the answers

What is a common symptom of Multiple Myeloma?

Frequent infections and bone pain Signup and view all the answers

What hormone's hypersecretion leads to Acromegaly?

Pituitary growth hormone Signup and view all the answers

What is the primary cause of Diabetes Insipidus?

Deficiency of antidiuretic hormone Signup and view all the answers

Which of the following best describes Non-Hodgkin’s lymphomas?

Blood cancers with a lack of organized pattern of metastasis Signup and view all the answers

Which of the following describes the role of PTA in treating patients with lymphoma?

Implement regular exercise as tolerated Signup and view all the answers

What condition is characterized by abnormally high blood sugar?

Diabetes Mellitus Signup and view all the answers

What is a potential life-threatening complication of advanced grave disease?

Thyroid storm Signup and view all the answers

What are beta blockers primarily used for in patients with advanced grave disease?

Managing tachycardia and hypertension Signup and view all the answers

Which of the following is a major manifestation of Cushing's syndrome?

Moon-shaped face Signup and view all the answers

What is the recommended treatment for serious cases of advanced grave disease that do not respond to medication?

Radioactive therapy or surgery Signup and view all the answers

Which medication is NOT commonly used in the management of Cushing's syndrome?

Methimazole Signup and view all the answers

In Addison's disease, which symptom is indicative of primary adrenal insufficiency?

Fatigue Signup and view all the answers

What dietary changes are generally suggested for patients with Addison's disease?

High protein and increased salt intake Signup and view all the answers

What role does a Physical Therapy Assistant (PTA) play in the management of patients with Cushing's syndrome?

Educating patients about exercise Signup and view all the answers

Study Notes

Fall Prevention and Balance

Goal: Promote function and maintain the ability to live as normally as possible
Physical therapy can assist with balance problems, lack of coordination, fatigue, gait, immobility, and weakness

Amyotrophic Lateral Sclerosis (ALS)

Degenerative disease affecting upper and lower motor neurons
A chronic, progressively debilitating disease that may be fatal in less than 1 year or may contribute for 10 years or more.
Causes muscles to become weak and wasted, resulting in movement that becomes stiff, awkward, and clumsy.
Muscle strength is affected, usually in the hands initially, and less often in the feet, mouth, or throat.
Treatment: Medication can help lessen symptoms.
Physical therapy can help maintain muscle strength.
Some assistance when eating to prevent choking for some patients.
Medications include baclofen, phenytoin, quinine, anticholinergics, antidepressants, cough suppressants, quinine, and newer drugs such as riluzole or edaravone, which target nerve cells.
PTA Role: Gentle, low-impact exercise, including passive and active assisted ROM exercises, supervised walking (often with an assistive device), swimming, and stationary equipment.
Stretching exercises and breathing are also indicated.
Helpful equipment may include braces, ramps, walkers, and wheelchairs.

Multiple Sclerosis (MS)

Chronic inflammatory disease involving demyelination of the white matter of the brain and spinal cord.
The cause of MS may be genetically linked.
Symptoms include lack of coordination, muscle weakness or numbness, unsteady gait, paresthesia, vertigo, difficulty speaking, dysphagia, loss of bladder function, and facial numbness or pain.
Treatment:
- Acute attacks are treated with corticosteroids.
- Chronic forms are treated with interferons, immune modulators, and antineoplastic agents.
- Muscle relaxants, vitamin supplements, braces, walking devices, PT, and adequate rest and diet.
PTA Role: Assist MS patients in exercise regimens that include core stabilization training, balance, and energy conservation.
Activities must be monitored to avoid fatigue.
Warm-up and cool-down phases should be incorporated along with fall interventions.
Exercises include water aerobics, aquatic therapy, and yoga.

Dystonia

Sustained involuntary muscle contractions
Symptoms include shutting of eyelids, spasmodic torticollis of the neck or back, grimacing, puckering of the lips, tongue protrusion, and writhing of the limbs.
Focal dystonias affect only one body part.
Segmental dystonia affects two or more parts.
Phalen's sign: Maximum passive flexion of the wrist for one minute causes paresthesia over the median nerve, finding in entrapment neuropathy such as carpal tunnel syndrome.
Sleep palsy: Temporary paralysis due to radial nerve compression within the arm, from direct pressure while sleeping; also called radial neuropathy and Saturday night palsy.

Spondylolisthesis

Anterior displacement of a vertebra or vertebral column in relation to the vertebrae below

Tinel's Sign

Indication of nerve irritability: A distal tingling sensation caused by percussion of a damaged nerve.

Common Conditions of the Peripheral Nervous System (PNS):

Diabetic neuropathy with paresthesia and dysesthesia
Thyroid Dysfunction
Carpal Tunnel Syndrome (CTS)

Sciatica

Form of radiculopathy due to nerve root changes that are usually linked to compression.
Most common in people from 40 to 60 years of age.
Signs and symptoms include pain radiating along the course of the sciatic nerve, usually down the buttocks and posterior aspect of the leg to below the knee.
L5 to S1 affects ankle jerk and L3 and L4 herniation may affect knee jerk reflex.
Treatment: Epidural injection of steroids at the target roots.
PTA Role: Nerve mobilization techniques such as flossing to reduce nerve tension and restore normal mobility.

Tardy Ulnar Palsy

Characterized by atrophy of the first dorsal interosseus muscle with difficulty performing fine manipulations.
People with diabetes have a much higher incidence of tardy ulnar palsy.
Signs and symptoms are aggravated by flexion of the elbow.
The hand has a claw shape.
MCP and IP flexion of the ring and little fingers due to unopposed action of the extensor.
To assess the ulnar nerve, clinical tests include the card test for Froment's sign.
Treatment: Moderate to severe compression requires surgery. Decompression is preferred over transposition of the ulnar nerve to the anterior elbow aspect.

Thoracic Outlet Syndrome (TOS)

Involves symptoms that may be difficult to identify and interpret.
Chronic compression of the nerves or the proximal plexus and arteries between the clavicle and the first rib.
Neurogenic form involves compression of the brachial plexus.
Vascular form involves compression of the subclavian artery, vein, or both.
Disputed form is non-specific.
Symptoms might be pain at night.

Botulism

Four stages: foodborne, wound, infant, and unclassified.
Signs and symptoms begin 12 to 36 hours after ingesting the neurotoxin.
Symptoms include malaise, blurred and double vision, weakness, dry mouth, nausea, and vomiting.
Respiratory failure can happen in 6 to 8 hours.
May cause difficulty swallowing, slurred speech, and light sensitivity.
Motor weakness of facial and neck muscles progresses.
Secondary effects include severe muscle wasting, pressure sores, and aspiration pneumonia.
Treatment: Observation, activated charcoal, and endotracheal intubation if needed.
For feeding, nasogastric intubation is preferred.
Patients with wound botulism require wound debridement and parenteral antibiotics.

Lead Neuropathy (Toxic/Poisoning)

Bell's Palsy

Also known as Idiopathic Facial Paralysis or Facial nerve palsy.
Possible causes include meningitis, tumors, diabetes, stroke, and head trauma.
Drooping of one corner of the mouth.
Treatment: Prophylactic high-dose corticosteroids for 5 days followed by tapered doses for 5 days.
PTA Role: Application of mild heat to warm up muscles prior to soft tissue mobilization. Self-care education and neuromuscular re-education.
Perfect practice initiates movement on the involved side by attempting slow and small movements. Perfect practice is emphasized to discourage synthetic patterns such as an eye narrowing.

Trigeminal Neuralgia

Also known as tic douloureux.
Disorder of the trigeminal nerve.
Patients experience intense attacks of lancinating pain of the nerve's distribution.
Sudden onset described as sharp and stabbing and lasting for seconds to minutes.
Pain is only in the maxillary division.
Clusters of pain are triggered by chewing, smiling, and mechanical stimulation or even slight breezes of wind.
Treatment: Oral carbamazepine is the preferred medication.

Inflammation and Healing

Acute Inflammation:

Inflammation that develops immediately and lasts for a short time; self-limited.

Chronic Inflammation

Collagen Formation

Process by which cells produce collagen, a protein that provides structure and support to the body; occurring in fibroblasts.

Fibroblasts

Cells that synthesize the extracellular matrix and collagen and play an important role in wound healing.

Granulation Tissue

Perfused, fibrous connective tissue that replaces the fibrin clot in wounds that are healing.

Hodgkin's Lymphoma

Highly curable, but aggressive blood cancer, characterized by Reed-Sternberg cells within the lymph nodes.
Four stages:
- Stage 1: Affecting a single lymph node
- Stage 2: Affecting two or more lymph regions on the same side
- Stage 3: Involved nodes on both sides of the diaphragm and the spleen
- Stage 4: Represents diffuse extra-lymphatic involvement.
Treatment: Radiation, chemotherapy, and surgery. Combination of drugs "ABVD"- adriamycin, blenoxane, velban, DTIC- Dome.
PTA Role: Assist patients with regular exercise as tolerable. Light activities and Borg rating of perceived exertion.

Non-Hodgkin's Lymphomas

Blood cancers that include all types of lymphoma.
Enlarged but painless lymph nodes.
Multiple node involvement throughout the body, and no organized pattern of metastasis.
Treatment: Similar to Hodgkin's, but more difficult to treat when tumors are not localized.
PTA Role: Treatment is based upon impairments and mobility limitations. PTA assists with the implementation of the plan of care.

Multiple Myeloma

Occurs mostly in older adults and involves plasma cells that replace bone marrow and erode the bone.
Also called plasma cell myeloma.
Initial signs may include frequent infections followed by bone pain, which is not alleviated by rest.
Treatment: Chemotherapy, analgesics for bone pain, and blood transfusions.
PTA Role: Assisting with regular weight-bearing exercise designed to improve bone strength. Walking and mild resistance training and low-impact aerobics are indicated.

Endocrine System

Key Terms and Common Diseases:

Acromegaly: Hypersecretion of growth hormone from the pituitary gland if it begins AFTER puberty.
Aldosterone: Hormone that increases reabsorption of water and sodium and the release of potassium in the kidneys.
Asphyxiation: Suffocation; the inability to breathe normally.
Cretinism: Severely stunted physical and mental growth due to untreated congenital hypothyroidism.
Diabetes Insipidus: Condition of excessive thirst and secretion of large amounts of severely diluted urine, most commonly caused by a deficiency of antidiuretic hormone.
Diabetes Mellitus: Condition of abnormally high blood sugar, either due to the inability of the body to produce enough insulin or because body cells do not respond to the insulin that is produced.
Diabetic Ketosis: Condition wherein, as a result of diabetes, the body has elevated levels of ketone bodies in the blood: These bodies are formed when glycogen stores in the liver are depleted.
Dwarfism: Abnormally short stature due to a variety of conditions, most commonly abnormally low amounts of human growth hormone.
Graves' Disease: An autoimmune disease affecting the thyroid gland, causing hyperthyroidism. Advanced Graves' disease causes exophthalmos. If symptoms are exacerbated, thyroid storm may occur, which is life-threatening.
Treatment: Reducing formation and secretion of thyroid hormone by administering propylthiouracil or methimazole. Tachycardia and hypertension are treated by beta blockers. If a patient does not respond to these treatments, radioactive therapy or surgery is recommended.
PTA Role: Assist patients with moderate exercise. Too much exercise can increase undesired cardiovascular responses. Monitor vital signs. Instruction for diaphragmatic breathing may be helpful if feeling anxious or insomnia.

Adrenal (Addison's Disease and Cushing's Syndrome)

Cushing's Syndrome

Hypercortisolism.
The pituitary form (Cushing's disease) results from excessive adrenocorticotropic hormone production by a tumor of the pituitary gland.
The second form is the adrenal form (Cushing's syndrome) caused by a benign or malignant adrenal tumor.
May be caused by a pituitary gland or adrenal cortex tumor.
It can also develop after prolonged doses of cortisone.
Major manifestations are a rounded or moon-shaped face and a buffalo hump on the upper back.
Symptoms include fatigue, poor wound healing, rounded abdomen, very thin arms and legs, weakness, hypertension, stretch marks, and osteoporosis.
Cortisol increases gastric acid secretion.
Treatment: Surgical removal of the pituitary or adrenal cortex tumor followed by lifetime hormone therapy.
Medications include spironolactone, metyrapone, mitotane, ketoconazole, and sometimes somatostatin analogs, dopamine agonists.
PTA Role: Educate patients about exercises such as water aerobics, walking, and cycling. Start mild and then increase intensity based on the patient's tolerance.

Addison's Disease

Primary adrenal hypofunction or insufficiency.
Signs and symptoms include fatigue, weakness, anorexia, weight loss, and gastrointestinal complications.
Conspicuous bronze discoloration of the skin may occur, especially in the creases of the hands, elbows, and knees.
Primary hypofunction is associated with cardiovascular abnormalities such as irregular pulse and cardiac output.
Causes anxiety, depression.
Patients may not be able to retain salt, potentially leading to a life-threatening situation.
Treatment: Glucocorticoid and mineralocorticoid drugs, control of salt and potassium intake, and eating larger amounts of carbohydrates and proteins. Hormone replacement therapy must continue throughout life.

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Description

This quiz covers essential aspects of fall prevention related to balance issues and the effects of Amyotrophic Lateral Sclerosis (ALS). Participants will learn about the roles of physical therapy in managing symptoms and maintaining muscle strength in patients with ALS. Further, the quiz addresses treatment options and interventions necessary for enhancing patients' quality of life.