Podcast
Questions and Answers
Which of the following is characteristic of the epidemiology of Multiple Sclerosis (MS)?
Which of the following is characteristic of the epidemiology of Multiple Sclerosis (MS)?
- Incidence rates are lower in temperate climates.
- Onset is most common between 20-40 years of age. (correct)
- Males have a two-time higher incidence than females.
- Onset is most common between 50-70 years of age.
What is the underlying cause of Multiple Sclerosis (MS)?
What is the underlying cause of Multiple Sclerosis (MS)?
- Prolonged exposure to environmental toxins.
- Its etiology is currently unknown. (correct)
- A bacterial infection that attacks the nervous system.
- A genetic mutation that directly causes demyelination.
Patches of demyelination in the white matter of the brain and spinal cord, leading to decreased responsiveness of the nervous system, are most closely related to which of the following?
Patches of demyelination in the white matter of the brain and spinal cord, leading to decreased responsiveness of the nervous system, are most closely related to which of the following?
- Epidemiology of MS
- Pathophysiology of MS (correct)
- Etiology of MS
- Definition of MS
Which cell type is primarily responsible for creating the myelin sheath in the central nervous system?
Which cell type is primarily responsible for creating the myelin sheath in the central nervous system?
A patient reports experiencing an initial episode of neurological symptoms consistent with MS that lasted for 24 hours. According to the material, what is the MOST appropriate classification?
A patient reports experiencing an initial episode of neurological symptoms consistent with MS that lasted for 24 hours. According to the material, what is the MOST appropriate classification?
Which of the following is the primary mechanism of action of Copaxone in the treatment of Multiple Sclerosis?
Which of the following is the primary mechanism of action of Copaxone in the treatment of Multiple Sclerosis?
A patient with MS reports a new onset of blurred vision, which worsens later in the day at the gym. This is MOST consistent with:
A patient with MS reports a new onset of blurred vision, which worsens later in the day at the gym. This is MOST consistent with:
What is the MOST likely cause of urinary retention as a clinical feature of Multiple Sclerosis?
What is the MOST likely cause of urinary retention as a clinical feature of Multiple Sclerosis?
Which diagnostic finding would be MOST indicative of Multiple Sclerosis?
Which diagnostic finding would be MOST indicative of Multiple Sclerosis?
A patient with MS is experiencing increased muscle spasms. Which of the following medications would be MOST appropriate to address this symptom?
A patient with MS is experiencing increased muscle spasms. Which of the following medications would be MOST appropriate to address this symptom?
What recommendation should a therapist emphasize regarding strength training for a patient with Multiple Sclerosis?
What recommendation should a therapist emphasize regarding strength training for a patient with Multiple Sclerosis?
A physical therapist is treating a patient with MS who exhibits ataxia. Which intervention would be MOST appropriate?
A physical therapist is treating a patient with MS who exhibits ataxia. Which intervention would be MOST appropriate?
To improve proprioceptive awareness, what interventions would be MOST appropriate for your patient?
To improve proprioceptive awareness, what interventions would be MOST appropriate for your patient?
A patient with MS presents with moderate spasticity. According to the provided resource material, which AFO might be contraindicated?
A patient with MS presents with moderate spasticity. According to the provided resource material, which AFO might be contraindicated?
Which of the following is a negative aspect of using a double upright metal with articulating ankle joint AFO?
Which of the following is a negative aspect of using a double upright metal with articulating ankle joint AFO?
What is the percent chance that a child will get Huntington's disease if one of their parents has it?
What is the percent chance that a child will get Huntington's disease if one of their parents has it?
All of the following describe the signs and symptoms of Huntington's disease, EXCEPT:
All of the following describe the signs and symptoms of Huntington's disease, EXCEPT:
Which of the following motor symptoms is associated with Huntington's Disease?
Which of the following motor symptoms is associated with Huntington's Disease?
If you observe involuntary movements affective all muscles of the body in your patient, which is the MOST appropriate term to use?
If you observe involuntary movements affective all muscles of the body in your patient, which is the MOST appropriate term to use?
Select the medication which is NOT used to treat chorea:
Select the medication which is NOT used to treat chorea:
What is the MOST common mental health condition associated with Huntington's Disease?
What is the MOST common mental health condition associated with Huntington's Disease?
In the early stages of Huntington's disease, what is a key role for the physical therapist?
In the early stages of Huntington's disease, what is a key role for the physical therapist?
Which of the following exercises has the MOST support (evidence) for improving function in patients with Huntington's Disease?
Which of the following exercises has the MOST support (evidence) for improving function in patients with Huntington's Disease?
Which guideline is BEST to follow when treating patients with distractibility and agitation?
Which guideline is BEST to follow when treating patients with distractibility and agitation?
What is the definition of motor control?
What is the definition of motor control?
Which stage of motor control involves the ability to maintain a steady position in a weight-bearing, antigravity posture?
Which stage of motor control involves the ability to maintain a steady position in a weight-bearing, antigravity posture?
Motor learning is BEST described by which description?
Motor learning is BEST described by which description?
During which stage of Fitts' stages of motor learning is the task new to the learner, requiring active thought about the goal?
During which stage of Fitts' stages of motor learning is the task new to the learner, requiring active thought about the goal?
In which phase of motor learning should extrinsic feedback be VERY limited?
In which phase of motor learning should extrinsic feedback be VERY limited?
Which of the following types of feedback is MOST effective for long-term motor learning?
Which of the following types of feedback is MOST effective for long-term motor learning?
A patient with Multiple Sclerosis is learning to use crutches. For optimal motor learning, which practice schedule is MOST effective?
A patient with Multiple Sclerosis is learning to use crutches. For optimal motor learning, which practice schedule is MOST effective?
What type of learning involves associating stimuli and responses through repetition?
What type of learning involves associating stimuli and responses through repetition?
A patient is learning a new balance strategy that requires dividing their attention from the task itself. Which type of attention is being challenged?
A patient is learning a new balance strategy that requires dividing their attention from the task itself. Which type of attention is being challenged?
Which area of the brain is MOST crucial for higher-level cognitive functions such as working memory, attention control, and abstract thinking?
Which area of the brain is MOST crucial for higher-level cognitive functions such as working memory, attention control, and abstract thinking?
All of the following are clinical strategies for improving working memory EXCEPT:
All of the following are clinical strategies for improving working memory EXCEPT:
Which change in motor performance is typical for Older Adults to display in comparison to younger adults?
Which change in motor performance is typical for Older Adults to display in comparison to younger adults?
Which clinical finding is MOST associated with dysesthesias in patients with Multiple Sclerosis?
Which clinical finding is MOST associated with dysesthesias in patients with Multiple Sclerosis?
A patient with MS reports experiencing graying and blurring of vision. Which condition is MOST likely contributing to these symptoms:
A patient with MS reports experiencing graying and blurring of vision. Which condition is MOST likely contributing to these symptoms:
Which of the following BEST describes scanning speech, often seen in individuals with Multiple Sclerosis?
Which of the following BEST describes scanning speech, often seen in individuals with Multiple Sclerosis?
A patient with MS reports that their fatigue increases with elevated ambient temperatures. This is MOST consistent with which phenomenon?
A patient with MS reports that their fatigue increases with elevated ambient temperatures. This is MOST consistent with which phenomenon?
A patient with MS is experiencing difficulties with problem-solving, short-term memory, and visual-spatial perception. Which of the following is the MOST likely cause of these cognitive impairments?
A patient with MS is experiencing difficulties with problem-solving, short-term memory, and visual-spatial perception. Which of the following is the MOST likely cause of these cognitive impairments?
What combination of clinical findings is required to confirm a Multiple Sclerosis diagnosis?
What combination of clinical findings is required to confirm a Multiple Sclerosis diagnosis?
Which medication is designed to shorten the duration of acute attacks in multiple sclerosis?
Which medication is designed to shorten the duration of acute attacks in multiple sclerosis?
When initiating strength training for a patient with MS, which strategy is MOST important to implement?
When initiating strength training for a patient with MS, which strategy is MOST important to implement?
A patient with MS is beginning a non-fatiguing strengthening protocol. How long should the patient contract their muscles during each non-fatiguing strengthening exercise?
A patient with MS is beginning a non-fatiguing strengthening protocol. How long should the patient contract their muscles during each non-fatiguing strengthening exercise?
A physical therapist is developing a spasticity management plan for a patient with MS. Which intervention should be MOST appropriate?
A physical therapist is developing a spasticity management plan for a patient with MS. Which intervention should be MOST appropriate?
When performing PNF techniques for a patient with spasticity, what is the MOST appropriate component to incorporate?
When performing PNF techniques for a patient with spasticity, what is the MOST appropriate component to incorporate?
A patient with MS is experiencing ataxia. Which intervention is MOST suitable for improving coordination and control?
A patient with MS is experiencing ataxia. Which intervention is MOST suitable for improving coordination and control?
What is the overarching goal for physical therapy management in the EARLY stages of Huntington's disease?
What is the overarching goal for physical therapy management in the EARLY stages of Huntington's disease?
Which of the following BEST describes chorea, a common movement disorder associated with Huntington's disease?
Which of the following BEST describes chorea, a common movement disorder associated with Huntington's disease?
During the middle stage of Huntington's disease, patients may exhibit several motor and cognitive changes. Which of the following BEST describes the typical impairments?
During the middle stage of Huntington's disease, patients may exhibit several motor and cognitive changes. Which of the following BEST describes the typical impairments?
Which of the following interventions has the strongest evidence for improving outcomes in patients with Huntington's Disease?
Which of the following interventions has the strongest evidence for improving outcomes in patients with Huntington's Disease?
According to clinical practice guidelines, what is the recommendation for balance exercises in persons with HD?
According to clinical practice guidelines, what is the recommendation for balance exercises in persons with HD?
What factor related to Huntington's Disease should be considered when performing physical therapy in a home environment?
What factor related to Huntington's Disease should be considered when performing physical therapy in a home environment?
Which of the following strategies would be most helpful in treating a patient with HD who is easily distracted?
Which of the following strategies would be most helpful in treating a patient with HD who is easily distracted?
What is the role of the therapist during the associative stage of motor learning?
What is the role of the therapist during the associative stage of motor learning?
Which of the following is MOST representative of the mobility stage of motor control?
Which of the following is MOST representative of the mobility stage of motor control?
A physical therapist is using verbal cues to guide a patient's movements during a new exercise. At which stage of motor learning is the patient MOST likely functioning?
A physical therapist is using verbal cues to guide a patient's movements during a new exercise. At which stage of motor learning is the patient MOST likely functioning?
Which of the following is BEST to incorporate during the autonomous stage of motor learning?
Which of the following is BEST to incorporate during the autonomous stage of motor learning?
What form of feedback is useful to use to provide at the end of the task?
What form of feedback is useful to use to provide at the end of the task?
If a patient is unable to self-correct using internal feedback, what can the PTA do?
If a patient is unable to self-correct using internal feedback, what can the PTA do?
A therapist is teaching a patient with impaired motor control to reach for a glass of water. The therapist initially provides feedback after every trial, but then gradually reduces the frequency of feedback as the patient's performance improves. Which type of feedback schedule are they utilizing?
A therapist is teaching a patient with impaired motor control to reach for a glass of water. The therapist initially provides feedback after every trial, but then gradually reduces the frequency of feedback as the patient's performance improves. Which type of feedback schedule are they utilizing?
A physical therapist is working with a patient on a complex motor task and wants to enhance long-term retention and skill transfer. Which practice method would be MOST effective?
A physical therapist is working with a patient on a complex motor task and wants to enhance long-term retention and skill transfer. Which practice method would be MOST effective?
What is the definition of non-associative learning?
What is the definition of non-associative learning?
The ability to learn a task by forming movement habits through repetitive practice describes which of the following types of learning?
The ability to learn a task by forming movement habits through repetitive practice describes which of the following types of learning?
A patient is performing a balance exercise while simultaneously reciting a list of words. This dual-task activity primarily challenges which type of attention?
A patient is performing a balance exercise while simultaneously reciting a list of words. This dual-task activity primarily challenges which type of attention?
Which of the following is MOST crucial for the ability to focus attention and filter out distractions?
Which of the following is MOST crucial for the ability to focus attention and filter out distractions?
Increased difficulty with bimanual coordination in older adults is MOST closely related to which factor?
Increased difficulty with bimanual coordination in older adults is MOST closely related to which factor?
What type of practice is beneficial use with children?
What type of practice is beneficial use with children?
In motor learning, what does the term "distributed practice" mean?
In motor learning, what does the term "distributed practice" mean?
What type of memory is involved in a task that requires sustained attention?
What type of memory is involved in a task that requires sustained attention?
In order to improve motor learning and attention, what is something that the patient requires?
In order to improve motor learning and attention, what is something that the patient requires?
Which of the following strategies is MOST likely to improve working memory for patients with neurological conditions?
Which of the following strategies is MOST likely to improve working memory for patients with neurological conditions?
Which statement BEST relates the role of experience to motor control?
Which statement BEST relates the role of experience to motor control?
Which of the following is an example of 'distributed practice' in motor learning?
Which of the following is an example of 'distributed practice' in motor learning?
In the context of ataxia management, which of the following interventions aims to improve coordination and control by increasing proprioceptive awareness?
In the context of ataxia management, which of the following interventions aims to improve coordination and control by increasing proprioceptive awareness?
A patient with MS is in the cognitive stage of learning a new sit-to-stand transfer. What is the MOST appropriate intervention?
A patient with MS is in the cognitive stage of learning a new sit-to-stand transfer. What is the MOST appropriate intervention?
What type of learning is involved when a patient with Huntington's disease gradually improves their ability to perform activities of daily living through repeated practice and habit formation?
What type of learning is involved when a patient with Huntington's disease gradually improves their ability to perform activities of daily living through repeated practice and habit formation?
A physical therapist is treating a patient with Huntington's disease who exhibits agitation and impulsivity. Which strategy is MOST appropriate for managing these behaviors during therapy sessions?
A physical therapist is treating a patient with Huntington's disease who exhibits agitation and impulsivity. Which strategy is MOST appropriate for managing these behaviors during therapy sessions?
A patient in the middle stages of Huntington's disease is prescribed gait training. To address the cognitive and motor challenges, which approach is MOST suitable:
A patient in the middle stages of Huntington's disease is prescribed gait training. To address the cognitive and motor challenges, which approach is MOST suitable:
What is the MOST accurate description of the 'associative' stage of motor learning?
What is the MOST accurate description of the 'associative' stage of motor learning?
A patient with MS reports increased fatigue during exercise. Which intervention strategy is MOST appropriate to manage this symptom?
A patient with MS reports increased fatigue during exercise. Which intervention strategy is MOST appropriate to manage this symptom?
You are working with a patient with ataxia on PNF techniques and want to incorporate rhythmic stabilization. What is the PRIMARY goal of this technique?
You are working with a patient with ataxia on PNF techniques and want to incorporate rhythmic stabilization. What is the PRIMARY goal of this technique?
Which of the following is the MOST accurate description of 'divided attention'?
Which of the following is the MOST accurate description of 'divided attention'?
Flashcards
Multiple Sclerosis (MS)
Multiple Sclerosis (MS)
Chronic debilitating disease that results from demyelination of the nervous system.
MS Onset Age
MS Onset Age
Onset is typically between 20-40 years of age
MS Gender
MS Gender
Females have a two-time higher incidence than males.
MS: Demyelination
MS: Demyelination
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MS: Myelin Cell Destruction
MS: Myelin Cell Destruction
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MS: Parasthesias
MS: Parasthesias
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MS: Dysesthesias
MS: Dysesthesias
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MS: Neuritis Definition
MS: Neuritis Definition
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MS: Diplopia
MS: Diplopia
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MS:Nystagmus
MS:Nystagmus
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MS: Scanning Speech
MS: Scanning Speech
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MS: Uhthoff phenomenon
MS: Uhthoff phenomenon
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MS: Clinically Isolated Syndrome (CIS)
MS: Clinically Isolated Syndrome (CIS)
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MS: Relapsing-remitting
MS: Relapsing-remitting
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MS: Primary Progressive
MS: Primary Progressive
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MS: Secondary-progressive
MS: Secondary-progressive
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MS: Diagnosis Criteria
MS: Diagnosis Criteria
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MS: CRAB Drugs
MS: CRAB Drugs
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MS Medical Management: Copaxone
MS Medical Management: Copaxone
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MS Medical Management: Interferons
MS Medical Management: Interferons
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Physical Therapy: MS Goal
Physical Therapy: MS Goal
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Physical Therapy:Strength Training in MS
Physical Therapy:Strength Training in MS
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Huntington's Disease (HD)
Huntington's Disease (HD)
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Is HD a heredity disease?
Is HD a heredity disease?
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HD: Chorea
HD: Chorea
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HD Medications to Reduced Chorea Symptoms
HD Medications to Reduced Chorea Symptoms
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HD Cognitive Impairments May Include:
HD Cognitive Impairments May Include:
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Stages of HD: Psychological Symptoms
Stages of HD: Psychological Symptoms
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Motor Learning is:
Motor Learning is:
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Phases of motor learning: Cognitive
Phases of motor learning: Cognitive
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Phases of motor learning: Associative
Phases of motor learning: Associative
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Motor Learning: Autonomous Phase
Motor Learning: Autonomous Phase
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Extrinsic Feedback: Summary
Extrinsic Feedback: Summary
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Feedback: Faded
Feedback: Faded
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Extrinsic Feedback: Delayed
Extrinsic Feedback: Delayed
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Motor Learning Time
Motor Learning Time
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Types of leanring and memory: Non-associative learning
Types of leanring and memory: Non-associative learning
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Types of Learning & Memory: Associative Learning
Types of Learning & Memory: Associative Learning
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Learning and Memory: Procedural (non-declarative) Learning
Learning and Memory: Procedural (non-declarative) Learning
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Learning and Memor: Declarative Learning
Learning and Memor: Declarative Learning
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Study Notes
- Topics covered include Multiple Sclerosis, Huntington's Disease, and Motor Learning
- Discusses neurologic interventions, objectives, review, clinical features, medical management, physical therapy management, motor learning and clinical strategies
Multiple Sclerosis (MS)
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Is a chronic debilitating disease resulting from demyelination of the nervous system.
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Onset is typically between 20-40 years of age.
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Females have twice the incidence compared to males.
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Affects over 400,000 people in the U.S.
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Higher rates are observed in the US, Canada, and Northern Europe.
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Etiology is unknown, but viral infections and autoimmune dysfunction are implicated.
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Having a relative with the disorder increases one's risk due to a genetic component.
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Patches of demyelination occur in the white matter of the brain and spinal cord.
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Cells that make myelin are also destroyed, preventing re-myelination of the axon.
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Inflammation accompanies the destruction.
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Myelin allows for increased speed of conduction; without it, nervous system responsiveness decreases.
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Sensory symptoms include parasthesias ("pins and needles") and dysesthesias (abnormal burning or aching).
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Visual symptoms include decreased acuity, neuritis (inflammation of the optic nerve causing graying or blurring), diplopia (double vision), and nystagmus (involuntary eye oscillation).
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Motor symptoms include motor weakness in one or both legs, corticospinal tract involvement, poor balance, ataxia, postural tremor, and scanning speech (slow, long pauses, lack of fluidity).
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Fatigue is a frequent symptom without a clear physiological reason, worsened by heat and linked to depression.
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Uhthoff phenomenon induces blurred vision, increased paresthesias and overwhelming fatigue when overheated.
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Cognitive impairment occurs in half of MS patients with mild to moderate severity that can affect problem-solving, short-term memory, visual-spatial perception, and conceptual reasoning and often present with emotional lability.
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Autonomic dysfunction may lead to impaired bowel and bladder control, urinary retention, nocturia, constipation, and, in later stages, complete loss of bowel/bladder control and sexual dysfunction.
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There are four types of MS:
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Clinically Isolated Syndrome (CIS): First episode of neurologic symptoms lasting 24 hours that can progress to MS.
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Relapsing-remitting: Definable exacerbations and remissions are the most common.
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Primary-progressive: Relentless progression without relapses, accounting for 10% of cases.
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Secondary-progressive: Starts with relapsing and remissions, then progresses with only occasional relapses.
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Diagnosis typically involves a clinical evidence of at least two lesions in the brain, spinal cord or optic nerve with evidence that damage occurred at different times, as well as ruling out other possible diagnose.
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Sometimes, Cerebral spinal fluid may show presence of oligoclonal bands and myelin protein.
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4 injectable medications (CRAB) have been developed.
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Copaxone reduces inflammation at lesion sites and frequency of attacks.
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Rebif, Avonex and Betaseron are Interferons Immune system modulators
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Other symptoms treated pharmacologically include muscle spasms, spasticity, weakness, fatigue, visual and urinary symptoms, pain, and depression.
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Cortisone/corticosteroids shorten acute attacks.
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Dantrium and Lioresal treat spasticity.
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Ditropan and Probanthine treat bladder urgency and frequency.
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Klonopin treats severe tremors.
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Provigil and Symmetrel treat fatigue.
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Tegretol treats tonic spasms, and Valium treats night spasms.
PT Management of MS
- Goals include minimizing progression, maintaining functional independence, preventing complications, maintaining respiratory function, conserving energy and managing fatigue, and patient/family education.
- Strength training in moderation, spasticity and ataxia management, cardiorespiratory training, and fatigue management are used.
- Low intensity with frequent repetitions, rest breaks, and non-fatiguing protocols are employed.
- Exercising to the point of fatigue is generally contraindicated.
- PNF used to be functional and reduce the spasticity.
- Pre-cooling may consist of fans, cool pools of 80-85 degrees, or cooling suits.
Spasticity Management
- Slow, static stretching prior to exercises can help.
- Particular emphasis on the cervical region, hamstrings, hip flexors, adductors, and heel cords.
- PNF techniques that are implemented hold and relax with rotation contract.
- Self-stretching should be taught to patient and family.
Ataxia Management
- Employs a developmental sequence.
- PNF techniques such as alternating isometrics, slow reversals, and rhythmic stabilization.
- Frenkel Exercises also help with this.
- The use of weight belts/vests help to raise proprioceptive awareness and increase stability.
- Light weights improve coordination and control.
- Balance training can implement the use of a tilt board, baps board, ball, and balance master.
- Gait training may use light distal weights on wrists and ankles for stability.
- Assistive devices: SPC quad cane, FWW or 4WW with seat may be used.
- Orthotics: AFO, as well as KAFO, and HKAFO.
Huntington's Disease (HD)
- Progressive, inherited neurodegenerative disease that causes death of neurons in the basal ganglia.
- It is a heredity disease that has an autosomal dominant trait that has an estimated effect of 3 to 7 per 100,000 people of european decent.
- It is usually diagnosed between ages 35-55.
- Movement disorder characterized by involuntary choreic movements.
- Mild alterations in personality, grimacing, protrusion of tongue, and ataxia with choreoathetoid movements are symptoms.
- Late stages bring mental deterioration, decreased IQ, dysphagia, incontinence, immobility, and rigidity.
- Chroea consists of involuntary movements that affect all muscles of the body specifically arms, legs, face, and tongue.
- FDA-approved medications to treat chorea include Tetrabenazine, deutetrabenazine and valbenazine.
- However, medications don't affect how the disease progresses.
- Cognitive impairments includes difficulty organizing task, perseveration and lack of impulse control.
Mental health conditions associated with HD:
- Depression, obsessive-compulsive disorder, mania and Bipolar disorder
Other Medications that will manage emotional symptoms:
- Antidepressants, Antipsychotic medications, and Mood-Stabilizing medications.
- The early stage is often with a largely fully functional individual.
- Psychological symptoms cane be prresent but are harder to recognize, especially in later stages, due to the limited communication.
- Role of physical therapy can depend on what stage of the disease.
- Early stage often to prevent mobility restrictions.
- Mid stage is often to slow down progress and help maintain function.
- Late stage: limiting impact of complications and providing supportive care.
- PT/PTA is a key member of the interdisciplinary team.
Clinical Practice Guidelines of HD includes:
- Aerobic exercise paired with strengthening to improve fitness and stabilize motor function
- Gait training to improved walking speed and step length
- Balance and breathing exercise and ADL seating and positioning may help although there is not recommendation.
PTA Considerations
- Treatment can get in the water. PTA should be aware if the patient is getting agitated complete activities in a quite room.
Motor Control
- It’s the ability to maintain and change postures and movement is the result of a complex set of neurologic and mechanical processes.
- The process involves and individual using a task and the surrounding environment as a guide.
- Stages of motor control involved mobility, stability, controlled mobility and skilled movement.
Motor Learning
- Process that brings about permanence in motor performance over the time of practice.
- Fitts' Stages of Motor Learning is an indicator of motor ability.
- Types of feedback include sensory , task performance, and motor functions.
- Influence of Practice includes Massed vs Distributed Practice and Part vs. Whole Training
- Types of learning and memory include non-assocaited learning and declarative learning.
- Many types of attention include sustained attention
- Prerequites for attention are Arousal and Concentration
- Clinical strategies includes giving feedback to stimulate learning.
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