Study Guide AOL #3 (PDF)

STUDY GUIDE AOL #3 (Modules 6-9) Module 6: Epilepsy and SCI Module Notes Pay particular attention to: Four sections of the spinal cord and their general function Paraparesis, Paraplegia, and Tetriplegia/Quadriplegia C-Level Injuries and T-Level Injur...

STUDY GUIDE AOL #3 (Modules 6-9) Module 6: Epilepsy and SCI Module Notes Pay particular attention to: Four sections of the spinal cord and their general function Paraparesis, Paraplegia, and Tetriplegia/Quadriplegia C-Level Injuries and T-Level Injuries Physical, Psychosocial, and Vocational Implications of SCI Types of Seizure Disorders Meningitis, Encephalitis, Sleep Apnea, and Narcolepsy (General Overview and Understanding) Video 1 - Epilepsy and Other Neurological Conditions: Epilepsy/Seizure Disorders ○ Group of syndromes that occur in conjunction with disruption of electrical activity in the brain ○ Affects consciousness, movement or actions through a seizure ○ Disrupts a lot of normal activity in one’s life ○ A lot of abnormal firing of electrical impulses in the brain ○ May cause temporary loss of control of certain body functions ○ Location of aberrant electrical activity in the brain, determines the type of seizure experienced Generalized: nerve cells discharge abnormally throughout whole brain Generalized tonic-clonic (grand mal) ○ Aura (i.e. flash of light, unusual taste or sensations, falling to the ground) ○ Tonic state ○ Muscles enter clonic state Generalized Absence (petit mal) ○ Mostly experienced by children ○ Brief blank or staring spells and loss of awareness ○ They may disappear spontaneously with age but they could go on to develop tonic-clonic seizures Focal (Partial): abnormal nerve cell discharge limited to one specific part of brain Simple-partial (aka focal or Jacksonian) ○ No alteration of consciousness ○ Affect only 1 side of the body ○ Uncontrollable trembling or jerking of arm/leg  Complex-partial (aka psychomotor seizure) ○ Impaired consciousness ○ Easily mistaken as being intoxicated Implications for Epilepsy ○ Management of Epilepsy Depends on cause and type of seizure experienced Medications don’t cure but help with managing them Determining patterns with the seizures Prompt-detection and early medical intervention are important ○ Psychosocial May have difficulty establishing interpersonal relationships Self-esteem ○ Vocational Accommodations: Workplace safety, written instructions because memory is impaired Other Neurological Conditions ○ Meningitis Inflammation of the meninges (membranes surrounding brain and spinal cord) caused by infection Caused by bacteria, viruses, other organisms that have entered the brain or body Hallmark is its rapid onset Confirmation by lumbar puncture (spinal tap) Manifestations/symptoms: headache, neck rigidity, photophobia (sensitivity to flashing light) Can recover quickly if diagnosed quickly ○ Encephalitis Inflammation of the brain due to direct invasion of an organism Caused by endemic virus or secondary to another infection No adequate intervention to manage Manifestations/symptoms: Headaches, stiff neck, coma Children and older adults are most susceptible ○ Sleep Apnea Disturbed sleep resulting in significant daytime sleepiness 2 types Obstructive ○ Something obstructs upper airway Central Sleep Apnea ○ Brain doesn’t send correct signals to the muscles that affect breathing Mechanical therapy: Continuous Positive Airway Pressure (CPAP) machine ○ Narcolepsy  Neurological sleep disorder involving CNS linked to disruption of sleep control mechanism Episodes of excessive sleepiness and uncontrollable sleep during the day Has devastating physical, psychosocial and vocational implications Video 2 - Spinal Cord and Traumatic Spinal Cord Injury: Structure and Function of the Nervous System ○ Central Nervous System (CNS) Brain Spinal Cord (extends from brain stem to lower part of the back) ○ Function of the nervous system Organizing and directing motor responses of voluntary muscle system Monitoring and recognizing external stimuli Monitoring and coordinating internal body states (especially those that have become dysregulated) Structure and Function of the Spinal Cord ○ The spinal cord is a bundle of nerves that are protected by our vertebrae and this bundle transmits messages to and from the brain ○ The communication system doesn’t always need to spinal cord to mediate the messages to and from the brain (i.e. knee-jerk responses) ○ Outer white matter: conveys electrical impulses up and down spinal cord between the peripheral nervous system and brain ○ Gray matter: coordinating center for reflex and other sensory activities ○ Spinal Cord Nerves Cervical vertebrae (C1-C8) Control nerves associated with control of the head, neck, diaphragm, arms, wrists, triceps & hands Thoracic vertebrae (T1-T12) Concerned with the central core part of our body ○ Some arms, chest muscles, abdomen, stomach, and organs in that part of the body Lumbar vertebrae Associated with legs Sacral nerves Associated with the bladder, bowels, sexual functions and heels Overview of Traumatic SCI ○ Most common cause: direct injury from motor vehicle accidents, sports injuries, falls, work-related injuries, or gunshot wounds ○ Degree of functional loss depends on location and degree of injury ○ Manifestations Paraparesis: Spinal cord is partially severed so some functionality may exist below the area of injury Paraplegia: injury affects only lower extremities Tetraplegia: injury affects all 4 extremities  General Physical Implications ○ Pulmonary Functioning The higher the level of SCI, the more the pulmonary system is affected due to the muscles needed for breathing being impacted ○ Ambulation Injury above T12, need a wheelchair ○ Bladder and Bowel Control Neurogenic Bladder and Bowel Bladder and bowel muscles are paralyzed and the individual cannot control them ○ Sexual Functioning and Fertility Healthy sexual functioning is still a possibility with individuals with SCI Implications of SCI ○ Cervical Level Injury C4 = Quadriplegia/tetraplegia Results in complete paralysis below the neck C1 or C2 injury can be fatal C4 or above Wheelchair used Personal attendant ○ Thoracic Level Injury Muscles of the trunk are affected May be able to have total independence Wheelchair may be necessary ○ Lumbar Level Injury Ambulation with braces is possible May be some bowel and bladder issues ○ Sacral Level Injury Also related to bowel and bladder function Management of Traumatic SCI ○ Preventing further injury ○ Stabilizing individual's physical condition ○ Performing surgery to realign spinal column or achieve decompression of spinal cord ○ Physical therapy ○ Learning self-care Potential Complications Associated with Traumatic SCI ○ Spascity: any tightness or stiff muscles which lead to inability to control those muscles (spasms related) ○ Contractures: hardening or stiffening in the muscles around the joints of the body and further limits movement ○ Autonomic Dysreflexia: requires immediate hospitalization; sudden onset of excessively high blood pressure Functional Implications of Traumatic SCI  ○ ADL’s and participating in one’s community and personal life may require a degree of modification ○ Personal and Psychosocial Issues Activities and Participation Environmental modifications Operating a motor vehicle Social and family participation Recreational activities Sexuality Vocational Issues After Traumatic SCI ○ Accommodations in the workforce typically focus on ADL’s personal assistant to help with work, grooming, toileting, eating access to workstation alternative access to computers speech recognition if arm movement is limited work site access including accessible restrooms, lunch rooms, break rooms traveling to and from work) Textbook Notes Chapter 6: Epilepsy and Other Conditions of the Nervous System | Oct. 1 Epilepsy causes seizures ○ Seizure: general term used to describe a state in which there is temporary loss of control over certain body functions ○ Epilepsy: condition in which there are recurrent, seizures due to a permanent, underlying neurological condition in which function of the neurons in the brain is disrupted so that they create atypical electrical discharges resulting in a seizure Not all seizures are caused by epilepsy ○ Acute symptomatic seizure: caused by an acute condition, like alcohol or drug intoxication or withdrawal, hypoxia, hypertension, stroke or trauma Types of Seizures ○ Focal: abnormal nerve cell discharge is limited to one specific part of the brain Classified according to the manifestations during the seizure Motor seizure: involves jerking or movement in one part of the body Olfactory Seizure: involves a manifestation in which the individual experiences an unpleasant smell Also classified according to degree of change in consciousness or awareness during the seizure Dyscognitive seizure: When consciousness or awareness is impaired during a seizure ○ Generalized: nerve cells discharge abnormally throughout the whole brain Generalized Tonic-Clonic Seizure (aka Grand Mal)  Some individual will experience an aura (warning sign) before it begins Then, they lose consciousness and collapse (tonic) - characterized by generalized body rigidity Then, muscles will enter a clonic state where the whole body has rapid, jerky movements Generally lasts a few minutes Absence Seizures (aka Petit Mal) characterized by brief blank spells or staring spells and a loss of awareness of the surroundings Generally lasts a few seconds ○ Status Epilepticus: used to describe seizures that are prolonged or that come in rapid succession without full recovery of consciousness between seizures Medical emergency Electroencephalography (EEG): primary diagnostic tool for evaluation individuals after seizures; noninvasive procedure where electrical activity of the brain is recorded and printed Magnetic resonance imaging (MRI): used to identify structural anomalies in the brain related to seizures Meningitis: refers to an inflammation of the meninges (membranes surrounding the brain and spinal cord) ○ Can be caused by bacteria, virus or other organisms ○ Rapid onset ○ Individuals are usually acutely ill with fever or flu-like symptoms Encephalitis: inflammation of the brain due to direct invasion of an organism ○ May be caused by an endemic virus (i.e. West Nile virus, herpes, etc..) Sleep Apnea: frequent episodes of breathing cessation during sleep ○ Obstructive sleep apnea most common type obstruction of the upper airway during sleep ○ Central sleep apnea can occur when the brain fails to send messages to muscles needed for breathing to initiate respiration; can be caused by stroke infections affecting the brain stem, or neuromuscular conditions that involve the respiratory muscles Narcolepsy: characterized by episodes of excessive sleepiness and uncontrollable sleep that occurs during the day Chapter 7: Traumatic Spinal Cord Injury | Oct. 1 The spinal cord transmits electrical messages to and from the brain that facilitate motor, sensory, and autonomic function. When injured, these functions are affected Common causes: motor vehicle accidents, sports injuries, falls, work-related injuries, or violence (i.e. gunshot wounds) Types  ○ When spinal cord is completely severed There is no coordinated neural communication with the brain below the level of injury so no voluntary motor or sensory function ○ When spinal cord is NOT completely severed The individual can have some motor or sensory function below the level of the injury May experience paraparesis - some function exists below the level of injury If afferent/sensory nerves are injured, some degree of sensory loss below the level of injury may exist If efferent/motor nerves are injured, some degree of motor loss below the level of injury may exist When both sensory and motor tracts are injured, both motor and sensory loss below the level of injury can be affected Manifestations ○ The degree of functional loss depends on the degree to which the spinal cord is injured and the location of injury ○ Paraplegia: when an individual’s injury affects only the lower extremities ○ Tetraplegia: if all 4 extremities are affected Physical Implications ○ Pulmonary (lungs) function ○ Ambulation Can be wheelchair or braces/crutches depending on location ○ Bladder and Bowel Control Injury at the thoracic or cervical level, most individuals experience neurogenic bladder/bowel- bladder or bowel muscles are paralyzed and the individual is unable to empty the bladder/bowel voluntarily ○ Sexual Function and Fertility Nerves to the genital region are almost always affected to some degree by spinal cord injury Ejaculation is absent for many men with spinal cord injury If it does occur, they may experience retrograde ejaculation - semen is deposited into the bladder rather than externally Physical Implications ○ Cervical Level (C1-C8) Quadriplegia: paralysis of upper and lower extremities Injuries at C1 or C2 can be fatal because functioning of all muscles (including respiration) is lost Typically need respiratory assistance Likely require assistance for self-care  C1-C3: Severe impact on breathing, requiring ventilator support. C4: May allow for some shoulder movement but limited ability to breathe independently. C5-C8: Some arm function with potential limitations in hand dexterity. ○ Thoracic Level (T1-T12) Paraplegia: paralysis of lower extremities T1-T3: Paralysis of the muscles of the trunk T7-T12: may be able to walk with use of long leg braces ○ Lumbar Level (L1-L5) Many of the muscles of mobility are intact All upper body muscles and many of the leg muscles remain functional Ambulation with braces or cane/crutches ○ Sacral Level (S1-S4) Ambulation is usually still possible with little or no equipment Most individuals can recover Complications ○ The higher the level of injury, the greater the risk of developing secondary incapacitating conditions ○ Pressure Sores (Decubitus Ulcers) Result from lack of blood supply (ischemia) to a body pressure point People with SCI are often immobile so areas of pressure on certain bony places are more likely to develop Can result in necrosis (skin tissue death) ○ Spasticity Exaggerated involuntary movement of muscles that results in exaggerated muscle jerks, hyperexcitability of reflexes, and muscle spasms ○ Contractures Permanent contraction of a muscle causing loss of range of motion or fixed deformity of a joint Physical therapy begins asap to prevent these ○ Osteoporosis Inactivity causing calcium removal and thus softening and weakening of bones ○ Chronic Pain Neuropathic pain Most common Atypical processing of sensory messages ○ Cardiovascular Complications Major importance since they account for the highest cause of death in this group  Thrombophlebitis: formation of blood clots in the legs Pulmonary embolism: a blood clot that travel to the lungs Orthostatic hypotension: condition where blood pressure becomes lower when the individual moves from a flat position to an upright position Autonomic Dysreflexia: complication of spinal cord injury usually above T6 Caused by loss of coordinated response by the autonomic nervous system Difficulty with Thermoregulation and Sweating Inability to effective respond to changes in temperature put individuals at risk of developing hyperthermia (abnormally high body temperature) or hypothermia (abnormally low body temperature) Pneumonia and other Pulmonary problems Urinary Tract and Bowel Complications Module 7: Neurodegenerative Conditions Module Notes Pay particular attention to: Role and Function of Neurotransmitters (e.g., axon, synapse, myelin sheath) Role of Dopamine and Acetylcholine Signs and symptoms of Multiple Sclerosis (MS) Interventions and Management of MS Vocational Implications of MS Neurodegenerative (e.g., Parkinson's, Huntington's, Alzheimer's) versus Neuromuscular (e.g., Myasthenia Gravis, Muscular Dystrophy, ALS) Video 1 - Multiple Sclerosis: A chronic and unpredictable disease that attacks the CNS Inflammatory, multi faceted, and progressive ○ It has a way of affecting multiple systems of the body Caused by multiple factors but most belief it is an autoimmune Myelin helps promote the transmission of the nerve impulses. Because the immune system is attacking our nerve system and it damages/scars ○ This slows down the transmission of the nerve impulses or blocks it entirely Symptoms Four Courses of MS ○ Relapse-Remitting Fluctuating course of relapse then followed by partial or total recovery ○ Secondary-Progressive Cessation of fluctuations with slow deterioration and progression  ○ Primary-Progressive Deterioration from the beginning ○ Progressive-Relapsing State of steadily worsening disease along with periods of exacerbation which may or may not be followed by remission Initial Manifestations ○ Vary dramatically from from person to person ○ Fatigue, numbness, muscle weakness, difficulty with vision, difficulty with walking and balance, coordination ○ Sensitivity to heat, varying levels of pain, portions of visual system affected (blurry, double vision), speech and swallowing issues, muscle weakness, motor (paralysis of the parts of the body, vertigo), depression, bowel or bladder control, sexual function and fertility Management of MS ○ Lifelong condition ○ No established pattern of functional change ○ No predictable outcome Anxiety provoking because they don't know how long their condition/symptoms will last ○ Varying degrees of progression rates of functional change ○ No cure and deterioration that has taken place can not be reversed ○ Interventions directed toward Managing individual manifestations Preventing/managing exacerbations and complications Maintain healthy lifestyle Identify potential triggers Medications (meant to prevent relapse/slow down progression ○ Anticholinergic Medication Form of psychotropic medication that help with neuro/nervous system transmission Side effects: dry mouth, blurriness, dizziness ○ Immunosuppressants ○ Steroids Maintaining function Vocational Implications ○ People are typically diagnosed in a period where they’re engaging in work ○ Functional abilities related to mobility communication, vision and cognitive function need to be addressed ○ Emotional stress and physical stress can cause temporary worsening of manifestations ○ Avoid hot and humid environments! ○ Increased susceptibility to complications Minimize exposure to other viruses and bacteria in the workplace to help reduce any potential sickness Video 2 - Neuromuscular and Neurodegenerative Conditions: Synaptic transmission: individual neurons are separated by a small space called a synapse or synaptic cleft ○ Neurotransmitters are the chemical messengers that carry information across the synapse ○ At any given synapse, the neurons sending the information is referred to as the presynaptic neuron and the neuron receiving the information is the postsynaptic neuron Neurotransmitters ○ Manufactured in the cell body and they’re transported down the axon and stored in terminal buttons and little pockets called vesicles ○ When an action potential arrives at the axon’s terminal button, neurotransmitters are released into the synapse ○ Molecules of the neurotransmitter substance than attach or bind to the specialized receptor sites on the dendrite or cell body of the postsynaptic neuron ○ Dopamine Movement Excess = Tourettes Lack = tremors; Parkinsons Memory Mood Lack of dopamine = depression Excessive dopamine = psychotic/psychosis based symptoms (i.e schizophrenia) Dopamine Hypothesis Used to treat certain disorders to try to level out movements ○ Acetylcholine Found in the CNS, at the neuromuscular junctions Muscle contraction Defects = impairment with voluntary movement (aka paralysis) Memory Sleep-wake cycle Neurodegenerative Conditions ○ May be inherited or acquired and show progressive deterioration of CNS over time Parkinson’s Disease Slowly progressive condition of CNS Leads to progressive loss of motor function ○ Bradykinesia (slowness of movement) ○ Muscle rigidity ○ Postural disturbance ○ Tremor Dementia can occur later in course of condition  ○ Because less dopamine is being produced thus a loss of memory Identification based on presence of tremor, stiffness, slow movement There is no cure Characterized by progressive debilitation Medication levodopa (L-dopa) used Exercise and activity is important ○ Trying to help minimize shrinkage of muscle Huntington’s disease (aka Huntington’s Chorea) Progressive, genetic condition of CNS Manifested in motor movements Neurons in basal ganglia of brain degenerate Associated with beginning in midlife Onset of involuntary body movements Death is imminent within 15-20 years Disorders of movement, cognition, and behavior ○ Cognitive deficits ○ Motor consequences ○ Behavioral changes No intervention known Major management component = physical therapy Symptoms increase in intensity by emotional or concentration on performance of physical tasks Alzheimer’s disease Dementia: decline of reasoning, memory, cognitive functions that interfere with daily function 80% of dementia cases are due to Alzheimer’s disease - an irreversible type of dementia Manifestation ○ Difficulty with concentration, memory, orientation, calculation Emotional, behavioral, and psychiatric manifestations ○ Depression vs. dementia in older adults No lab test can confirm disease Neuromuscular Conditions ○ Affect nerves or muscles ○ Results in degeneration of motor neurons in areas of central and peripheral nervous systems ○ Muscle weakness; atrophy (shrinkage) of muscle ○ May be acquired or inherited Amyotrophic lateral sclerosis (ALS) Referred to as Lou Gehrig’s disease Gradual degeneration of motor neurons  Cause unknown; no cure Increasingly weak and immobile with progressive paralysis Muscular dystrophy Group of inherited muscle conditions characterized by weakness and progressive degeneration of skeletal muscle Muscle fiber degeneration with atypical muscle regeneration (dystrophy) Muscle weakness, muscle wasting, apparent lack of coordination, contractures of joints ○ Duchenne’s muscular dystrophy (occurs between 2-5 years; most children do not survive into adulthood) Myasthenia gravis Autoimmune neuromuscular condition Interruption in transmission of nerve impulses to muscle to the point where nerves initiate contraction of muscles ○ Drooping eyelids and muscle fatigue (particularly in the face) Generally progressive Decrease in acetylcholine Class Notes Cognition ○ Content vs. process What you know vs. how you manipulate things in order to know ○ Attention vs. concentration ○ Memory Procedural Driving, riding a bike Declarative Stating facts Working Being able to take a piece of info and being able to manipulate it in your mind (i.e. doig 91 x 8 in our heads) ○ Working Memory Short term and long term ○ Dementia Global deterioration of the brain Textbook Notes Chapter 8: Multiple Sclerosis | Oct. 8 An inflammatory, demyelinating condition of the central nervous system ○ Affects nearly twice as many women as men ○ Is the second most incapacitating neurologic condition affecting young adults (#1 is trauma)  Some experts believe it is an autoimmune condition in which the body’s immune system attacks segments of myelin. But the triggers that causes the body’s immune system to attack myelin are unknown It is a lifelong condition The Role of Myelin ○ Myelin: fatty, protective sheath that surrounds and insulates the axon in the brain and spinal cord and promotes rapid transmission of nerve impulses ○ When areas of myelin are destroyed and scar tissue (plaque) forms transmission of nerve impulses is slowed or blocked by the plaque This alters neurological function in a specific area ○ Multiple sclerosis = multiple areas of scarring (sclerosis) that occur when myelin surrounding nerve fibers in the brain and spinal cord is destroyed Types of Multiple Sclerosis ○ Relapsing–remitting: characterized by fluctuating course of relapses with associated neurologic deficits, followed by periods of partial or total recovery after relapse Periods of exacerbations/relapses (when manifestations become worse), alternating with periods of remission (when manifestations become better) 90% of individuals have this kind Most individuals with this kind progress to secondary after 20-40 years ○ Secondary progressive: characterized by cessation of fluctuations with slow deterioration and progression ○ Primary progressive: characterized by deterioration from beginning Manifestations of Multiple Sclerosis ○ Initial Manifestations Manifestations of multiple sclerosis fluctuate and often involve sensory or visual manifestations, in addition to fatigue, weakness, and impaired balance or coordination, depending on the part of the central nervous system affected ○ Systemic Changes Fatigue Sensitivity to heat ○ Sensory Manifestations Vary from decreased sensation to pain Some experience a sensation of numbness or tingling in some part of the body (paresthesia) ○ Vision May experience optic neuritis (dimness, blurring of vision or pain over the eye); diplopia (double vision) ○ Motor Manifestations Cause muscle weakness or partial/complete paralysis of any part of the body May be spasms  May experience difficulties with coordination and balance (ataxia) or dizziness (vertigo) ○ Speech and Swallowing Dysphagia (difficulty swallowing) ○ Cognitive Changes most frequently experience difficulties with attention, conceptualization, memory, or new learning ○ Depression ○ Bowel or Bladder Control ○ Fatigue Identification of MS ○ No definitive laboratory tests ○ Instead, diagnosis of multiple sclerosis is based on clinical history, manifestations, and the results of a full neurological examination (includes MRI) Managing MS ○ Manifestations of multiple sclerosis often fluctuate between periods of remission (when manifestations get better) and periods of exacerbation (when manifestations get worse). ○ Although manifestations may partially resolve when the condition is in remission, each exacerbation can bring about additional functional changes that are permanent. ○ Interventions are directed toward managing individual manifestations, maintaining function, and modifying the course of the condition so that future exacerbations can be prevented or delayed to the extent possible Chronic Pain Management ○ Physical therapy and occupational therapy may be helpful in assisting individuals to minimize pain due to spasms or postural difficult Functional Implications ○ Restrictions on abilities, activities, and social relationships call for significant initial psychosocial adjustment and alteration of self-concept as well as continual readjustment as exacerbations and remissions occur and as new incapacitating features of the condition emerge ○ Continued flexibility and adjustment is needed as the condition changes ○ Assistive devices and home modification may be needed as ability to perform ADLs becomes reduced ○ Vocational Issues Educational attainment, severity of manifestations, and presence of alteration in cognitive function are predictors of employment status Specific accommodations and needs for each person with multiple sclerosis must be evaluated individually Paralysis in lower extremities = wheelchair accommodations Balance problems = avoid situations where falling can be hazardous or need a walking aid Vision affected = specific visual accommodations needed  Cognitive function affected = cognitive retraining or memory enhancement programs Excessive fatigue, particularly to the point of over exhaustion, should be avoided. Frequent rest periods may be needed Avoid heat and environments with exposure to infectious conditions Chapter 9: Neurodegenerative and Neuromuscular Conditions | Oct. 8 Neurodegenerative conditions: consist of a number of conditions that may either be inherited or acquired and that show progressive deterioration of the central nervous system over time ○ Parkinsonism General term to describe a condition where 4 basic manifestations occur: Tremor Rigidity Akinesia (absence of movement) Postural disturbance) Secondary Parkinsonism: when manifestations stem from another condition (i.e ingestion of certain drugs (prescription or illicit) or exposure to toxic substances, such as carbon monoxide or other chemicals Ex: Alzheimer’s disease, Encephalitis, Brain tumor, Head trauma, Huntington’s disease Parkinson’s Disease: slowly progressive neurodegenerative condition of the CNS that leads to progressive loss of motor function Involves extensive degenerative changes in the basal ganglia (gray matter embedded in the white matter of the brain; affects complex movements) AND the loss of or decreases in levels of dopamine (a neurotransmitter) in the basal ganglia Manifestations ○ Bradykinesia (slowness of movement) or akinesia Small shuffling steps or difficulty standing from a chair or bed ○ Muscle rigidity May blink less and develop expressionless face Develop difficulty swallowing quick enough may cause speech changes related to incoordination and reduced movement of muscles that control breathing, voice (volume of speech = hypophonia), pronunciation, and rate of speaking ○ Postural disturbance Lose posture stability and demonstrate gait irregularities ○ Tremor Most frequent early manifestation  Tremor intensifies when the hand rests in the lap (resting tremor) and diminishes with voluntary movement. Identification ○ No single test is used but identification is usually based on the presence of tremor, stiffness, and slow movement and ruling out other causes of Parkinsonism Management ○ No cure ○ Characterized by progressive debilitation, although the progression occurs slowly over years ○ Intervention is directed toward reducing the effects of manifestations and preventing complications, thereby enabling the individual to remain active longer. ○ Interventions Medicine Levodopa (L-dopa): decreases manifestations by helping to increase the level of the neurotransmitter dopamine in the brain Non-Pharmaceutical regular exercise, physical therapy, speech therapy, and psychosocial support ○ Staying active is important because of the tendency of the muscles to be stiff and rigid Implications ○ Vocational Jobs that require considerable walking, stooping, or bending should be avoided. Transportation to and from work may be the largest obstacle to maintaining employment ○ Huntington’s Disease Progressive, genetic condition of the CNS in which neurons of the brain degenerate Characterized by disorders of movement, cognition, and behavior Most manifestations are not developed until ages 30-50 Manifestations Cognitive Deficits ○ First becoming increasingly absent minded and having difficulty with concentration; progresses to dementia Motor consequences ○ Early, involves movement of fingers like fidgeting but progresses to movement and coordination continue to  deteriorate, with bradykinesia and rigidity interfering with the individual’s ability to walk; jerky, involuntary movements (chorea) also present Behavioral changes ○ Delusions to impulse-control problems Identification Usually based on individuals manifestations, family history and genetic testing Interventions No intervention known to slow it down or cure it Usually directed toward preventing complications and managing manifestations (i.e physical therapy) Psychotropic medications may be used to help alleviate or control behavioral manifestations regardless of their cause ○ Alzheimer’s disease Most prevalent type of dementia (decline from prior levels of cognitive functioning in of reasoning, memory, language, visuospatial ability, or changes in personality or behavior that interferes with daily function) Progressive and initial manifestations may be subtle, insidious, and not easily recognized. Concentration, memory, orientation, and calculator difficulties Identification Primarily based on physical and neurological examination ruling out other conditions that may mimic manifestations Neuromuscular conditions: affect the nerves or muscles, which results in degeneration of motor neurons in the areas of the central and peripheral nervous systems, leading to muscle weakness and atrophy (shrinkage) of muscle ○ Amyotrophic lateral sclerosis (ALS) Characterized by gradual degeneration of motor neurons, the nerve cells that convey impulses to the voluntary muscles Manifestations May be subtle initially including muscle weakness As muscular weakness gradually progresses, muscle atrophy occurs, and there may be spasticity (stiffening of muscles) with exaggerated reflexes (hyperreflexia) Gradually will lose ability to stand, walk and use arms No cure and no way to identify it Individuals with ALS experience increasing loss of function and increased dependence on others over time ○ Muscular dystrophy Group of inherited muscle conditions characterized by weakness and progressive degeneration of skeletal muscle  Features muscle fiber degeneration with atypical muscle regeneration (dystrophy), usually consisting of fat and connective tissue that replaces muscle fibers Characterized by primary degeneration of muscle fiber with progressive muscle weakness. Duchenne’s muscular dystrophy is the most common inherited muscle disease, typically identified in boys between 2 and 5 years of age Characterized by progressive muscle weakness that results in clumsiness, frequent falls, difficulty running and difficulty going up stairs Later shoulder muscles become weakened Identification In addition to health history and family history, blood tests that quantify levels of enzymes indicating muscle damage (creatine kinase [CK]) or tests that measure electrical activity in the muscle (electromyography) may be utilized No cure; management interventions are directed toward preventing complications and maintaining mobility function for as long as possible ○ Myasthenia gravis Autoimmune neuromuscular condition in which there is interruption in transmission of nerve impulses to muscle at the point at which nerves initiate contraction of a muscle that can occur at any age Initial manifestation is usually painless muscle weakness that increases with muscle use and decreases after rest of the muscle Management Medications that prolong and enhance the ability of neurotransmitters to activate muscles are utilized Module 8: Developmental Conditions and Neurological Conditions (Continued) Module Notes Video 1: Polio, GB, Lyme, and Bell's Palsy Poliomyelitis ○ Polio: Acute infectious viral condition ○ Largely eradicated in industrialized nations; still prevalent in many developing countries ○ Enters body when contaminated water or food ingested Also coming in contact with sneeze with someone infected (less common) ○ Targets nerve cells that control muscles; muscle cells lose ability to contract Can affect a person’s spinal cord, causing paralysis Paralysis is the biggest side effect ○ Manifestations of Acute Polio Gastrointestinal or upper respiratory manifestations accompanied by fever  Headache Stiff neck Muscle pains Affected muscles paralyzed or weakened Legs most frequently affected ○ Manifestations of Post-Polio Syndrome Non-contagious neurological disorder Case unknown Slowly progressive muscle weakness and fatigue In muscles that were previously affected by the polio infection Some individuals experience only minor symptoms while others develop visible muscle weakness and atrophy Skeletal changes Respiratory weakness Difficulty swallowing Guillain-Barre Syndrome ○ Neurological disorder where immune system mistakenly attacks part of the PNS ○ Inflammatory condition of peripheral nerves ○ Cause unknown; appears to be immune mediated condition ○ Muscle weakness on both sides of the body is the biggest indication Often affect the arms, lungs, face ○ Paralysis can occur ○ No known cure Some therapies can lessen the severity and shorten recovery time There may be some ongoing issues with fatigue and paralysis after recovery ○ Can cause respiratory failure Lyme Disease ○ Transmitted by bite of infected tick ○ Common symptom: circular rings of rashes ○ Multisystem inflammatory condition that affects nervous system, joints and muscles ○ First stage is often described as flu like symptoms Fever, chills, swollen lymph nodes, headache, fatigue, muscle aches ○ Some neurological complications can occur during 2nd stage Numbness, pain, Bell's Palsy, weakness, visual disturbances ○ Other problems may come later Cognitive issues: difficulty concentrating, irritability, memory loss, sleep disorders, nerve damage in arms and legs ○ They do respond well to antibiotics (especially when it’s their first time in contact with it) and often have full recovery Bell’s Palsy (AKA idiopathic facial palsy) ○ Form of temporary paralysis or weakness on one side of the face  It results from dysfunction of cranial nerves which direct the muscles on one side of the face including those that control the eyes, blinking and make facial expressions ○ Most researchers believe that reactivation of an existing viral infection may be the cause of the disorders Or impaired immunity from stress, sleep depreciation, physical trauma, minor illness or autoimmune syndromes ○ For individuals with first onset of Bell’s Palsy, steroids are considering to be effective for recovery Video 2: Intellectual, Developmental, and Pediatric Related Disabilities What is intelligence? ○ There is no uniform definition ○ Some prefer to use to term “general abilities” as markers in intelligence Logic and rules Self awareness EQ Memory and retention Planning and problem solving skills Executive functioning ○ Theories of Intellectual Development Piaget’s Theory of Cognitive Development - specific cognitive tasks that children develop in each stage Sensorimotor, Preoperational, Concrete operational, Formal operational stages Gardner's multiple intelligences Linguistic, musical, logical-mathematical, spatial, body kinesthetic Sternberg's Triarchic Model of Intelligence Looks at different components as elements of intelligence Overview of Developmental/Pediatric Conditions ○ Limitation in one or more areas of function Speech and/or language Attention and/or emotional affect Cognitive or learning ability Self-direction and/or social behavior Motor skills and mobility Self-care and independence ○ Developmental Conditions Present from birth, or shortly afterward; persist thought life ○ Developmental Disability Occurs in childhood and are lifelong Affects intellectual and/or physical functioning Requires ongoing special services and support Intellectual Disability  ○ AAIDD changed term “mental retardation” to intellectual disability Characterized by impairment and limited ability in intellectual and adaptive behavior/function Everyday social and practical skills Occurs in 2-3% of population Originated before age 22 ○ Causes 50% of cases can’t be determined Some are a result of genetic abnormalities: fragile X syndrome or trisomy 21 (Down syndrome) Congenital: brain malformations and chromosomal abnormalities Prenatal causes: maternal exposure to infections, drug or alcohol abuse, exposure to toxic chemicals or radiation or to prescription drugs Postnatal: Brain injury during birth, trauma, infections, toxic substance exposure, metabolic conditions, hypothyroidism, malnutrition ○ Identification of Intellectual Disability Takes a number of years and it requires extensive diagnostic testing Must be at least 2 independent tests of intelligence Wechsler Intelligence Scales for Children Stanford-Binet Intelligence Scale’ Also have at least 2 tests of adaptive functioning (akin to ADL’s - grooming, getting dressed avoiding danger, following school rules, ability to work and take personal responsibility) Vineland Adaptive Behavior Scales American Association on Mental Retardation Adaptive Behavior Scale (ABS) DSM-5 Specifiers Mild, moderate, severe & profound ○ Based on adaptive functioning, not IQ score Learning Disabilities (Learning Disorders) ○ Group of conditions that affect ability to acquire or use information Some include issues with reading, writing, mathematical calculation, listening, speaking or reasoning ○ Severe learning disabilities affect academic and functional skills People with learning disabilities have average or above average intelligence but there is a gap between the individual's potential and actual achievement ○ No specific cause identified Learning disabilities are also attributed to genetic and/or neurobiological factors that alter brain functioning ○ Managed successfully when accurately identified General Issues in Intellectual and Learning Disabilities ○ Personal and Psychosocial Issues Every age, ethnic, racial, socioeconomic group  Increased risk for range of health problems, including mental health problems Communication problems common May be unable to describe their feelings and experiences or may have difficulty communicating needs and wishes Many live with their families into adulthood Employment potential for helping to achieve independence and social inclusion Cerebral Palsy ○ Classified as developmental disability ○ Neurological manifestations due to damage to brain that occurred before, during or shortly following birth ○ Inability to totally control or coordinate muscle movement ○ Not progressive, communicable or inherited ○ Manifestations are permanent ○ Complications Lifelong condition; not progressive Contractures: loss of range of movement or fixation of a joint Scoliosis: lateral curvature of spine Dental problems Osteoporosis and osteopenia Respiratory infections Degenerative joint disease Spina Bifida ○ Congenital condition that involves the spinal column 1 or more vertebrae are left open and the spinal cord is left exposed ○ Different forms Most severe is when spinal cord is entirely exposed Pervasive Developmental Conditions ○ Autism Spectrum Disorder Difficulty with communication and interaction with other people Restricted interests and repetitive behaviors Symptoms that hurt the person’s ability to function property in school, work and other area of life ○ Asperger’s Disorder and Pervasive Developmental Disorder, not otherwise specified DSM changed this to be a series of syndromes on a spectrum Textbook Notes Chapter 10: Post-Polio Syndrome and Other Conditions of the Nervous System | Oct. 15 Post-Polio Syndrome Poliomyelitis (aka polio): an acute infectious viral condition that was prevalent in the United States in the first half of the 20th century.  ○ The virus enters the body when contaminated water or food is ingested or when hands that have been contaminated with the virus touch the mouth ○ Targets the nerve cells that control muscles Brain stem, spinal cord, and neuromuscular system may all be affected ○ The nerve cells or motor neurons damaged by the poliovirus are located in the anterior horn of the spinal cord and extend to the muscles. As neurons are affected, muscle cells lose the ability to contract = paralysis Poliomyelitis itself is not a progressive condition Post-polio syndrome: new manifestations in people who experienced poliomyelitis decades earlier Manifestations ○ Noncontagious neurological disorder ○ Manifestations include: Slowly progressive muscle weakness Generalized and muscular fatigue Gradual decrease in muscle size (muscle atrophy) Muscle pain (myalgia) and joint pain Increasing skeletal changes such as curvature of the spine (scoliosis) Respiratory muscle weakness Difficulty swallowing (dysphagia) ○ Post polio syndrome is progressive, meaning manifestations will become increasingly worse Identification ○ Manifestations be difficult to distinguish from those associated with other degenerative conditions of muscles and joints (i.e osteoarthritis or osteoporosis) Management ○ No specific intervention is available to alter the course of post-polio syndrome ○ Generalized fatigue is managed with lifestyle changes consisting of energy conservation measures ○ Increasing muscle strength through non fatiguing exercise may be used to treat mild to moderate weakness ○ Braces can be used to decrease mechanical stress on the joints to minimize muscle and joint pain Vocational Implications ○ The onset of manifestations related to post-polio syndrome may require the alteration or retraining of job duties. Some may need to change occupations or retire early ○ Manifestations of post-polio syndrome—whether pain, weakness, or fatigue—may necessitate use of additional assistive devices or frequent rest periods Guillain-Barré Syndrome Guillain-Barré Syndrome: acquired inflammatory condition of the peripheral nerves Exact cause is unknown but it appears to be immune-mediated condition, often following infection  Manifestations ○ Weakness is the most common initial manifestation but severity varies Usually begins in the lower extremities and spreads upward Identification ○ Usually based on manifestations and physical exams Management ○ Due to the potential for rapid incapacitation, it requires hospitalization for observation ○ Respiratory muscles can be affected, so respiratory failure can be a potentially life-threatening condition ○ Interventions are directed toward specific manifestations and used to prevent additional complications ○ Physical therapists are usually involved in early stages to prevent muscle atrophy, contractures or pressure sores Vocational Issues ○ Because individuals have been incapacitated for a lengthy period of time, most will require an extensive period of rehab i.e driver retraining, learning to pace activities and reemployment training Infections of the CNS Any infection of the brain or the membranes that surround the brain and spinal cord can cause serious neurological effects ○ Meningitis Inflammation of the meninges (membranes surrounding the brain and spinal cord and the cerebrospinal fluid) Can be caused by bacteria, viruses or other causes such as drug hypersensitivity or tumors Types Specific name is frequently related to its cause ○ Staphylococcal meningitis and pneumococcal meningitis are named for the organisms responsible for these infections ○ Aseptic meningitis: inflammatory process involving the meninges when there is no evidence of bacteria; it is usually caused by a viral infection ○ Mumps meningitis: meningitis caused by the mumps virus The meninges of the brain and spinal cord can be infected in several ways From the upper respiratory tract To the blood from another site and then infect the meninges Direct contamination after skull fracture Individuals with meningitis are usually acutely ill, initially with fever Within a short period of time, they develop severe headache, neck rigidity, and visual discomfort when exposed to bright lights (photophobia)  As the condition progresses, individuals become confused and often lose consciousness. Identification Identified by a history of manifestations rapid onset, including fever, stiff neck and change in mental status Can be examined using lumbar puncture (spinal tap) - to take out cerebrospinal fluid ○ Encephalitis inflammation of the brain itself, due to direct invasion of an organism Most common cause of epidemic encephalitis in US is the West Nile virus Most common case of non epidemic encephalitis in US is herpes Manifestations Nonspecific flu-like manifestations (i.e. sore throat, cough, vomiting, diarrhea) such as fever and muscle pains (myalgia) Progresses to headache, photophobia, and potentially seizures or altered state of consciousness Identification Identified through manifestations, computed tomography (CT) scan of the brain, and analysis of the spinal fluid through lumbar puncture Other Conditions Affecting the Nervous System Lyme Disease ○ Multisystem inflammatory condition that affects the nervous system as well as joints and muscles ○ Result of an infection caused by a type of organism called a spirochete and is transmitted by tick bites ○ Manifestations Neurological manifestations such as gait, sensations of pain, or confusion, dyspnea (difficulty breathing), syncope (fainting); Lyme arthritis, affecting joints, commonly the knee Cardiac manifestations (i.e. palpitations (awareness of heartbeat) Bell’s Palsy ○ Sudden partial or complete paralysis of one side of the face ○ Occurs when a nerve running from the brain to the face becomes inflamed As inflammation progresses, the nerve swells, becomes compressed and no longer transmits signals causing paralysis Central Sleep Apnea ○ Obstructive sleep apnea When upper airway to collapse or partially collapse during sleep, leading to reduced or absent breathing ○ Central sleep apnea Occurs when the brain fails to appropriately communicate with muscles needed for breathing to initiate respiration Narcolepsy  ○ Causing impairment of the sleep-wake cycle and resulting in excessive daytime sleepiness with sudden involuntary attacks of sleep ○ Manifestations Cataplexy (sudden loss of voluntary muscle control so that the individual is unable to move) Dream-like hallucinations while awake Total paralysis after falling asleep Chapter 11: Developmental Conditions: Cerebral Palsy and Spina Bifida | Oct. 15 Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas Present at birth, or shortly afterward, and that persist throughout life The term developmental disability replaced diagnostic categories (such as mental retardation or cerebral palsy) with a general term that encompassed a wide variety of conditions that occur in childhood, are lifelong, affect intellectual or physical functioning, and require ongoing special services and support Developmental Disabilities Assistance and Bill of Rights Act of 1990: emphasized functional capacity rather than categorizations and stressed empowerment of individuals with developmental disabilities Developmental Disabilities Assistance and Bill of Rights Act of 2000 ○ Defines a severe chronic disability if it: results from mental or physical impairment, or both; appears before age 22 expected to be lifelong causes significant limitations in three or more life areas (e.g., self-care, language, learning, mobility, independence, economic self-sufficiency); requires lifelong or long-term services, supports, or assistance Cerebral Palsy Involves a variety of disorders caused by various factors acting at different points in fetal development ○ Impacts development of movement and posture Cerebral palsy is not a progressive condition, and progressive deterioration does not occur as a direct result of the cerebral palsy itself The type of cerebral palsy and the manifestations experienced depend on the location and the extent of the injury to the brain Cause ○ Prenatal (before birth) Mother’s exposure to toxic chemicals or infectious conditions Rh or ABO blood type incompatibility Lack of oxygen to the fetus’s brain ○ Perinatal (during or shortly after birth) Trauma where infant’s skull is injured during delivery Fetal anoxia (lack of oxygen) ○ Postnatal (after birth)  Traumatic brain injury (i.e. infant abuse) Meningitis, encephalitis, or other infections Exposure to toxic chemicals Anoxia (i.e. drowning or carbon monoxide poisoning) Classification ○ The ICF describes disability as dysfunction at one or more of three levels: Impairment of body structures (i.e organs or limbs) or functions (physiologic or psychological) Limitations in activities Restriction of participation (involvement in life situations) ○ Components of CP classification Motor abnormalities Hypertonia ○ Abnormally increased resistance to externally imposed movement about a joint Spasticity ○ Hypertonia in which resistance to passive movement increases with increasing velocity of movement ○ Caused by a hyperactive stretch reflex mechanism Dystonia ○ A movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal posture, or both Hyperkinetic movements ○ Any unwanted excess movement Accompanying impairments Anatomical and neuro-imaging findings Causation and timing Topography or Limb Distribution ○ Hemiplegia: manifestations are found on only one side of the body) ○ Diplegia: all extremities are affected, but lower extremities are more severely affected ○ Quadriplegia/tetraplegia: manifestations affect all four extremities ○ Triplegia: three limbs are involved Classification of Activity Limitation ○ Gross Motor Function Classification Gross Motor Function Classification System-Expanded and Revised (GMFCS-ER) Rated patients’ ambulatory function, including use of mobility aids, and performance in sitting, standing, and walking Levels ○ Level I: Walks without limitations ○ Level II: Walks with limitations ○ Level III: Walks using a hand-held mobility device  ○ Level IV: Self-mobility with limitations may use powered mobility ○ Level V: Transported in a manual wheelchair Functional Mobility Scale Measured ambulatory performance in children with CP Administered by patient/parent interview Focuses on ambulation and is not intended to substitute for the GMFCS-ER Manual Ability Classification System (MACS) Describes upper extremity performance in ADL’s for children with CP Has a 5 level scale like the GMFCS-ER Communication Function Classification System (CFCS) used to describe communication performance of individuals with any disability 5-level classification system modeled after the GMFCS and MACS Manifestations ○ Characterized by irregularities of movement including alterations in: Muscle tone Muscle control Posture ○ Movement Irregularities Spasticity Exaggerated muscle tone resulting muscle stiffness and strong muscle contraction Ataxia inability to control the accuracy of muscle movement Chorea: purposeless, jerky, or abrupt movements, especially of the upper extremities Athetosis: slow, continuous writhing movements Choreoathetosis: combination of chorea and athetosis ○ Hearing and vision may be affected; Seizures are a common manifestation Complications/Management ○ The best management of below complications is through prevention: Contractures Scoliosis Dental problems Osteoporosis (reduction in bone mass) or osteopenia (diminished bone tissue) Respiratory infections ○ Management is directed toward helping individuals reach their optimal functional capacity by providing functional supports based on specific manifestations and preventing complications that could interfere with functional capacity. Spina Bifida  One of several congenital conditions, collectively known as neural tube defects, which involve incomplete development of the brain, spinal cord, or coverings of these structures. ○ One or more vertebrae are left open so that the spinal cord is exposed 3 types ○ Spina bifida occulta Refers to an opening in one or more vertebrae of the spinal column Mildest form No damage to spinal cord ○ Meningocele The meninges protrude through the opening of the spinal column The protruding part (aka a meningocele) contains only the meninges, not portions of the spinal cord ○ Myelomeningocele Most common and most severe form Nerves of the spinal cord as well as the meninges protrude through the opening of the vertebrae to the outer part of the body Spinal fluid may leak from the protrusion and increase risk of infection Usually results in paraplegia Manifestations ○ Characterized by muscle paralysis, loss of sensation, and loss of bowel and bladder control ○ Although the condition itself is not progressive, problems associated with the condition itself may increase over time Management ○ Instigated within 24 hours of birth since it’s obvious ○ Intervention depends on the extent of neurologic problems present, the level of spinal cord affected, and the existence of any complication Chapter 12: Neurodevelopmental Disorders | Oct. 15 Intellectual Disability (AKA intellectual developmental disorder) ○ Replaced “mental retardation” ○ Characterized by impairment in both intellectual and adaptive functioning, featuring significant limitations both in intellectual performance and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills ○ Causes May occur in prenatal, perinatal, or postnatal period, up until age 18 Congenital causes Include brain malformations (such as neural tube defects) and chromosomal abnormalities Prenatal causes Maternal exposure to infections, maternal abuse of drugs or alcohol, maternal exposure to toxic chemicals or radiation, and  exposure to prescription drugs that have teratogenic (producing abnormal fetal development) effects Postnatal causes Due to brain injury or trauma experienced during childhood as a result of accident or abuse Childhood infections (i.e. meningitis, phenylketonuria, hypothyroidism) ○ Identification Conducted through measurement of both intellectual functioning and adaptive behavior Deficit in intellectual functioning is 1 of the 3 diagnostic criterion for intellectual disability and its level of severity Mild, Moderate, Severe, Profound Assessment of adaptive function (2/3) Adaptive behavior (3/3) ○ Classification American Association on Intellectual and Developmental Disability developed a system Intermittent/Mild: indicates a need for support periodically or on a short-term basis during times of transition or crisis Limited/Moderate: indicative of low-intensity, time-limited supports for specific need areas Extensive/Severe: refers to a need for ongoing, regular supports on a low-intensity basis to maintain adequate function in the home or work environment Pervasive: extensive, ongoing, high-intensity support is required for safety and well-being Autism Spectrum Disorder ○ Alteration of brain function that has a broad range of behavioral consequences, i.e impairment in reciprocal social interaction and impairment in verbal and nonverbal communication, play skills, and cognitive and adaptive functioning ○ Characterized by two distinguishing features that occur on a continuum based on level of severity: marked deficits in social communication and interactions cross-environmentally A pattern of restrictive, repetitive behaviors ○ Most likely that it results from a brain function alteration that is biologically based and arises from a combination of genetic ○ Diagnostic criteria include:  Deficits in social skills, including communication, social interaction, relationship development and maintenance, as well as restrictive or repetitive behaviors and hyper reactivity to sensory input ○ Management planning often involves a multidisciplinary approach including the following elements: Audiological exam Speech and language evaluation Occupational therapy evaluation Psychiatric observation and interview Neurological exam Attention Deficit/Hyperactivity Disorder Specific Learning Disorder (AKA learning disability) Module 9: Hearing and Vision Related Conditions Module Notes Hearing Loss and Deafness PPT Structure and Function of the Auditory and Vestibular Systems ○ Auditory System Detection of sound waves and hearing The Ear Inner ear (labyrinth): fluid filled cavity within temporal bone of skull; important not only for hearing, but for maintaining balance/equilibrium Mechanism of Hearing Sound waves enter the external ear and move through the ear canal striking the eardrum causing it to vibrate. Movements of malleus, incus, stapes conducts sound waves from eardrum to inner ear Movement of hair cells stimulates nerve endings to transmit impulses to the cochlear nerve. Carries impulses to auditory center of brain, where they are interpreted as sound Sense of Hearing Comprises the neural perception of sound energy Sound characterized by pitch (tone) and intensity (loudness) ○ Vestibular System Body equilibrium, orientation, balance Include semicircular canals and small rounded chamber (vestibule) Classic manifestation is vertigo (illusionary sense of motion) Conditions of the Vestibular System  Physiologic vertigo Benign paroxysmal positional vertigo Vestibular neuritis Meniere’s Disease Other infections and vascular insufficiency Hearing Loss and Deafness ○ Disruption to any part of the hearing system can result in hearing loss ○ Degree of hearing loss characterized as: Partial Total Temporary Permanent Mild Profound ○ Classification of Hearing Loss Type and location Conductive (damage in external or middle ear) Sensorineural (damage in inner ear or auditory nerve) Mixed (combination of conductive and sensorineural) Central (impairment in the central nervous system) Age of onset Prelingual Postlingual Prevocational Postvocational ○ Congenital Vs. Acquired Hearing Loss Congenital Hearing Loss Genetic (syndrome related) Prenatal exposure to drugs or toxins Prenatal exposure to infections, such as measles (rubella) Acquired: occurring after birth or later in life Recurrent ear infections Noise Injury Viruses Degenerative conditions Aging Ototoxic drugs Tumors Manifestations of Hearing Loss Can lead to depression, social isolation, stress, and functional problems such as impaired balance.  Develop recruitment, a manifestation characterized by an abnormally rapid increase in the perception of loudness with small changes in signal energy ○ Conditions of the Auditory System Outer Ear Obstruction disrupts transmission of stimuli Middle Ear Perforated tympanic membrane Otitis media Mastoiditis Otosclerosis Inner Ear Tinnitus Acute peripheral vestibulopathy (labyrinthitis) Meniere’s disease Trauma or other health conditions Presbycusis ○ Identification of Hearing Loss Health Examination Audiometric Testing Degree of hearing Type of hearing loss Ability to understand speech ○ Pure-tone and bone conduction audiometry ○ Speech and acoustic immittance or impedance audiometry ○ Electrocochleography/auditory brain stem response ○ Otoacoustic emissions ○ Management of Hearing Loss and Deafness Hearing Aids Digital versus analog Implantable hearing aids Effective hearing aid use Assistive Listening Devices and Systems Telecoil circuitry Telephone devices Telecommunication display devices Hard-wired systems (personal listening systems) Large-area systems ○ Audio loop systems ○ FM systems ○ Infrared systems Captioning Services and Telecaption Adapters Altering Devices Surgical Interventions  Myringotomy Mastoidectomy Tympanoplasty Stapedectomy Cochlear implant Other Assistive Interventions Speech reading (lip reading) Sign language Certified interpreters ○ Functional Implications Personal and Psychosocial Issues Communication and development Deafness and deaf culture Activities and Participation Issues in the environment Issues in childhood Issues in the social environment Family interactions Sexuality Support groups ○ Vocational Issues Difficulty receiving instructions or supervision or participating in staff meetings or training. Difficulty interacting as part of work-related social functioning. May need special assistive devices, communication aids, signaling devices. Employer familiarity with individuals’ accommodation needs Conditions of the Eyes and Blindness PPT Structure and Function of the Eye ○ Eyeballs: spherical organs encased in orbital cavities of skull. ○ Eyelid: serves a protective function. ○ Lacrimal glands: secretes tears to keep eyeball moist. ○ Cornea: admits light and protects inner eye from foreign particles and organisms. ○ Sclera: forms white part of eye ○ Iris: colored part of eye. ○ Pupil: admits light to inner part of eye. ○ Aqueous humor: nourishes cornea and lens. ○ Vitreous humor: helps to maintain form and shape of eyeball. ○ Retina: contains special light-sensitive cells called rods and cones ○ Rods: detect light and dark; shape and movement. ○ Cones: daylight and color vision; perception of sharp visual detail. ○ Optic nerve: enters back of eye through optic disk.  ○ Optic nerves from both eyes join together at the base of the brain to form optic chiasm. Measuring Vision ○ Visual acuity: sharpness of visual image perceived. ○ Visual acuity tests: measures level of best vision; measures the need for corrective lenses. Snellen test Visual field Peripheral vision Central vision Types of Visual Conditions ○ Refractory errors ○ Difficulty with coordination of the eyes ○ Opacities of the eye ○ Damage to the eye due to injury ○ Damage to eye secondary to other conditions ○ Degenerative changes of the eye ○ Visual loss may be temporary, reversible, progressive, or permanent. Central field of vision Peripheral field of vision Night vision Color vision Binocular vision Blindness Conditions of the Eye and Blindness ○ Refractive Errors Changes in cornea, aqueous humor, lens, or vitreous humor; prevents proper bending of light rays to converge on retina. Types of errors: myopia, hyperopia, astigmatism Presbyopia: associated with aging. ○ Incoordination of the Eyes Result of heredity, disease, damage to brain. ○ Opacities of the Eye Cornea Cataracts ○ Injuries to the Eyes ○ Injury to cornea caused by foreign body Chemical burns Corneal laceration Bleeding into anterior chamber ○ Inflammation and Infections of the Eye Conjunctivitis Uveitis Keratitis  ○ Glaucoma Results in visual field loss. Left unmanaged, permanent damage to the optic nerve can result, causing blindness. Types of glaucoma Primary open-angle Secondary open-angle Primary angle-closure Secondary angle-closure Management Reducing intraocular pressure Medication (eye drops or oral) must be on a lifelong basis. ○ Retinopathy Any condition that affects the retina; named for cause. Most common type and cause of blindness: diabetic retinopathy. ○ Retinal Detachment Sensory layer of retina becomes separated from pigmented layer. Flashes of light or loss of vision. Prompt identification/surgical intervention essential. ○ Retinitis Pigmentosa Hereditary, degenerative condition of retina. Slowly progressive loss of peripheral vision and, in many cases, blindness. ○ Macular Degeneration Degenerative changes in macula; part of eye needed for seeing fine detail and central vision. Occurs after age of 50; no apparent cause. Does not result in complete blindness Identifying Functional Capacity of the Eye and Eye Conditions ○ Comprehensive eye examination ○ Tonometry ○ Gonioscopy ○ Ophthalmoscopic examination ○ Fluorescein angiography Management of Conditions ○ Eyeglasses and contact lenses ○ Refractive surgery Photorefractive keratectomy Laser-assisted in situ keratomileusis Laser epithelial keratomileusis ○ Prosthetic devices and eye replacement ○ Assistive devices and low-vision aids ○ Orientation and mobility training ○ Mobility aids  Functional Implications ○ Partially Sighted Do not fit into the category of either blind or sighted population. Often special needs are overlooked. May attempt to “pass” as a sighted person. Some activities are more restricted. Emphasis on self-care and independence tempered with judgment and concern ○ Severe Vision Loss or Blindness Isolation and social withdrawal. Influenced by degree of loss and age at which individual experiences that loss. Must develop adaptive skills and new abilities. May be dependent on assistance from others. Must orient themselves to home environment. Absence of visual cues can place individuals with visual loss at disadvantage in social setting. General Vocational Issues ○ Degree of vocational impact depends on Nature of employment Type and extent of visual loss Life stage at which visual loss occurs ○ Barriers to employment Deficits in skills or education Lack of work experience Lack of job preparation skill Lack of motivation or information Textbook Notes Chapter 16: Conditions of the Eye and Blindness | Oct. 22 Accommodation: when changes in the shape of the lens permit the eye to focus for near or far vision Adaptation: process when the eye adjusts to varying amounts of light, enabling individuals see in the dark Measuring Vision ○ Visual acuity test Visual acuity: defined as the sharpness of the visual image perceived These tests are used to measure the level of best vision and to measure the need for corrective lenses Snellen test  ○ Visual field testing Visual field: size of area that individuals can see without turning the head or moving the eyes Peripheral vision is measured by a curved divide called a perimeter Central vision is tested with the individual looking at a tangent screen where a test object is systematically moved across the screen Types of Visual Conditions Visual impairment or loss: when any deviation of normal vision exists Visual impairments/loss range from mild visual loss to total loss of vision Conditions that involve the eye are: ○ Refractory errors ○ Difficulty with coordination of the eyes ○ Opacities of the eye ○ Damage to the eye due to injury ○ Damage to the eye secondary to other ○ conditions ○ Degenerative changes of the eye Visual loss may be temporary, reversible, progressive, or permanent. Such a loss may involve any of the following components of vision: ○ Central field of vision Able to see images in the periphery of the visual field but not images in the center. ○ Peripheral field of vision Able to see images in the center of the field of vision but not in the periphery (tunnel vision) ○ Night vision Difficulty seeing at night (night blindness). ○ Color vision Difficulty distinguishing colors, especially red and green Rarely, individuals have complete lack of color vision with associated low visual acuity (achromatopsia). ○ Binocular vision  Difficulty with the coordinated use of both eyes to produce a single image As a result, they may have double vision (diplopia). Conditions of the Eye and Blindness Refractive Errors ○ Most frequent cause for diminished visual acuity ○ Occurs when changes in the cornea, aqueous humor, lens or vitreous humor prevet proper bending of light rays to converge on the retina ○ Types Myopia (nearsightedness) elongation of the eyeball so that light rays focus on a point in front of the retina Hyperopia (farsightedness) Eyeball is shorter than normal so that light rays focus on a point beyond the retina Astigmatism results from irregularity of the shape of the cornea or (at times) the lens so that vision is distorted. Presbyopia Usually associated with aging Gradual loss of accommodation occurs due to loss of elasticity of the lens and weakening of the ciliary muscle Usually remedied with corrective lenses or Lasik Incoordination of the Eyes ○ When both eyes don’t work together to fuse images into a single image ○ Incoordination of the eyes can be the result of heredity, disease, or damage to the brain ○ Nystagmus Eyes move involuntarily even though the gaze is fixed in one direction Congenital or develop later in life ○ Strabismus Misalignment of the two eyes so that the two eyes are not simultaneously oriented The eyes may be crossed, both turning inward (esotropia), or there may be deviation of one or both eyes outward (exotropia) Suppression amblyopia (lazy eye) is a condition in which one eye does not develop good vision, usually because of strabismus Opacities of the Eye ○ Opacities of the Cornea Any condition that causes scarring or clouding of the cornea can cause permanent partial or total loss of vision Cataracts clouding or opacity of the lens of the eye management involves removal of the lens and its replacement with an implant, with glasses, or with both  Injuries to the Eye ○ Most common typ