Final Study Guides: Mind Body Systems 1 Pulmonary Disorders 1. What are the common symptoms of pulmonary disorders? cough with or without mucus many respiratory infections fatigue wheezing trouble catching breath shortness of breath ***because symptoms develop slowly some may not know they are sick 2. What is COPD? What are the common symptoms and principal cause? SMOKING nonsmokers rarely, lack protein alpha-1 antitrypsin exposure to certain gases or fumes in the work place exposure to heavy amounts of second hand smoke and pollution frequent use of cooking fire without proper ventilation 3. How does emphysema affect the lungs and what are some symptoms? destruction of lungs overtime alveoli overstretched and rupture 4. What are the common signs and symptoms of asthma, and what is used to treat it? Difficulty breathing Coughing Tightness in chest Wheezing Low peak flow reading 5. Describe the genetic basis of cystic fibrosis, diagnosis, symptoms Genetically recessive: each parent has to be a carrier and need to get both copies of recessive carrying gene Diagnosis: at birth or by age 2, it’s diagnosed using a sweat test or genetic testing Symptoms: severity of symptoms varies depending on type of mutation very salty tasting skin persistent coughing frequent lung infections including pneumonia and bronchitis wheezing poor growth or weight gain despite having good appetite 6. What is the average life span, and most common cause of death in individuals with CF? Average Life span: Mid 30’s Most Common Cause of Death: frequent respiratory infections 7. What are the treatments used to fight CF?
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Final Study Guides: Mind Body Systems 1Pulmonary Disorders
1. What are the common symptoms of pulmonary disorders?cough with or without mucusmany respiratory infectionsfatiguewheezingtrouble catching breathshortness of breath***because symptoms develop slowly some may not know they are sick
2. What is COPD? What are the common symptoms and principal cause? SMOKINGnonsmokers rarely, lack protein alpha-1 antitrypsinexposure to certain gases or fumes in the work placeexposure to heavy amounts of second hand smoke and pollutionfrequent use of cooking fire without proper ventilation
3. How does emphysema affect the lungs and what are some symptoms?destruction of lungs overtimealveoli overstretched and rupture
4. What are the common signs and symptoms of asthma, and what is used to treat it?Difficulty breathingCoughingTightness in chestWheezing Low peak flow reading
5. Describe the genetic basis of cystic fibrosis, diagnosis, symptomsGenetically recessive: each parent has to be a carrier and need to get both copies of recessive carrying geneDiagnosis: at birth or by age 2, it’s diagnosed using a sweat test or genetic testingSymptoms: severity of symptoms varies depending on type of mutation
very salty tasting skinpersistent coughingfrequent lung infections including pneumonia and bronchitiswheezingpoor growth or weight gain despite having good appetite
6. What is the average life span, and most common cause of death in individuals with CF?Average Life span: Mid 30’sMost Common Cause of Death: frequent respiratory infections
7. What are the treatments used to fight CF?mucus thinnersdifferent antibiotics to slow the growth of germsanti-inflammatory drugs to decrease lung inflammationbronchiodilators
Key Terms Dyspnea: shortness of breath Hemoptysis: spitting or coughing up bloodCyanosis: bluish or purple tint to the skin Alveoli: tinny air flaps in the lungsBronchodilators: medication that dilates the bronchioles to decrease breathing difficulty
Final Study Guides: Mind Body Systems 2Chronic Fatigue and Fibromyalgia
Describe suggested causes and typical symptoms of CFS and Fibromyalgia?CFS
Viral infectionCFS can develop after enduring a viral infection therefore questioning if the virus triggers the disorder
Immune SystemSome people with CFS appear to have an impaired immune system
HormonesAbnormal blood levels of hormones produced in hypothalamus, pituitary gland, and adrenal gland seen in some patients
Hypothalamic-Pituitary Adrenal AxisStress can affect the CNS altering activity of the HPA axis, leading to altered release of corticotrophin-releasing hormone, cortisol, and other hormones
Nutritional DeficiencyMay be associated with poor diet and declining health
FibromyalgiaDon’t know for certain but theories do existFamily history suggests linkage to geneticsInfections- certain illnesses seem to trigger fibromyalgiaPhysical or Emotional Trauma
What are similarities and distinctions between CFS and fibromyalgia?Fibromyalgia is characterized by pain and CFS is not
What is the diagnostic criterion for CFS & Fibromyalgia?CFS
No diagnostic lab test or biomarker“invisible illness”Illness has a pattern of remission and relapseDiagnosis of exclusion
FibromyalgiaWidespread pain lasting at least three monthsNo other underlying condition that might be causing the painBlood tests to rule out other conditionsAge of onset typically ages between ages 29 and 37 (Roy, 2011)
What is the prevalence of CFS & Fibromyalgia in the US? Who is more prone to experiencing them, Men or Women?CFS
4 million people have CFS, 1 million people are diagnosedAll ethnic and racial groups, women are more affected than med
FibromyalgiaOne of the most common chronic pain conditionsEffects an estimated 10 million in the US, 3-6% of the world populationMore prevalent in womenOften seen in families
How can occupational therapy improve quality of life for individuals with CFS & FM?CFS
Pain management and symptom relief!!Early diagnosis and interventionSet up routines and schedules
Final Study Guides: Mind Body Systems 3Healthy dietSleep management techniquesBalancing time between activity, rest, and sleepCreate manageable tasksHelp cope with memory difficulties by using organizers, puzzles, and word games to increase focusStretching and light exercise before bed
FibromyalgiaThe use of certain assistive technology, such as mobility scooters or walking aids to increase independence.The rearrangement of your office workspace to increase comfort.An exercise program specifically tailored to needs and symptoms.The use of mental exercises to increase memory, such as word recalls and crossword puzzles.Learning how to use different coping strategies to deal with emotional stress and physical pain.One-on-one, group, or family therapy sessions to help deal with emotional issues.
Visual ImpairmentsDescribe 20/20 vision, visual acuity and visual field is the definition of low vision, legal blindness, and total blindness?
20/20 is normal vision—you can see at 20 feet what should normally be seen at that distancelow vision is when a person still does not have 20/20 vision even with corrective lensesLegal Blindness—is 20/200 or worse vision in your better eyeTotal Blindness—a condition of total blackness, the person cannot tell the difference between light and dark
What are some signs or symptoms of cortical visual impairments?Cortical Vision impairments are cause by damage to toe visual pathway not the eye itself. it can cause problems with face recognition, depth perception, and visual field loss
Examine visual impairments (macular degeneration, glaucoma, cataract, retinitis pigmentosa and diabetic retinopathy) in relation to eye structure. Which eye structures are involved in each condition?
Macular degenerationMalfunction of the photoreceptor cells in the macula
GlaucomaIncreased fluid pressure in the eye that affects the optic nerve
CataractClouding of the lens
Retinitis pigmentosaDegeneration of the photoreceptors (rods and cones)
Diabetic retinopathyLeaking blood vessels in the retina cause macular edema
How is vision altered in different visual impairments-macular degeneration, glaucoma, cataract, retinitis pigmentosa and diabetic retinopathy? Explain how vision would appear to the client?
Macular degenerationCentral vision loss
GlaucomaLoss of vision from the outside in causes tunnel vision
CataractClouding of the lens so the vision is blurry
Retinitis pigmentosa Donut shaped field loss (tunnel vision)
Diabetic retinopathyHalos in visual field, spots or floaters
Final Study Guides: Mind Body Systems 4Distinguish between Dry and Wet AMD
Wet AMD: abnormal blood vessels behind the retina start to grow, then leak blood and fluid which raises the macula Dry AMD: the blood vessels are not leaking and there are drusen despites that cause the macula to thin and dry out
Discuss the at risk populations in terms of age for various visual impairments?People over the age of 50 are more at risk
Refer OT role, and describe when an OT may work towards remediating/restoring a visual impairment. What is vision enhancement and vision substitution from the standpoint of assistive technology?
Adapt activities and educate about assistive tech available to help those who are visual impaired
Key TermsAcuity: clearness of vision Visual Field: amount that you can see (peripheral vision) Low vision: decreased vision even when using corrective lenses Legal blindness: visual acuity of 20/200 or worse in your better eyeMyopia: nearsightednessHyperopia: farsightednessAstigmatism: abnormal curve in the cornea, causes difficulty seeing fine detailsHemianopia: decreased vision or bindness happens in half the eyeStrabismus: “cross eyes” the eyes do not line up in the same direction so they are focused on different things at the same time Amblyopia: “lazy eye”
Eye structureRetina: Light sensitive layer of tissue at the back of the eyeMacula: Oval shaped pigmented yellow spot near the center of the retinaScleraPupilL opening that allows light to pass into your eye Iris: colored part of the eye that regulates the amount of light entering the eyeRods: photoreceptors responsible for sight in low light (black and white)Cones: photoreceptors responsible for sight in high light (color vision)
Prematurity
1.What is prematurity? What are “premie” and “micropremie”?A birth that occurs at least three weeks before a baby's due date is prematureless than 37 weeks gestationA baby born this early is referred to as a “Preemie”Micro-preemie birth (before 28 weeks gestation)
2.Describe Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA)Small for gestational age (SGA) is a term used to describe a baby who is smaller than the amount a baby typically weighs at her stage of development, Below the 10th percentile for height/weight,SGA babies can be premature, full term, or post term,Main Cause: intrauterine growth restriction (IUGR). Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her developmental stage,An appropriate for gestational age full-term infant is heavier than 2500 grams (about 5.5 lbs.) and lighter than about 4000 grams (about 8.75 lbs.).
Final Study Guides: Mind Body Systems 5
3.List the factors considered in APGAR Score.Blood gas analysisBlood tests to check glucose, calcium, and bilirubin levelsChest x-rayContinuous cardiorespiratory monitoring (monitoring of breathing and heart rate)
4.What are some major risk factors for preterm birth?Health complications because organs may not be fully developed, incubator, tubes for breathing and eating
5.What treatment do mothers receive who are likely to give birth prematurely?Tests- measure length of cervix, fetal fibronectin screening to test fetal protein
6.Describe these complications that premature babies face?Apnea-infants stop breathing during sleep for a few secondsIntraventricular Hemorrhage- bleeding into the brain of the newbornRespiratory Distress Syndrome- extra air in the tissue of the lungsBroncho pulmonary Dysplasia- long term complication
7.How can a mother lower her risk of having a premature baby?40% are unknown causes, don’t drink do drugs or smoke, good education, have children between ages 16 and 34
Key TermsPreeclampsia- hypertension (high blood pressure) during pregnancy and protein in the urinePlacenta Previa- placenta is implanted low in the uterus and blocks the opening to the cervix
Failure to Thrive1. What is failure to thrive? What are the signs and symptoms of FTT?
“Children whose current weight, or rate of weight gain is significantly below that of other children” Signs and Symptoms
Slowed or stopped growth and/or weightDelayed or slowed developmental skillsFeeding difficultiesChange in eating habits or appetiteConstipationExcessive Crying of TirednessIrritabilityAvoiding Eye ContactDisinterest in Surroundings
2. What is the difference between Nonorganic FTT and Organic FTT? What are some of the common causes under each type?
Organic – medical, underlying health problem, inadequate nutrition, feeding difficultiesNonorganic – psychological or social problems, more environmental, emotional deprivation, poverty, exposure to toxins, pregnancy complications, poor caregiver-child relationship
3. What are the 3 main diagnostic criteria for FTT?Weight, height, head circumference
Final Study Guides: Mind Body Systems 6
4. When should a parent/guardian seek help?Abnormal Development, Drop in Weight,Lack of Interest in Food, Major Change in Eating Pattern, Feeding Difficulties
Key TermsGastro esophageal reflex disease- a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach).Celiac disease- disorder of small bowel malabsorptionCystic Fibrosis- is a serious genetic disorder damaging the lungs and pancreas (an organ essential for sugar metabolism)
FAS & FAE
1. How does Fetal Alcohol Syndrome differ from Fetal Alcohol Effects?FAS is “a set of physical, mental, and neurobehavioral birth defects due to maternal consumption of alcohol during pregnancy”FAE is “prenatal exposure to alcohol but do not meet the criteria of FAS ,Lack FAS facial features”
2. Examine the fetal development chart (in your slides or this one:http://www.cerebralpalsychildren.com/CP1.jpg) and indicate the periods of time (marked in red) that teratogen (alcohol) may maximize impairment to key body structures (CNS, limbs, heart, eyes & ears)
3. What are the diagnostic criteria for FAS?Presence of the following: * Confirmed prenatal exposure to alcohol Characteristic facial features- smooth philtrum - thin vermillion border -small palpebral fissures Growth retardation: -pre/postnatal weight and height at or below 10th percentile CNS dysfunction-structural and functional
4. What are the physical, cognitive and behavioral symptoms of FAS?Physical- low birth weight, small head, heart, brain, kidney, liver defects, deformed joints, arms legs and fingersCognition- executive functioning, abstract thinking, memory, attention, poor judgment, poor impulse control, sensory integration, poor impulse controlBehavioral- hyperactivity, attention deficit, impulsivity, stubbornness, anxiety, problems forming freindships
5. List the comorbid conditions associated with FAS.Mental retardation Failure to thrive Learning disabilities ADHD/ADD Cerebral Palsy EpilepsyMusculoskeletal abnormalities Depression
Key termsTeratogen- any substance that can harm a fetusMicrocephaly- small head circumferenceMicrognathia
What figures are considered to be overweight, obese and morbidly obese as per BMI? Overweight- Extra body weight from muscle, bone, fat, and/or water. BMI of 25-29.9%Obesity- High amount of extra body FAT, 20% over normal body weight. BMI of 30-39.9%Morbidly obese- 50-100% over normal body weight, severely impacts health and normal functioning. BMI of 40+
What are strengths of using BMI for diagnosing obesity? BMI= body weight divided by height. Quick, easy, cheap, takes into account teens at different ages
What are limitations of BMI? Doesn’t always account for muscle and water weight, these factors could be viewed as fat in the calculations
Which ethnicities and geographical regions in the United States have highest prevalence rates of obesity? Ethnicities- Hawaiians are much more likely to be obese, African Americans have highest rate followed by Hispanics. Southern U.S. has highest prevalence followed by Midwest then West
What are some of the physiological and environmental risk factors/causes of obesity? Cushing’s syndrome (body gains fat centrally in body, due to excess of hormones), hypothyroidism (underactive thyroid), medications, genes (FTO gene), metabolism (leptin= hormone), fatty/high calorie foods, high fructose diets, lack of exercise
List some common disorders ascribed to obesity. Stroke, heart attack, coronary heart disease, congestive heart failure, hypertension (high blood pressure), respiratory problems, osteoarthritis, cancers, gynecological problems, type 2 diabetes, gallstones, liver and gallbladder disease, sleep apnea
Discuss ways by which OTs can play a role in weight management and obesity prevention.Collaborate with a nutritionist, analyze occupations to create healthy ones for weight management, involve family, lifestyle modifications, monitor food intake and choices,
Terms to rememberHyperplasia- An increase in the number of cells/ proliferation of cells Hyper-plastic obesity- Process in childhood when excessive calories convert into new fat cellsAdipose tissue- body fat
Sensory Modulation DisordersWhat is SMD? What broader classification does SMD fall under?
SMD is a subtype of sensory processing disorder (a condition where sensory signals don’t get organized correctly). SMD: A problem regulating responses to sensory inputs which results in withdrawal or strong negative responses to sensations that don’t bother most people
Prevalence- What conditions are Sensory Modulation Disorders associated with? Does it exist only with preexisting conditions? Are boys more prone to having it than girls?
Austism Spectrum disorders, ADHD/ADD, fragile X, speech disorders, learning disabilities, CP, Tourette’s, MS, behavior disorders, depression/anxiety, FAS, auditory and visual impairments, epilepsyIt does not have to exist with another condition
How is SMD diagnosed? Screening, clinical observations, client history, checklists, standardized testing- looking for responses that person is overreactive, underreactive, sensory seeking, or all of these
What does it mean to be hyperresponsive? Hyporesponsive?Hyperresponsive/hypersensitivity- Most common. Experience sensory input as faster, more intense, longer. Overreaction to sensory stimuli= higher anxiety or avoidance
Final Study Guides: Mind Body Systems 8Hyporesponsive/hyposensitive- Low registration of stimuli. May be clumsy, apathetic, withdrawn, inattentive, sluggish
What are some common examples of how hyper modulation and hypo modulation sensory disorders of Touch, Smell, Sound, & Movement (vestibular, kinesthetic and proprioception) sensations become evident in children?
TOUCH: Hyper- React negatively to light touch or possibility of touch, overreact to pain, avoid certain textures, dislike of water, avoiding messy play, avoid walking on certain textures. Hypo- Hurt people or pets, don’t realize if they drop something, show little reaction to pain, unaware of touch, unable to perform fine motor tasks, difficulty holding and writingPROPRIOCEPTION: Hyper- Don’t know where body parts are, trouble placing body parts to get dressed, withdrawn from movement experiences, avoid putting weight onto joints when standing, complain about lifting heavy objects. Hypo- Deliberately bump into things (sensory seeking), stamp or slap feet when walking, rub hands on table, crack knuckles, enjoy being wrapped in a blanket, chew constantly on objects, press hard when writing, often break things because handle objects forcefullyAUDITORY- Hyper- Oversensitivity to sounds, overly emotional when hearing loud noises, cover ears often, scream or talk loudly to compete with the noise, fail to listen/pay attention, fail to follow through requests, confused where sounds come from. Hypo- Enjoy loud places, like making loud noises, talk excessively, like to sing/dance to musicVESTIBULAR: Hyper- Dislike playground activities (swinging, spinning, sliding), cautious/slow movers, uncomfortable in elevators/moving transportation, carsick easily, nauseous easily, lose balance. Hypo- Need to keep moving, repeatedly and vigorously shake head, rock back and forth, jump up and down, “thrill seekers”, don’t get dizzyDoes not include examples of smell or kinesthetic.
What are some specific calming and arousal techniques? Deep breathing, muscle relaxation, yoga, deep pressure, therapeutic activities (swinging, finger painting, ball pit, trampoline, dancing, jogging)
Give some examples of possible adverse stimuli in a child’s day. See question 5
Discuss two ways in which SMD can be assessed? Sensory profile and sensory diet
What is meant by sensory profile and sensory diet? Sensory diet= routine incorporation of key sensory info throughout day, controls exposure to specific sensations, adaptations
Sensory profile= 125 questionnaire, measures child’s responses to various sensory input experiences, child must be 3-10 years old, grouped by sensory processing, modulation, behavioral, emotional responses
Outline some basic goals of sensory integrationGives opportunities for child to engage with environment in a manner that will give an adaptive response, proprioceptive, tactile, vestibular, opportunities
Key TermsHypersensitive: Sensory input is faster, more intense, longer duration than typically. Overreaction of
sensory stimuliHyposensitive: Lack of response to normal stimuli. Clumsy, apathetic, withdrawn, inattentive, sluggishAdaptive Response
Down Syndrome
Final Study Guides: Mind Body Systems 9Describe the genetic causes of Down Syndrome and the three types of Down Syndrome as determined by abnormal cell divisions.
Extra copy of chromosome 21. Abnormal cell division. Trisomy 21- 95% , has 3 copies of chromosome 21 in all of his/her cells. Abnormal cell division during the development of the fathers sperm cell or mothers egg cell, the additional genetic material alters the course of development and causes the characteristics Mosaic Down syndrome- 4% cell division in early fetal developmentTranslocation Down Syndrome- 1% can be inherited
What are the three diagnostic tests used during pregnancy? How is Down Syndrome diagnosed after birth?Amniocentesis Chorionic villus samplingPercutaneous umbilical blood sampling Diagnosed for new born- chromosomal karyotype – administered based on physical appearance of baby
What increases the risk of having a child with Down Syndrome?Maternal age- chance of have baby with downs increases with age, having a previous child with downs, being carries of the genetic translocation- men and women
What screening techniques are used during pregnancy?First trimester combined test – ultra sound, blood testsFull integrated testing, done in 2 parts over first 2 trimesters of pregnancy- first trimester- ultrasound and blood test second trimester- screening done at 15-20 weeks quad screening
Explain the new testing and possible implicationspreimplantation genetic disorder- may become available for couples undergoing in vitro fertilization, testing embryo for genetic abnormalities before its implanted in the womb analysis of circulating fetal DNA- evaluate fetal DNA in circulating in mothers blood, prenatal diagnosis and prevention of chromosomal abnormalities
What physical features are characteristic or DS?Broad, flat face with an upward slant eyes, short neck, protruding tongue, deep crease in palm of hand, small hands and feet, poor muscle tone, special skin ridge patterns
What health concerns are associated with Down Syndrome?Thyroid problems, early menopause, seizures, hearing loss, premature aging, skeletal problem, poor vision, celiac disease, heart defects, leukemia, infectious disease, dementia, sleep apnea, obesity, gastrointestinal blockage
Explain risks of hypermobility and atlantoaxial instabilityhypermobile joints, or joints that easily surpass normal ROM are common in individuals with down syndrome. Flexion and extension beyond what is considered normal due to loose or weak ligaments, flat feet tend to accompany hypermobility, puts individuals at risk for dislocation, arthritis, sprains and strains atlantoaxial- increased mobility between C1 and C2- often discovered when subluxation or dislocation occur, asymptomaitic AAI-usually discovered by xray, symptomatic aai- fatigue, walking difficulties; torticollis (head tilt) clumsy and incoordinated movement, limited neck mobility, hyperreflexia, sensory defecits. Cause contradictions for sports participation
What sensory issues are seen in DS?
Final Study Guides: Mind Body Systems 10Tactile issues- hypersentivie to touch/not adequately sensitive, perception differences with pain and temperature, visual deficits- vision problems, convergence difficulties, difficulty with eye contact and central vision, hearing problems
What behavioral difficulties are seen in individuals with Down Syndrome?Individuals with Down Syndrome often exhibit behavioral problems such as...Obstinant temperments, Attention problems, Non-compliance, stubborn nature, Later in life more apt to develop depression, anxiety and withdraw socially
Behavioral difficulties are oftentimes attributed toSleep disturbances Illness, Response of others can lead to worsening of behavior
Explain strengths in social interactionsempathy, social understanding, many social cues are non verbal so speech delays do not necessarily delay social understanding. Speech and cognitive functioning may affect ability to develop and maintain friendships, important to work towards age appropriate social behaviors to enable positive interactions with peers, in school and in the community
Why is IQ not a good determining factor for outcomes of individuals with Down Syndrome?IQ scores do not take verbal, social, or behavioral skills into consideration or show if individuals can use public transportation, communicate with peers, or function independently
What is the OT role across the lifespan with this population?Infancy to toddler Phase
Facilitate development of gross motor milestones [Use play as the medium]Facilitate tone, joint stability and strength Train parents in positioning and safe handling of the infant (focus on neck stability)Evaluate and treat sensory modulation disordersEducate parents about feedingConsider precautions- joint instability, cardiac complications and seizure disorders
Childhood to adolescenceEncourage learning through play and exploratory activitiesProvide sensory motor training on ADL activitiesIncrease ability to initiate and explore new activities- Sports, social groups, computer gaming….Provide instructions in a concrete format
AdultTraining in social skills (relevant to work demands)Job placements and supportive employment
ALSWhat is ALS? What neurons are affected and where in the central nervous system?
A motor neuron disease: nerve cells located in the brain, brainstem, and spinal cord that control units and vital communication links between the nervous system and the voluntary muscles (Messages from the neurons in the brain-UMN- are transmitted to neurons in the spinal cord-LMN-then to particular muscles) ALS (Lou Gehrig’s Disease) is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement. These motor neurons die, and muscles gradually become paralyzed
What is the difference between Sporadic and familial ALS?Sporadic: randomly overtakes a person by unknown reasons (90%)-Most commonFamilial: result from a specific gene defect that leads to mutation of the enzyme known as superoxide dismutase (SOD1)
Final Study Guides: Mind Body Systems 11Usually results from a pattern of inheritance that requires only one parent to carry the gene responsible for the disease (About 5-10% of cases are inherited)
What are the early signs of ALS? Where do the weakness first appear? Is there a pattern to the weakness?Muscles may be weak and soft, or stiff, tight and spasticMuscle cramping and twitching (fasiculations) occurLoss of muscle bulk (atrophy)May experience: fatigue, poor balance, slurred words, a weak grip, and tripping when walkingweakness fist appears in limbs (usually in LE first)No consistent pattern (“selective weakness”)
How do the signs and symptoms vary depending on the type of ALS?Bulbar onset: motor neurons in the brain stem are affected first: symptoms start in the face, mouth, throat, and tongueLimb onset (more common): motor neurons in the spinal cord are affected first, then symptoms start in the limbs-arms, legs, hands, or feetLimb onset tend to live longerIn all types of onset: will eventually spread to other areas of the body
Is the person’s cognition, intellectual capacity and language (not speech) affected in ALS?Usually does not impair a person’s mind or intelligence. Although in some patients they have alternations in cognitive functions such as depression, problems with memory or decision-making
Demographics- About how many people in the US get diagnosed with ALS every year? Men vs Women? When is the typical age of onset?
Affects approximately 5 out of 100,000 people wordwide (idk about US)More common in men than womenAverage age of onset is 50 years old
What are some common complications associated with ALS?Muscles become paralyzed (unused muscles may cause contractures)Inability to speak in late stages (Dysarthria)Inability to break or swallow on own in late stages (Dysphagia)-need ventilators and gastrostomyChoking
Describe the course, prognosis and stages of ALS [Refer OT role]. What consideration must be given by an OT while recommending assistive technology and home modifications for a client with ALS?
Stage 1 (mild weakness, clumsiness, ambulatory, independent in all ALS)Continue or increase activitiesConserve energyMaintain ROM and strength to prevent muscle atrophy
Stage 2 (moderate “selective” weakness, increasing fatigue, decreased independence)Simplify and pace activitiesPrevent contracturesCautious strengtheningOrthosis and splinting-Provide ADL adaptations
Stage 3 (severe selective weakness, signs of dysarthria, decrease independence)Consider extensive home and workplace modificationConsider hi-tech power wheelchair and communication deviceBreathing exercises
Final Study Guides: Mind Body Systems 12Stage 4 (severe LE weakness, “hanging arm syndrome”-pain in shoulder and edema in hand, WC dependent, can perform some ADLS)
Consider technologies for environmental control and computer accessExtensive ADL adaptationsPAMs to control pain and edema
Stage 5 (severe LE weakness and moderate UE weakness, risk of skin breakdown, severe dysarthria and dysphagia)
Passive and active assisted ROMExtensive modifications to PWC-Respirator, cushion and single switch controllerAdjustable bedCaregiver trainingDiet and feeding inerventions
Stage 6 (Severe weakness to paralysis, confined to bed, completely dependent in ADLs and position)Passive ROM to maintain joint integrity and prevent contracturesMay require feeding tube or dietary intervention
KeywordsPalsy-paralysis of a body part (often accompanied by loss of sensation and by uncontrolled body movements)Bulbar-pertaining to or involving the medulla oblongata (impairment of function of the cranial nerves, due to a LMN lesion)Amyotrophic-progressive wasting of muscle tissueAnterior horn cell-(spinal cord)-ventral (front) grey matter section of the spinal cord which contrains motor neurons that affect the axial muscles ???Fasciculation- “muscle twitch”-small, local, involuntary muscle contraction and relaxation visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers
CARDIOVASCULAR
What do you understand by coronary artery disease?Narrowing of the lumen of one or more of the coronary arteries, usually due to atherosclerosis; myocardial ischemia; can cause congestive heart failure, angina pectoris, or myocardial infarction.
What is atherosclerosis? When does it begin and how does it progress?Irregularly distributed lipid deposits in the intima of large and medium arteries; such deposits provoke fibrosis and calcification. The fatty deposit become calcified into thick plaques due to inflammatory mediation. Low density lipid molecules increases this inflammatory mediation
What are the signs of atherosclerosis in the early stages? What is the sign later when 75% of the coronary arteries have narrowed?
Virtually no signs until late stages, at 75%, angina pectoris which is short lasting pain/discomfort in the chest wall, across neck left shoulder and ulnar border of arms and hands.
What are the contributing factors of atherosclerosis? List the modifiable, manageable and non-modifiable risk factorsModifiable: lifestyle, smoking, diet, lack of exercise, alcohol. Managable: predisposing factors, cholesterol, triglycerides, diabetes, hypertension, stress, obesity. Non modifiable: Gender, aging, race, family history.
What is HDL and LDL cholesterol? What should be their ideal ratio to total cholesterol?
Describe the pathology and signs of Angina Pectoris?Myocardial Ischemia: Temporary interruption of blood supply to the heart tissue. Imbalance between cardiac output and oxygen supply to heart tissue. Triggers- Exertion, stress, cold exposure, after meals
Final Study Guides: Mind Body Systems 13What is myocardial infarction and how does it progress from being an Angina Pectoris in terms of pathology?
MI (heart/coronary attack) is the development of ischemia and necrosis of myocardial tissue. Ischemia causes necrosis of myocardium. Typically on the left side (left coronary artery). Myocardium heals with scarring in 6 to 8 weeks. Scarred tissue fails to function optimally
What are the warning signs of an MI? Compare them to Angina Pectoris?Persistent crushing chest pain (30 mins to hours) can radiate to neck, left UE, upper abdomen, and between scapulas. Accompanying signs, pallor, dyspnea, disphoresis, nausea. 25% of MIs have no acute signs.
What is Cardiac Arrhythmias?abnormal heart rhythms
What is Congestive Heart Failure (CHF) and what are the risk factors?the inability of the heart to supply adequate blood throughout the body, defined by failure of left side.
Describe the pathological events leading to a CHF and its progression to a right sided failure? Include signsrisk factors are coronary heart disease including MI, hypertension, smoking, obesity, diabetes, valvular diseases.
What is MET level?Energy costs as measured by oxygen intakeClass 1: with no symptoms up to 7 can be performed.Class 2: met level 5Class 3: comfortable at rest, 2 metsClass 4: persistent symptoms even at rest, less than 2 mets
List the AHA functional classification for CVDsClass I. “Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity (not more than ≤ 7.0 METS) does not cause undue fatigue, palpitation, dyspnea or anginal pain”Class II. “Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity (≤ 5.0 METS) results in fatigue, palpitation, dyspnea or anginal pain”Class III. “Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity (≤ 2.0 METS) causes fatigue, palpitation, dyspnea or anginal pain”Class IV. “Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity (≥ 2.0 METS) is undertaken, discomfort increases”
Describe the role of OT in each phase of cardiac rehabilitation.Phase 1 (inpatient): patient education, risks, energy costs and conservation, improve activity tolerance, AROMS, light intensity ADLs, home programPhase 2: (outpatient): Education, risk management and life style changes, improve activity tolerance, work, IADLs, leisure, graded exercise programPhase 3 (community integration): community based health programs
Key TermsArthrosclerosis: A disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.Angina Pectoris: a heart condition marked by paroxysms of chest pain due to reduced oxygen to the heart.Ischemia: an inadequate blood supply to an organ or part of the body, esp. the heart muscles.Hypoxia: Deficiency in the amount of oxygen reaching the tissuesNecrosis: The death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.Beta-Blockers: any of a class of drugs that prevent the stimulation of the adrenergic receptors responsible for increased cardiac action
Final Study Guides: Mind Body Systems 14Angiotensins: any of several vasoconstrictor substances (trade name Hypertensin) that cause narrowing of blood vessels.Arrythmia: condition in which the heart beats with an irregular or abnormal rhythmMET: the resting volume oxygen consumption per minute
Spina Bifida
What is spina bifida?“Split spine”-Congenital birth defect Abnormal central nervous system development Neural tube defect (develops inot baby’s brain and spinal cord) Failure of the fetus’s spine develop or to close during embryonic development Usually in the lumbar or sacral region on the spine
At what stage of neuro development does the neural tube close?28 days (about a month) of gestation
What are the three types of spina bifida? What is the severity of each? And what is the pathophysiology involved in each?
Occulta (mildest form)Small separation or gap in 1 or more vertebraeSpinal nerves not involvedRarely causes disability or symptomsOther indication can be found on a newborn’s skin (abnormal tuft of hair, collection of fat, small dimple, skin discoloration)
Meningocele (rare form)Protective membrane (meninges) push out through defect in vertebrae column, which then forms a CSF filled sacSpinal cord remains intactUsually there is little or no damage to nervesAfter birth, corrective surgery is done to close spot
Myelomeningocele (most severe)Meningeal membrane and spinal cord protrude from back, forming a sac (tissue, CSF, nerves, and spinal cord)Usually damage to spinal cord (Partial or complete motor paralysis*, loss of sensation*, bowel/bladder problems, seizures)Amount of disability depends on the amount of nerve damage
What are the signs and symptoms of spina bifida?Loss of bladder/bowel control Decreased or lack of sensationDecreased or lack of paralysis of the legs Weakness of the hips, legs, or feet of newbornDimpling of sacral area Hydocephalus
What is a known nutritional supplement that can prevent spina bifida?Maternal nutrition during pregnancy (Folic acid)
What prenatal and postnatal tests are used to diagnose spina bifida?Prenatal screening:
AFP (alpha fetoprotein)Triple Test (maternal blood screening looks for AFP HCG-hormone produced within the placenta, and estrial-estrogen produced by fetus and mother): Non invasiveAmniocentesis
Final Study Guides: Mind Body Systems 15Post-natal screening
XraysMRICT scan
What are the 4 signs of Hydrocephalus?Health care provider test: when provider taps fingertips on the skull, there may be abnormal sounds that indicated thinning and separation of skull bones. Scalp veins may appear stretched or enlarged Enlargement of the head (part or the entire head. Most commonly seen in the front part of the head. Head circumference measurements may get larger)“Setting-sun eyes”-eyes may look “sunken in.” The white part of the eye may appear above the colored part of the eye, given the eyes a “setting-sun” appearanceCT scan (one of the best tests for identifying)
What complications arise from hydrocephalus and shunt placement?Shunt placements:Can get blocked up or breakMost common sign of a shunt problem is headachesLess common are: seizures, significant change in intellect (school performance or personality), back pain at the closure site, worsening arm or leg function, increasing scoliosis, worsening speech or swallowing difficulties, changes in bowel/bladder functionShunt infections (5-10% of ppl)—Signs of infection: fever, neck stiffness, pain, tenderness, redness…
What is the OT role?
Key TermsNeural TubeHydrocephalus-“water in the brain”, build up of CSF around the brain (can be confused with Arnold-Chiari). In infants, CSF fluid builds up in the CNS, causing the fontanelle (soft spot) to bulge and the head to be large than expectedArnold Chiari Malformation-structural defects in the cerebellum. When the indented bony space at the lower rear of the skull is smaller than normal, the cerebellum and brainstem can be pushed downward. Resulting pressure can block the flow of CSF and cause a range of symptoms including dizziness, muscle weakness, numbness, problems with balance and coordination…
Mental Retardation/Intellectual Disability
What are the genetic/environmental risk factors of MR/ID?Causes are classified according to time of onset (prenatal, perinatal, postnatal), or by their origin (biomedical or environmental)Causes can be linked to genetics, the environment, growth deprivation, as well as sensory and motor deprivationGene disorders:
Autosomal Dominant, Autosomal Recessive, Sex LinkedChromosomal Aberations:Missing or extra chromosomesAutosomes and sex chromosomes are affectedMost common: tisomy 21, 18, 13
Environmental influences:Prenatal: Maternal infection, low birth weight, maternal substance abuse, lack of prenatal care/nutrition, exposure to industrial chemicals or drugs (particularly in the first trimester)Perinatal: Mechanical injuries at birth, perinatal hypoxia, active herpes simplex II
Final Study Guides: Mind Body Systems 16Postnatal: Traumas or infections that result in injury or lack of oxygen supply to the brain, sociodemographic characteristics
What two primary aspects are evaluated when diagnosing an intellectual disability?Standardized intelligence tests-IQ testsAssessment of adaptive behavior (collection of conceptual, social, and practical skills that people have learned so they can function in their everyday lives)
What domains of adaptive behavior are assessed when using the VARS scale?Communication Daily living skillsSocialization Motor skills
How is an individual's intellectual functioning measured?By standardized intelligence quotient (IQ) scores through standardized testing (Disability-score of approximately 70 or 75 or below)
Is an unknown cause more common in mild or severe cases of intellectual disability?Severe2/3 of kids with severe have additional neurological disordersThose with mild, were found to have less than 20% to have an additional neurological diagnosis
How does DSM-IV classify mental retardation?Classified according to the severity of the impairment in intellectual functioningAAMR defines MR as condition that is present in childhood, with an IQ below 70-75 in two or more adaptive skills areasStandardized testing-two standard deviation units below meanIQ tests identify the levels of MR as mild (85%), moderate (10%), severe (3.5%), and profound (1.5%) range of function
Is mental retardation progressive or nonprogressive?Nonprogressive
What are the four categories of mental retardation as per IQ? Focus on what each level means for functioning across the lifespan.
MildIQ range (50/55-70/75)Identified in elementary schoolCan take care of their BADLs themselves-for more complex many need reminders (may need assistance when unusual social or economic stress)Able to take care of homeCan hold a simple job-employmentAble to function within their communities, just a “slower” rate
ModerateIQ range (35/40-50/55)Identified in early childhood (show difficulty within home, school, and community settings)Independent functioning (feeds, dresses, grooms, prepares simple meals…)Carries on simple conversations, use complex sentencesMay do simple routine household choresMay function in supported employment Can learn some functioning living skills-shopping, laundry, post office…
Severe
Final Study Guides: Mind Body Systems 17IQ range (20/25-35/40)Identified in early childhood (limited cognitive functioning, slower rate or learning and development)Can contribute partially to self-care with total supervisionCommunicationMay prepare simple foodsCan help with simple household tasks but requires much supervision (bed making, setting table…)
ProfoundIQ range (less than 20/25)Identified in infancy (very limited cognitive functioning)Requires total supervisionDependent upon others for personal careVery minimal languageMinimal participation
Describe the role of OT with IDClassification of ID from an OT standpoint:Intermittent: Does not require constant supportLimited: Requires ongoing support of varying intensityExtensive: Requires daily and ongoing consistent levels of supportPervasive: Requires an ongoing high level of support for all day-to-day activitiesWork with family or school or workplace to:Help develop play skillsPromote pre-academic readiness and learning skillsFacilitate sensory awareness and processingIncrease ability to follow directionsBuilding social skills
Epilepsy
Distinguish between epilepsy and seizures.Epilepsy
“A chronic neurological condition characterized by recurrent episodes of seizures of varying severity” Also known as a seizure disorder Epilepsy is the diagnosis and seizures are what manifest
SeizuresSeizure is a sudden surge of electrical activity in the brain that affects how a person feels or acts for a short period of time Some seizures can hardly be noticed, whereas others cause a brief loss of consciousnessAn episode
What percent of the American population experience a seizure in their lifetime?2 in 100 people in the U.S. will experience a seizure once in life.
Which conditions put people at highest risk for seizures?Common during early childhood and after age 65 Gender- Slightly more common in men. Family history Brain infections- meningitis Prolonged seizures in childhood- High fevers Head injuries Stroke and other vascular diseases
What triggers may cause a seizure?Some people who have epilepsy have no special seizure triggers, while others are able to recognize things in their lives that do affect their seizures.
Final Study Guides: Mind Body Systems 18Photosensitve epilepsy- when exposure to flashing lights at certain intensities or to certain visual patterns triggers seizures (3% people with epilepsy)
Triggered by exposure to television screens due to the flicker or rolling images, to computer monitors, to certain video games or TV broadcasts containing rapid flashes or alternating patterns of different colors, and to intense strobe lights like visual fire alarms. Also, seizures may be triggered by natural light, such as sunlight, especially when shimmering off water, flickering through trees or through the slats of Venetian blinds.
Certain visual patterns, especially stripes of contrasting colors, may also cause seizures. People have wondered whether flashing lights on the outside top of buses or emergency vehicles may trigger seizures in people with photosensitive epilepsy.
What are the two basic types of seizures: Localized and Generalized?Focal/partial seizures- When seizures appear to result from abnormal activity in just one part of the brain. These seizures fall into two categories. (They may or may not spread to other parts; 60% of people with epilepsy) Focal seizures are often described by the area of the brain in which they originate. For example, temporal lobe epilepsy, or TLE, begins in the temporal lobes located on either side of the brain. Generalized seizures are divided according to the effect on the body, but all involve loss of consciousness
Explain the sub-types under localized (simple partial and complex partial) and generalized seizures (petit mal, myotonic, atonic, tonic, clonic and tonic-clonic) How do they manifest during an episode? Emphasize Tonic-clonic (grandmal) seizure.
Simple focal/partial seizures- don’t result in loss of consciousness but exhibit involuntary movements and sensory symptoms Complex focal/partial seizures- alter consciousness or awareness, result in staring and nonpurposeful movementsGeneralized seizures- Seizures that seem to involve all of the brain Six types:
Absence seizures (also called petit mal). These seizures are characterized by staring and subtle body movement, and can cause a brief loss of awareness.Tonic seizures. These seizures cause stiffening of the muscles, generally those in your back, arms and legs and may cause you to fall to the ground.Clonic seizures. These types of seizures are associated with rhythmic, jerking muscle contractions, usually affecting the arms, neck and face.Myoclonic seizures. These seizures usually appear as sudden brief jerks or twitches of your arms and legs.Atonic seizures. Also known as drop attacks, these seizures cause you to lose normal muscle tone and suddenly collapse or fall down.Tonic-clonic seizures (also called grand mal). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. Most common and severe
Explain the phases of a generalized (grand-mal) seizure: Aura, tonic-clonic, ictus, & post-ictus. How long does each phase last?Aura
Dogs can feel energy before a seizure Strange sensationsTingling of face Smelling an odor Emotional changes
Ictus Actual seizure
Post ictus
Final Study Guides: Mind Body Systems 19Recovery rest and sleepTakes the longest
What is status epilepticus? At what point does a seizure become status epilepticus?Status epilepticus- prolonged or clustered seizures sometimes develop into non-stop seizures; medical emergency
When would you as an OT seek emergency care for a seizure episode?First known seizureSeizure happened in waterSeizure does not stopSeizure stops and starts againFails to breathe Resulted in secondary injuries
What first aid measures should an OT perform at the event of a seizure?Remain calm and reassure others Clear the area around and prevent injuriesPlace some padding/cushion under the head Time the episodeDon’t restrain the seizure Loosen clothes around neckRotate head to the side Do not try to force the mouth openStay with the client until the end and consciousness is regainedAllow rest and sleep as necessary
KeywordsEpilepsy: a disorder of the nervous system, characterized either by mild, episodic loss of attention or sleepiness (petit mal) or by severe convulsions with loss of consciousness (grand mal). Seizures: a sudden attack, as of epilepsy or some other disease. Convulsion: contortion of the body caused by violent, involuntary muscular contractions of the extremities, trunk, and head. Aura: a sensation, as of lights or a current of warm or cold air, preceding an attack of migraine or epilepsy.Ictus: the actual seizurePost Ictus: s the altered state of consciousness that a person enters after experiencing a seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine and other disorienting symptomsInfantile Spasm: infantile spasms (also called West syndrome because it was first described by Dr. William James West, in the 1840s) consist of a sudden jerk followed by stiffening
FracturesWhat are some symptoms of peripheral nerve damage?
Numbness, prickling sensation (paresthesia), sensitivity to touch or muscle weakness, burning, muscle wasting, paralysis
Describe the three nerve injury classifications and the outlook for recovery under each.Neuropriaxia- temporary loss of motor and sensory function do to nerve compression from imflammation. Nerve is NOT severed Axonotmesis: sever of the myelin covering of the axon but the connective tissue framework of the nerve is still intact. Caused by a crush or stretching of the nerve. Damage can be repaired- wallerian degeneration occurs after this Neurotmesis: most sever but has potential for recovery. Caused by severe contusion, stretching and laceration to axon but not to the connective tissue. Results ins loss of motor and sensory functions
Final Study Guides: Mind Body Systems 20Which key muscles of hand are affected by injury to these nerves- Median, Ulnar & Radial? [You can also use your human movement lab manual as a reference]
thenar imminence, adduction pollicus is ulnar nerve, finger flexors, lumbricals, muscles of wrist flexors and nerve and wrist and finger extensors
Deformities associated with nerve injuriesClaw hand deformity- Injury to median and ulnar nerve causing weakness of intrinsic (lumbrical) muscles Ape hand deformity- Injury to median nerve causing weakness and atrophy of thenar muscles
Describe the classification of Fractures: Simple Vs Compound; and Complete Vs Incompletecomplete: a bone break that completely severs the bone across its widthincomplete: a fracture in which the bone fragments are still partially joinedcompound (open) a fracture where the bone breaks through the skil closed (simple)- a fracture that has not broken through the skin
Describe and compare some common types of fractures in terms of the pattern and complexity of breakage of the boneGreenstick ( bone bends and cracks, but does not completely break)Oblique( break has curved or sloped pattern)Spiral(bone is twisted and breaks in a circular pattern)Comminuted (bone breaks into several pieces) ** MOST SEVERETransverse (break is at a right angle to bones axis)
What fractures are most common in adults and what are most common among the old? Distinguish between Collies and Smith’s fracture:
RADIAL FRACCTURES(break between elbow and wrist) are the most UE fracture or scaphoid fracture (broken wrist)Collies fracture is a fracture of the distal radius in forearm caused by falling on wrist while extendedSmiths fracture: fracture of the distal radius of forearm cuased by falling on wrist while flexed. Old people= hip fractures most common fracture (80% women)
What is the role of OT in UE fractures- Immobilization and Mobilization phases?Immobilization Phase (Post surgery-3 to 5 weeks)
Immobilized in functional position in cast Encourage mobility of uninvolved distal jointsPositioning to prevent edema
Mobilization PhasePromote use of injured hand in functional activitiesPrevent stiffness and tendon adhesionsStatic and dynamic splintingStrengthening and ROM
Amputations
Briefly describe some of the non-traumatic predisposing conditions leading to amputations. Why is diabetic foot one of the leading causes for amputation?
Frostbite, skin and underlying layers freeze due to prolonged exposure to extreme cold temperaturesPeripheral artery disease, plaque build up in arteries that deliver blood to extremities, decreased blood flow causes nerve damageGangrene, results from necrosis, or tissue death, can cause deathOsteomyelitis, infection of bone, carried through blood stream, leaves bone ends open to more germs
Final Study Guides: Mind Body Systems 21Diabetic Foot, open sores and ulcers (* most common b/c people don’t check the bottoms of their feet a lot, so it goes unnoticed for a while until the point it’s too late)
What are the types of traumatic amputations? Describe them.Common Causes of trauma based amputations
Factory, farm, power tool accidents, motor vehicle accidents, natural disasters, war*, terrorist attacks
Illustrate various levels of amputations in UE Forequarter amputation (at top of shoulder by neck)Transhumeral (above elbow) Transradial (below elbow) Shoulder disarticulation (at shoulder) Wrist disarticulation
Discuss phantom limb sensation and pain, and neuromaphantom limb is the sensation that an amputated limb is still intact. The brain assumes the limb is still there, and will commonly send signals of pain and discomfort to the limb that has been amputated
Outline OT role with clients undergoing amputationspre prosthetic phase : improve psychosocial adjustment and body image, promote stump management, increase upper body and proximal muscle strength prosthetic phase: education and training in use of prosthesis
Key TermsEcchymosis- bruise larger than 1 centimeter located in skin or in a mucous membrane- forms in stage 1 of the fracture healing processCalcification-is the process in which calcium salts build up in soft tissue, causing them to harden.Callus- toughened area of skin in which the skin becomes relatively thick and hard in response to frictionOsteomyelitis- infection of bone or bone marrowPeripheral neuropathy- damage to nerves of peripheral nerves Neuroma- Neuro= nerve/ oma= swellingNeuroma is a growth or tumor of nerve tissue- the nerves grow up until they’re right underneath the skin, open nerve is extremely painful complication after amputation
Repetitive Trauma Disorders
Explain the sequence of events that cause soft tissue damage in RTDs?repetitive micro trauma (uninterrupted motions), natural healing0inflammation, fribroa plasia and remodeling, lack of rest-continuation of micro trauma (causing tendonitis), Prolonged chronic inflammation—thickening of soft tissued. Compression, impingement of adjoining soft tissues, including nerves.
What are common signs and symptoms of repetitive trauma disorders?General, mild aching sensation, pain on movement, numbness, tingling (parathesia), visible swelling or redness, loss of dexterity, loss of grip strength, loss of movement.
What are common risk factors of RTD’s?repetitive motions, motions using force or friction (pulling, pushing, gripping, lifting), awkward and unnatural posture and body position, holding same body position without moving or resting for long periods, mechanical compressions against soft tissue, vibrations, mentals stress, not enough recovery time.
What is the prevalence of common RTD’s in the work force?
Final Study Guides: Mind Body Systems 22seen commonly in data entry workers, automobild workers, meat packers, rock drillers, dentists and hygienists, musicians, grocers store workers, skilled nursing staff, saw mill workers, carpet installers, luggage movers at airports, athletes
Distinguish the differences in motor and sensory involvement in Median, Ulnar and Radial nerve damage- Which movements are affected with each nerve? How is the sensory distribution lost with involvement of each nerve? (Also refer your MMT book from Human Movement)
radial nerve: sustained extension in wrist and elbow. Associated with racquet sports like tennis and badminton or constant computer keyboard/mouse use. Pain in turning a door knob, steering a car, shaking hands or picking up a cup.Ulnar nerve: runs between medial epicondyle and olceranon process. flexion of wrist and elbow, ulnar deviation, small muscles of the hand. Weakness while pinching or grasping, pulling reaching lifting. 4th and 5th digitsmedian nerve: flexion of wrist and elbow, thumb, 2nd 3rd half of 4th digit, thenar eminence, difficulty with grasp and pinch, loss of hot and cold sensations
Examine these common U/E RTDs- Tennis & Golfer’s elbow, Carpal Tunnel & Cubital Tunnel Syndrome, Rotator cuff injury & Dequervein’m s Tenosynovitis by their anatomical location, common work or occupational causes, signs and symptoms, involved soft tissues and nerves. [Note- Try to physically analyze which movements and activities may be contributing to them]
Tennis elbow: radial nerve, extensor muscles, raquet sports, butcher, construction worker, plumber, cook, constant computer use. Dull pain on lateral side of elbow, elbow tenderness, sight edema, weak grasp, pain increases with activities like turing door knob. Golfers elbow, flexor muscles, median and ulnar nerve, sustained contraction of wrist and elbow flexors. Shoveling, gardening, using hand tools, chopping wood, swimming, golf, baseball, javelin, archery. Tenderness on medial aspect of elbow, inflammation, compression—parasthesis in 4th and 5th digits, pain during pronation, pain throughout forearm, pain worsens with wrist flexion.Carpal tunnel: compression of median nerve, thenar eminence, burning tingling and numbness or wrist palms and surface of hands in thumb index and middle fingers, feel swollen, worse at night, general weakness over time, difficulty with grasp or pinch. Typing, grocery store checkers, violinists, carpenters, golfing, knitting, gardening, bricking, sewting, cutting.Cubital tunnel: pressure of ulnar nerve at elbow, pain numbness or tingling, weakness or clumsiness. Involves small muscles of the hand. Pulling levers, bagging, driving, running machinery, sleeping. rotator cuff injury: tendonitis: when elbow is overhead for long time and swells tendons, can lead to frozen shoulder. Tear, from injury or degenerative changes. People over 40 more susceptible due to wear and tear, repetitive lifting overheard activites, athletes like tennis players or baseball pitchers. Constrain pain even at rest, weak muscles, limited ROMTenosynovitis: irritation of tendons synovial sheath, fluid cases swelling and pain. Cause by unnatural positions, force or pressure, poorly arranged work station, bad work habits. Symptoms: tenderness, cracking sounds, loss of some function in affect body part.Dequerveins synovitis: movements, twisting of hand and forceful gripping. Occs, buffers, grinders, sewers, cutters, packers and housekeepers, golfers, knitters, raquet sports players, mail sorters, filing clerks, pain/swelling on thumb side of the wrist, work when hand/thumb is in use, snapping sensationw hen moving thumb, numbness on back of thumb and index finger.
Describe some diagnostic screening tests for RTDs- Phalen’s, Tinel’s & Finkelstein’s tests.Finkesteins test: positive if pain with passive wrist ulnar deviation while flexing the thumb into fist.Phalens: test for carpal tunnel, wrist are flexed against eachother for 1 minuteTinel’s: lightly banding over the nerve to elicit tinling or pain in the distribution of nerve
What muscle of the rotator cuff is most affected in rotator cuff injuries?supraspinatus
Final Study Guides: Mind Body Systems 23Outline the role of OT and ergonomics in prevention and management of RTDs.
prevention: awareness and relation to activities at work, education and training in work environment, avoiding repetitive patterns of work—job rotation and use of machines, Management: rest, splinting, PAMs, modification of workstations, tools or work schedule, behavioral interventions, work hardening program.
KeywordsInflammation: localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, esp. as a reaction to injury.Tendonitis: inflammation of a tendonTenosynovitis: Inflammation and swelling of a tendon, typically in the wrist, often caused by repetitive movements.Parasthesia: An abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves
Multiple Sclerosis What is MS, and what area of the neuron is affected by it? Where are these neurons located?’
A debilitating immunological and neurodegenerative disease, chronic, body attacks myelin sheath surrounding nerves, location various from person.
In what populations is MS more common, and what is the typical age of onset?2-3 more common in women, most people diagnosed between 20-30
What is thought to cause MS?Genetics plays an important role, risk rises 1/40 with anyone who has a close relatives (parents, siblings, child) with the disease
List some motor, sensory, cognitive and psychological symptoms of MS. What is the main complaint of most people with MS?
Motor symptoms- bladder and bowel dysfunction, gait problems, loss of balance, fatigue, communication problems, muscle spasmsCognitive- 40-60%, memory loss, decreased attention span, poor judgment, sadness, word retrieval difficulties Sensory- abnormal sensation, numbness, dizziness, vertigo, vision problems (double vision), hearing loss Physiological- Main complaint- fatigue
Important: Explain the 4 types of MS in terms of their course, pattern and progression of disability. Approximately what percent of people with MS acquire each type? Which is the most common? Which one is the most severe with the fastest progression?
Relapsing Remitting MS- most common, 90% of patients w ms, inflammatory attacks on myelin, series or relapses and remissions which represents inflammations within the brain and spinal cord, people tend to have more brain lesions, containing more inflammatory cells, areas of brain and spinal cord become inflamed causing disability, consequently these areas will heal and this completes a relapse and remitting cycle
Primary Progressive MS- 10% of population, men and women affected equally, later onset, steady worsening of neurologic functioning, without any distinct relapses (also called attacks or exacerbations) or periods of remission, people tend to have more spinal cord lesions, containing fewer inflammatory cells, a person’s rate of progression may vary over time with occasional plateaus of temporary improvements but the progression is continuous
Secondary Progressive MS- Of the 85% of people who are initially diagnosed with relapsing-remitting MS (RRMS), most will eventually transition to SPMS, which means that the disease will begin to progress more
Final Study Guides: Mind Body Systems 24steadily (although not necessarily more quickly), with or without any relapses
Progressive Relapsing remitting MS- Least common of the four types, 5% MS population, People with PRMS experience disease progression from the very beginning — but they experience occasional relapses as well . Because PRMS is progressive from onset, the doctor may initially diagnose it as PPMS, subsequently changing the diagnosis to PRMS when a relapse occurs.
What is the prognosis and possible treatments for MS?Prognosis- varies, life expectancy can be normal, most people continue to walk and function at work with minimal disability for 20 years or moreTreatments- meds- steroids(decrease severity of attacks), cholinergic meds- reduce urinary problems, antidepressants, amantadine(fatigue)
What is the role of the OT with patients with MS?Assisting the client adapt with the variable and progressive nature of the diseaseEvaluation (periodical and comprehensive)ADLs, IADLs, Work, Leisure, & Social ParticipationInterviews, observation, COPM, KELS, FIM, EDSS….Motor and Process skillsMMT, Tone, ROM, sensation, endurance, vision, perceptual skills, attention, memory, planning and executive functioning….Therapeutic exercise programMaintain strength, tone & ROMAdaptations and assistive technologyEnergy conservation and activity scheduling
Key TermsSclerosis- the damaged myelin forms scar tissueRelapseRemissionMyelin - When any part of the myelin or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur
Polio/Post-PolioWhat causes polio? How does it enter the body?
Poliomyelitis is a disease caused by infection with the poliovirusDue to stool of an infected person saliva Primarily spreads via fecal-oral route.
Has polio been eradicated worldwide? What is the primary way to prevent polio?Globally there are a total of 1,348 cases there is no cure for polioPolio vaccine, given multiple times, can protect a child for lifeIMMUNIZATION! – Especially to individuals traveling to an area that has experienced a polio outbreak
What are ways by which the polio virus can spread?Polio virus enters the body through the mouth Fecal - Oral Transmission: contaminated water or food Oral – Oral Transmission: by way of infected person’s
What are the three types of polio? Give symptoms of each.Subclinical Infections95% of cases reporteda loss of motor neurons during acute polio but with no obvious deficit
Final Study Guides: Mind Body Systems 25might not have symptoms, or their symptoms may last 72 hours or lessNon-Paralytic & Paralytic forms may arise after recovery of subclinical
Non-paralytic (a.k.a abortive polio)Does not lead to paralysisMild flu-like symptoms, fatigueSymptoms usually last 1-2 weeks
Paralytic - Most severe, sudden paralysis
Explain the pathophysiology, symptoms, and phases of paralytic polio?Paralytic Polio: Symptoms Initial signs and symptoms (5-7 days prior to other symptoms): fever & headache
Within a week loss of reflexes severe muscle aches/spasmsflaccid paralysis Abnormal sensations(NO loss of sensations) Bloated Difficulty breathing Constipation Difficulty initiating urination Drooling HeadacheIrritability Muscle contractions/ spasms in the calf, neck, or backMuscle pain Stiff neck and backSwallowing difficulty
List common musculoskeletal deformities seen in children/teens with polio?
About how many individuals in the US are at risk of experiencing PPS?more than 440,000 polio survivors in the United States may be at risk for PPS.
How long after the initial polio attack does Post-Polio Syndrome (PPS) occur? What is stated to be the pathological cause behind PPS?
Age of onset: 15 to 30 years after the initial polio virus
Post-Polio Symptoms new muscle weakness or abnormal muscle fatigability with or without generalized fatigue, muscle atrophy, or muscle and joint pain. Paralytic type: may have problems with breathing or swallowing.
What are the complications and the prognosis of PPS?Falls Possible hip fracturesMalnutrition DehydrationPneumonia Acute respiratory failureRISKS: Obesity, smoking, curvature of the spine, anesthesia, prolonged immobility and certain medications OsteoporosisProlonged inactivity and immobility are often accompanied by loss of bone density and osteoporosis
Spinal Cord InjuryDescribe complete and incomplete spinal cord injuries (SCI). What are the differences between these two forms of SCI?
Complete injury is a complete transection of the spinal cord disrupting all ascending and descending pathways. An incomplete lesion is a partial damage to the spinal cord. People with an incomplete injury may have feeling, but little or no movement. Others may have movement and little or no feeling. The major difference is that some motor and sensory function still remains below the level of injury.
Final Study Guides: Mind Body Systems 26What are the causes of SCI? What is recognized as the leading cause? Who is most likely to experience a spinal cord injury and how?
Motor vehicle accidents, falls, gunshot wounds, sports-related injuries (diving). Vehicle accidents are the leading cause. Most common in males ages16-30.
Why can some individuals who experience a spinal cord injury still have involuntary reflexes?After injury, reflex arcs are intact. Impulse skips brain and instead it ‘loops’ within the spinal cord (enters dorsal nerve root, synapses, and exits by ventral nerve root). This reflex causes certain muscle functions or responses without direction from brain.
Describe the types of incomplete SCI syndromes- Anterior cord, central cord, Brown Sequard and Cauda Equina Syndrome
Anterior cord syndrome is an injury to anterior portion of spinal cord characterized by complete paralysis, loss of pain and temperature sensation. Preservation of position of arms, legs, vibration, and sense of touch.
Brown Sequard syndrome is injury occurs when one-half of the spinal cord is damaged. One side of the body becomes stronger than the other side below the level of injury. Weaker side is able to feel sensation of hot/cold, sharp/dull better than the other side.
Central cord is damage to central portion of the spinal cord. More loss of movement and sensation in the arms than in the legs. Usually due to hyperextension of the neck, Degradation of spinal canal brought upon by arthritis, most prevalent in aging populations.
Cauda Equina Syndrome--a collection of blood surrounding the nerves following trauma (epidural hematoma) in the low back area compressing the cauda equina--Loss of motor function and sensation below injury and an absence of reflex arc
What is the difference between myotomes and dermatomes? List myotome distribution for key motor and sensory areas and explain their relevance in assessing the level of SCI and functional outcome.
Myotomes- muscle innervations, Dermatomes- sensory distribution. Myotome distribution indentifies the level of injury by the muscles that have been affected. (i.e. intact diaphragm, but muscle weakness at and below rhomboids and deltoids indicates C5 injury)
Differentiate the signs and symptoms of UMN and LMN spinal injury. [UMN=Spasticity, increased DTRs, while LMN=flaccid, decreased or no DTRs] These signs are the same presented in the introductory performance skill deficit lecture]
Hypertonicity- Spasticity-Increased muscle tone (Velocity dependent, Clasp knife phenomenon) Cause: Lesion in UMNHypotonicity-Flaccidity-Decreased to no muscle tone Cause: Lesion in LMN
Explain the causes and signs for the following secondary complications associated with SCIAutonomic dysreflexia- Unopposed, exaggerated response of the ANS system. Sudden increase in blood pressure. Triggered by irritation of nerves below the level of injury (ie: overfull bladder, UTI, ingrown toenail, pressure sores).
Symptoms: Pounding headache, sweating, goose bumps, seeing spots or blurred visions, anxiousness, nauseaPostural (orthostatic) hypotension- Sudden drop in blood pressure upon sitting upright.
Impairment of autonomic regulation and blood pressure control- Most common with lesions at T6 level and above.
Symptoms: light-headedness or faintingDVT-Formation of a blood clot most often in lower extremity; If undetected, may cause embolism or death
Final Study Guides: Mind Body Systems 27Reduced circulation caused by decreased muscle toneFrequent direct trauma to legs causing vascular damage (repeated transfers or bed mobility activities)SignsSwelling in the lower extremitiesLocalized rednessLow-grade fever
Pressure sores- Result from unrelieved pressure to bony prominences of body (sacrum, elbows, knees, and ankles) Circulation impairment due to pressure and lack of movementTissue necrosisMajor reason for hospital re-admissionsCan result in death
How many stages of pressure ulcers are there? What are some of the characteristics of each? (Bed sores) 4 stages—
Stage 1: reddened or darkened skin, superficial damage, can be stopped by removing pressure from area.Stage 2: skin is reddened and open, blistering and scabbing, involves epidermal, dermal and underlying adipose tissue.Stage 3: skin breakdown is deeper, visibility of muscle tissue, ulcer development Stage 4: superficial layers to the bone are destroyed, infection and bone decay, surgical intervention likely, must apply no pressure to affected area for several weeks
What are the treatment methods for a SCI? Muscle spasticity can be relieved with Botox injections. Pain killers (analgesics) and muscle relaxers are used to help control pain.Persons with SCI are advised to follow lifelong exercise programs to preserve and enhance ROM and strength and promote cardiovascular health and weight managementIf methylprednisolone is given within eight hours of injury, some people experience mild improvement. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. Functional Electrical Stimulation (FES)--Application of small electrical pulses to paralyzed muscles to restore or improve function--assists with breathing, grasping, transferring, standing and walking, and helps some to improve bladder and bowel function
What is the role of an OT with a client recovering from a SCI?Education- Train client on prevention of complicationsHelp transition from hospital to inpatient to home/community- Return to school/workManage occupational rolesMinimize barriersProjected functional independence based on spinal level- ADLs, IADLs…Help maintain/restore strength and enduranceFunctional training- Sitting balance, transfers….Assistive Technology and OrthoticsKnow which ones typically applies to which levelExamples- Wheelchair, standing frame, forearm crutches, padded tub, computer access devices….
Key Terms:Cauda Equina- ◦Nerve roots exiting from lower end of spinal cord to innervate lower trunk, legs, bowel and bladder. Begins below L1Tetraplegia- loss of motor/sensory function in the extremities, as well as trunk and pelvic organsQuadriplegia- loss of motor control/sensory function in all extremities due to cervical cord damageParaplegia: the loss of function in the lower extremities and trunk (below arms)due to lesions to thoracic, lumbar, or sacral cord segments
Final Study Guides: Mind Body Systems 28Hyperreflexia: overactive or overresponsive reflexesTachycardia: heart rate that exceeds the normal range for a resting heart rateBradycardia: resting heart rate of under 60 beats per minute,Edema: abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling.Spasticity: muscle tone involving hypertonia, unusual "tightness" of muscles. defined as velocity dependent resistance to stretch, where a lack of inhibition from the CNS results in excessive contraction of the muscles, ultimately leading to hyperflexiaHeterotrophic Ossification: bone tissue forms outside of the skeleton. Calcification of connective tissue around joints Can appear 1-4 months after injury
AutismWhat are the three critera/ characteristics for an ASD diagnosis?
Impairment in social interaction Impairment in communicationRestricted/repetitive/stereotyped behaviors
What are the 5 subtypes of ASD, their distinctive features, severity and age of onset?Disorder Key Features Prognosis Age of diagnosis/Ratio
Autistic Disorder Severe deficit in all 3 areas-social interaction, communication, and behavior. 75% have low IQ, lack of speech or social withdrawal; prognosis poor Early childhood, affects more boys than girls 0.2% of children
Rett Syndrome Normal dev. At least 5 months, then slowed dev. Decreased head growth. Genetic mutation(known cause) Generally life long with marker delay in social and cognitive skills 6-18 months Females only 0.01% of children
Asperger’s Syndrome Social and behavioral symptoms-No delay in language or cognition. Dependent upon child-many can live independently and hold meaningful jobs as adults. Early childhood, more boys than girls 0.1%
PDD-NOS Severe impairment in social intxn. Does not meet any other criteria for ASD. Varies, depending on uniqueness of disorder Varies in childhood 0.3% of children
Childhood Disintegrative Disorder Normal development at least 2 years, loss of skills after. Impairment in social intxn and communication. Normal development for first 2 years of life then loss of previously acquired skills. Loss of skills between 2 and 10 years. 0.002% children
What makes Asperger's different than the other disorders?No delay in language or cognition.
What age(s) do(es) the decline in skills occur for CDD?Between 2 and 10 years of age, child begins losing skills that had previously acquired.
Which of the subtypes is considered atypical autism or subthreshold autism?PDD-NOS
What are the three most recognizable signs/symptoms of Asperger’s Syndrome?Child has long one-sided conversations without realizing if listener is bored or wants to change topicSocial awkwardnessObsession in one or two specific topicsUnusual non-verbal communicationsLack of eye-contact, few facial expressions, awkward body posture and gesturesMay seem insensitive to others feelings
Final Study Guides: Mind Body Systems 29Difficulty reading others’ emotions or humorSpeaking in toneless voice which may be rigid or unusually fastClumsy/poor coordination
What are common co-morbidities of Asperger’s Syndrome?ADHD Tic disorders (Ex: Tourette Syndrome)Depression Anxiety disordersOCD Gastrointestinal disorders
When would a person be diagnosed with PDD-NOS?varies
How does PDD-NOS differ from autism?Someone who has autistic characteristics in a milder form or who only experiences symptoms in one area
What is typical age of onset of Childhood Disintegrative Disorder?Between 2 and 10 years of age, child begins losing skills that had previously acquired.
Which type of ASD has a known gene disorder linked to it?Rett syndrome
Does Rett syndrome affect boys or girls?1 in 10,000 live female births
What is the typical path of development for Rett syndrome?Stage I (Early Onset): infant may begin to show less eye contact and have reduced interest in toys. There may be delays in gross motor skills such as sitting or crawling. Hand-wringing and decreasing head growth may occur, but not enough to draw attention. This stage usually lasts for a few months but can continue for more than a year.
Stage II (Rapid destructive): ages 1 and 4 and may last for weeks or months. Its onset may be rapid or gradual.• Child loses purposeful hand skills and spoken language.• Characteristic hand movements such as wringing, washing, clapping, or tapping, as well as repeatedly moving the hands to the mouth. • Slowed head growth• Hyperventilation
Stage III (Plateau): ages 2 and 10 and can last for years. • Apraxia • Motor problems • Seizures• Improvement in behavior, with less irritability, crying, and autistic-like features. • May show more interest in her surroundings and her alertness, attention span, and communication skills may improve
Stage IV (late motor deterioration):• Reduced mobility • curvature of the spine (scoliosis)• Muscle weakness • Rigidity• Spasticity • Increased muscle tone with abnormal posturing• Cognition, communication, or hand skills generally do not decline
