Clin/tech 7- Ms & Cerebral Palsy

Front 1

What is Multiple Sclerosis? What does it attack?

Back 1

-Unpredictable, disabling disease of CNS
-Attacks myelin (protective covering wrapped around nerves of CNS)

Front 2

What are the causes of MS?

Back 2

-Not known

Front 3

Risk factors of MS?

Back 3

-Environmental factors
-Genetics
-Epstein-Barr virus
-Inadequate sunlight exposure

Front 4

How does adequate intake of vit D decrease getting MS?

Back 4

-Vit D --> activate vit D receptors on immune regulatory cells
-Decrease immune activity --> decreasing risk of autoimmune disease like MS

Front 5

Diagnosis of MS?

Back 5

-MRI: images of lesions in CNS; 2nd MRI to confirm dont after 3 mo. at min
-Evoked potential test: measures speed of nerve impulse conduction in pathways of CNS; slowed w/ MS bc myelin damage; place small electrodes on head and body, stimuli applied EX. lights/sounds, EP records how fast stimuli registered in CNS
-Lumbar puncture: small needle in base of spine to sit in space btwn lining of CNS and spinal cord; small amt of cerebrospinal fluid around CNS andand circulates though this space collected; fluid examined for presence of proteins present w/ inflammation in CNS
-No real test to diagnose MS. All causes of symp ruled out before confirming

Front 6

Predisposing factors of MS?

Back 6

-Any age
-Onset common 20-40 y/o
-Women 3x frequent
-100, 000 Canadians
- 1/500-1, 000
-Canada high risk bc further away from equator
-1,000 new cases of MS in Canada/yr

Front 7

Symptoms of MS?

Back 7

-Unpredictable and vary btwn people
-Inflammation and damage to myelin in patches (bc of attack on myelin of brain and spinal cord)
-Interruption or distortion of nerve fibers
- Depends on parts of CNS affected

Front 8

Signs/Symp of MS?

Back 8

-Inappropriate affect (aka pseudo bulbar affect, emotional incontinence, involuntary emotional expression disorder- IEED)
-Incoordination
-Electric shock down spine w/ neck flex
-Tremor; Useless hand syndrome
-Heat intolerance
-Weakness
-Mood liability/bipolar affective disorder
-Spasms
-Balance and dizziness
-Bladder dysfunction
-Bowel constipation, diarrhea, incontinence
-Cognitive impairment
-Depression, fatigue
-Dry mouth, difficulty speaking, difficulty swallowing
-Difficulty walking
-Optic neuritis (inflammation of optic N.)
-P.
-Sensory impairment, numbness, tingling

Front 9

What are the 4 types of MS?

Back 9

-Relapsing remitting MS (RRMS)
-Primary progressive MS (PPMS)
-Secondary progressive MS (SPMS)
-Progressive relapsing MS (PRMS)

Front 10

Relapsing Remitting MS (RRMS)

Back 10

-Unpredictable new symptoms appear or existing ones get worse
-Start w/ alternating relapses and remissions. During relapse, new signs/symp appear and old sign/symp recur/worsen
-Remission after relapse where pt fully/partially recovers from deficits during relapse
-Attacks are few hrs - few days lasting 48hrs-few mo.
-Relapsing/remitting is initial disease course in 85% cases
-W/out Tx will transition to secondary progressive MS

Front 11

Primary Progressive MS (PPMS)

Back 11

-Steady functional decline from onset w/ mainly spinal cord symp w/out relapses
-10% o f cases
-Dignosed after 40 y/o

Front 12

Secondary Progressive MS (SPMS)

Back 12

-Continuous neurologic decline w/ fewer or no relapses
-When relapses occur, less apparent
-Occasional flare-ups, minor improvements, and even periods of stability may occur
-Overall, one accumulating disability

Front 13

Progressive Relapsing MS (PRMS)

Back 13

-Steady functional decline w/ superimposed relapses and partial remissions
-Function never fully recovers during remissions
-Rarest course
-5% of cases

Front 14

Tx for MS?

Back 14

Medications first category: disease modifying therapies
-Drugs that impact underlying disease
-Work by targeting inflammatory process of MS, w/ aim of preventing inflammation which causes relapses
Medications second category: decrease severity and duration of relapses
-EX. Steroids
-Relapse cause by area of acute inflammation in CNS and steroids work to actively suppress inflammation
Medication third category: ease MS related symp
-Help fatigue, spasticity and P.

Front 15

MT Tx for MS?

Back 15

-Stress management: bc decreases symp
-Exercise: help improve overall health, reduces fatigue and stiffness, increases strength and mood

Front 16

What is Cerebral Palsy?

Back 16

-Movement and postural disorder caused by permanent, non-progressive damage to developing brain

Front 17

Causes of CP?

Back 17

-Difficulties during birth process
-Genetic, metabolic, immune, endocrine and coagulation disorders, and maternal infection
-Cognitive, somatosensory, visual, auditory and speech deficits associated
-During pregnancy: multiple births, damaged placenta (interfere w/ fetal growth), infections, poor nutrition, exposure to toxic substance (nicotine/alcohol), maternal diabetes/hyperthyroidism/high BP, biochemical genetic disorders, chance malformations of developing brain
-During labour: premature delivery, abnormal positioning of baby, rupture of amniontic membranes leading to fetal infection
-In early childhood: meningitis, brain hemorrhages, head injury following falls, car accidents/abuse, lack of O2 (asphyxia) from accidents like drowning, seizures

Front 18

Diagnosis of CP?

Back 18

-CAT scan & MRI identifies lesions in brain

Front 19

Prevalence of CP?

Back 19

-Estimated 1/500 babies
-Up to 1/3 premature babies affected
-Over 50,000 Canadians w/ CP

Front 20

What are the 5 types of CP?

Back 20

-Spastic
-Dyskinetic
-Ataxic
-Hypotonic
-Mixed

Front 21

Spastic CP?

Back 21

-Excessive involuntary mm contraction making mm more stiff
-Causes toe walking and scissor gait
-Scissor gait: 1 leg swings in front of other
-Caused by: damage to axons adjacent to lat ventricles

Front 22

Dyskinetic CP?

Back 22

-Mm tone fluctuates ranging from hypertonia (excessive resistance to stretch produces unwanted stiffness) to hypotonia (inadequate mm contractions for movements and to maintain normal head and trunk posture)
-Common form: choreoathetoid- involuntary choreiform (jerky, abrupt, irregular) and athetoid (slow, writhing) movements
-Less common form: involuntary sustained skeletal mm contractions
0Neuronal damage is in basal ganglia

Front 23

Hypotonic CP?

Back 23

-Very low mm tone, often described as floppy
-Little or no ability to move
-Site of damage unknown

Front 24

Ataxic CP?

Back 24

-Incoordination, weakness, and shaking during voluntary movement
-Damage is in cerebellum

Front 25

Mixed CP?

Back 25

-when more than one type of abnormal movement coexists

Front 26

Classification of CP?

Back 26

According to area of body affected
-Hemiplegia: both limbs on one side
-Quadriplegia: all four limbs equally
-Diplegia: upper limbs less severely affected than both lower limbs
-Paraplegic: both legs only

Front 27

Tx for CP?

Back 27

-Medications: for severe spasticity or painful spasms.
-Nerve blocking injections: reduce spasticity temporarily
-Orthotics, Casts or Splints: supplements therapy programs, provide stability, keeps jts in position, help stretch mm
-Surgery: orthopaedic and soft-tissue surgery to counter effects of spasticity on spine, hips and legs. Help lengthen/transfer tendons, enabling child to move easily

Front 28

Communicating to someone with CP?

Back 28

-Determine how pt communicates EX. symbol board, voice synthesizer, etc
-Ask pt to repeat if you don't understand
-Speak same way you would with anyone else
-Mm around mouth and throat challenging to control so do not talk down to pts.
-Don't interrupt or cut off someone

Front 29

MT Tx for CP?

Back 29

-