Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
Study Group #2- Mobility Part 2 Concepts
Multiple Sclerosis (MS)
-Immune-mediated disorder of the CNS in which immune cells attack the myelin sheath around
nerve cells, causing decreased transmission of nervous signals (autoimmune disease)
-4 Classifications of MS
1. Relapsing-remitting MS: most common form
-Experience clearly defined flare-ups with worsening neurologic function
followed by periods of partial or complete remission with few or no symptoms
-Periods of relapse that lasts for days or months and periods of remission that lasts
from weeks, to months, to years
2. Primary-progressive MS: 10% of patients
-Slow but continuous worsening of their disease from the time of onset with no
distinct remissions
3. Secondary-progressive MS: develops within 10 years of diagnosis in about half of the
patients with relapsing-remitting MS who are not receiving treatment
-Initial period of relapsing-remitting, followed by a progressive form of the
disease with or without occasional flare-ups and minor remissions
4. Progressive-relapsing MS: rare, occurs in 5% of individuals with MS
-Steady worsening of the disease with acute relapses
-The periods between relapses are characterized by continued progression of the
disease rather than remission of the symptoms
-Risk factors for MS:
-Individuals ages 20-40 years old
-Women
-Smoking
-Clinical Manifestations:
-A true exacerbation must last at least 24 hours and must be separated from the previous
attack by at least 30 days
-Fatigue
-Paresthesia (numbness, tingling, burning)
-Lack of coordination and balance
-Unsteady gait
-Bladder and bowel dysfunction
-Tremor
-Visual disturbances (unilateral loss of vision, optic neuritis, double vision, blurred
vision, red-green color distortion)
-Dizziness
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-Sexual dysfunction
-Pain, headache
-Cognitive dysfunction (lack of concentration, memory loss, reasoning problems, poor
judgment)
-Depression, anxiety
-Muscle spasticity or weakness in one or more limbs
-Speech disorders
-Swallowing problems
-Hearing loss
-Seizures
-Breathing problems
-Itching
-MS hug (feels like there's a tight band around the abdomen)
-Partial or complete paralysis
-Diagnostic Tests:
-MRI: used to detect the presence of lesions in the CNS that may indicate demyelination
and MS
-Pharm:
-Goal is to decrease the number of relapses
-Treated based on their symptoms
-Nonpharm therapy:
-PT, OT, speech-language therapy, cognitive therapy, vocational rehabilitation (help with
employment)
-Participate in a mild exercise program like walking, swimming, and weight training to
increase muscle strength and balance
-Getting plenty of rest
-Avoid excessive heat and keep cool
-Eating a balanced diet, adequate fluids/hydration
-Stress reduction
Parkinson Disease (PD)
-Progressive neurological disorder that primarily affects movement
-Dopamine: brain neurotransmitter that regulates voluntary movement, reward-seeking behavior,
memory and learning, attention, sleep, and affect
-PD is characterized by a loss in dopaminergic neurons
-Risk factors:
-Age
-Males
-Inherited
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-Clinical manifestations
-Motor symptoms (usually begin unilaterally)
-Tremor, most prominent at rest
-Pill-rolling motion
-Interfere with ADLs
-Rigidity (resistance to movement)
-Interfere with ADLs
-Muscle aches and weakness, stiffness → limited ROM, and pain
-Cogwheel rigidity: extremity moves in short jerky movements
-Bradykinesia (slow movements)
-Difficulty with speech, swallowing, and chewing → excessive drooling,
difficulty eating, slurred speech, lethargy, pauses between speech, lower
voice volume
-Postural instability → stooped posture → balance problems and falls
-Retropulsion: tendency to topple backward when bumped or rising,
standing, or turning
-Parkinsonian gait:
-Small, shuffling steps
-Freezing
-Increases the risk of falling forward
-Nonmotor symptoms
-Fatigue, irritability, loss of sense of smell (early), dementia (later on)
-Cognitive defects: slowed thinking, confusion, memory loss
-Depression, fear, anxiety, panic attacks
-Sleep problems: insomnia, daytime sleep attacks, restless leg syndrome, frequent
awakenings at night due to muscle movement
-Pharm therapy
-Levodopa
-MOA: restores dopamine levels in the brain
-Side effects: dry mouth, dizziness, orthostatic hypotension
-On-off effect: characterized by a sudden lack of symptom control especially
when used long-term
-Dopamine Agonists
-MOA: mimic dopamine in the brain, activating dopamine receptors
-Side effects: hallucinations, swelling, drowsiness, compulsive behaviors
-Dopamine Modifiers
-MOA: used to extend the action of dopamine in the brain
Spinal Cord Injury (SCI)
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-SCI occurs when vertebrae or other objects are forced against the spinal cord, damaging nerve
cells and preventing the transmission of nerve impulses between the body and the brain
-Causes of SCI
-Hyperflexion: forward bending beyond normal limits
-Hyperextension: backward bending beyond normal limits
-Compression: occurs when a vertical force is applied to the spinal column (falling,
diving into shallow water)
-Rotational injuries: caused by lateral flexion or twisting of the head and neck
-Transection: occurs when the individual is injured by a gunshot or stabbing, that
partially or completely severs the spinal cord
-The most common cause of SCI is: Vehicular crashes
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
4) Cervical C1-C8, neck
-Innervation: head and neck, diaphragm, upper
limbs
5) Thoracic T1-T12, upper back
-Innervation: chest muscles, abdominal muscles,
some back muscles
6) Lumbar L1-L5, lower back
-Innervation: lower abdomen and back, parts of
lower limbs
7) Sacral S1-S5, hip area
-Innervation: bowels and bladder, buttocks and
anus, parts of lower limbs, parts of external
genital organs
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-Risk factors for SCI:
-Men, especially single young adult men
-Those who engage in risky behaviors
-Shallow diving, playing sports without protective gear, driving ATVs and
motorcycles at high speed over rough terrain
-Older adults most likely due to a fall
-Prevention of SCI:
-Fall precautions
-Safe driving practices
-Seatbelts, designated driver
-Checking water depth before diving, never diving into above ground pools
-Appropriate protective equipment for sports
-Clinical manifestations:
-Depends on the level of injury
-All systems below the level of injury will be affected by damage to the spinal cord, so
the higher the injury, the greater the extent of motor and sensory deficits
-For example: a patient who experiences damage at C3 level will experience more
widespread effects than an individual with an injury at the T11 level
-An individual with SCI at level C3 or higher loses control of all four muscle groups
needed for breathing and require immediate ventilator support
-Any injury below the C5 level conserves diaphragm function
-Emergency signs and symptoms that may indicate SCI:
-Extreme pain or pressure in the neck or back
-Weakness, paralysis
-Lack of sensation in any part of the body
-Loss of bladder or bowel control
-Impaired breathing after injury
-Oddly positioned or twisted neck or back
-Muscle spasms
-Spinal Shock: characterized by spinal cord swelling, decreased blood flow and blood pressure;
and complete loss of motor function, spinal reflexes, and autonomic function below the level of
injury
-Usually occurs immediately after injury and can last for several hours to several weeks
-Classification of SCI:
-Involve a total loss of all sensory and motor function below the level of injury and cause
irreversible damage: complete SCI
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-Involve only a partial loss of sensory and motor function below the level of injury,
patients have a better chance of recovering sensory and motor function: incomplete SCI
-Types of paralysis:
a) Quadriplegia
b) Hemiplegia
c) Paraplegia
-Complications of SCI:
-Autonomic dysreflexia: the abrupt onset of excessively high blood pressure as
the result of an overactive autonomic nervous system, usually occurs in patients
who have injuries at T6 and above
-Triggers: irritation, pain, or other stimulus below the level of injury such
as an urge to urinate or defecate, pressure injuries, burns, or pressure from
tight clothing
* Most common cause is an overdistended bladder
-Signs and symptoms: flushing, sweating, pounding headache,
bradycardia, sudden hypertension, vision changes, goosebumps
-Treatment should be immediate and includes changing positions,
emptying the bladder or bowels, or removing tight clothing
-If not treated may lead to seizures, stroke, MI, or death
-Neurogenic Shock: watch for decreased BP & HR
-DVT → stroke, pulmonary embolism
Kaitlyn Dery
N-535 Study Group
derykr@alverno.edu
-Respiratory problems: difficulty clearing secretions, atelectasis (collapsed lung),
pneumonia
-Pressure injuries, burns, cuts
-Catheterization → risk of UTIs, kidney and bladder stones
-Emotional changes: grief, depression
-Pharm therapy:
-Most patients will receive high-dose methylprednisolone within 8 hours after injury to
improve neurologic recovery
-Helps to decrease inflammation and reduce damage to surrounding nerve cells