Neurological conditions and the role of OT

1. Distinctions, Clinical Features, and the Role of OT
Stephanie Lancaster, MS, OTR/L, ATP, CAPS
University of Tennessee Health Science Center

2. OT 537

3.  Generally characterized by
the loss of neurons and
secondary gliosis (scarring)
without evidence of major
inflammation or necrosis of
tissue
 Incidence rises with age,
especially >65
 Degeneration of specific
groups of neurons or brain
areas causes classic
characteristic clinical
symptoms:
 Motor weakness
 Movement pattern irregularities
 Dementia
 Autonomic failure

4. Parkinson’s Disease Motor neuron disease
Huntington Disease Basal ganglia degeneration
Multiple Sclerosis Damage to myelin
Guillain-Barre Syndrome Demyelination of peripheral nerves
Amyotrophic Lateral Sclerosis Denervation of UMN & LMN
Myasthenia Gravis Destroyed ACH receptors

5.  Addiction – Opiod peptides
 ADD/ADHD – NE and DA
 ALS – ________
 Alzheimer’s – _________
 Autism – ST
 Eating disorders – ST
 Fibromyalgia – Substance P, ST, Opioid
peptides
 Huntington’s – __________________
 Multiple Sclerosis - _____________
 Muscular Dystrophy - ___________
 Myasthenia Gravis – _____________
 Parkinson’s – ___________________
 Schizophrenia – GLU and DA

7.  Signs (initial – leading up to the diagnosis – and post-
diagnostic symptoms)
 “Standard patient” (demographics)
 Mildness vs. severity
 Rate (and pattern of) of progression
 Impact of the condition on a person’s lifespan

8. • Demyelinating disease
• Unpredictable, often disabling
disease of the central nervous
system
• Body’s own defenses attack the
protective myelin covering of the
central nervous system
• Increased risk in first degree
relatives (children, siblings)
• The most common neurological
disease in young adults
• The most common neurological
disease in young adults
• 1 out 750 people in the U.S may
develop MS

11.  Weakness
 Intention tremor
 Nystagmus/decreased
acuity/diplopia
 Extreme fatigue
 Hyper-reflexia:
Babinski Sign
 Speech problems
 Dysphagia
 Numbness/tingling
 Altered vibratory/position
sensation
 Pain-abnormal
aching/burning
 Cognitive Issues
 Dysmetria/ataxia

12. https://www.youtube.com/watch?v=I8M1spBk3yE

14. Relapsing-Remitting Primary Progressive
Secondary Progressive Progressive-Relapsing

15.  No medical treatment for MS that can prevent or cure it –
aim is to slow down the progression and alleviate
symptoms
 Medical Management
 Synthetic Interferon
 Muscle Relaxants

16.  Focus on removing or reducing challenges to promote and
enable participation in meaningful occupations
 Can be preventative, educational, compensatory, remedial,
or consultative
 Therapeutic use of meaningful goal-directed activities to
achieve therapy goals
 Intervention may also focus on maintenance of current
functional abilities
 Increase awareness of sensory deficits

17. Assessment of …
 Energy level/endurance
 Strength
 Cognition
 ADL performance
 Pain
 ROM
 Muscle tone
 Sensation
 Mood/Coping skills

18.  Canadian Occupational
Performance Measure (COPM)
 The Occupational Performance
History Interview II
 Modified Fatigue Impact Scale –
part of the MS Quality of Life
Inventory (MSQLI)
 The MS Neuropsychological
Screening Questionnaire (MSNQ)

20. STRETCHING
-Avoid fast, ballistic movements
- Target hip flexors and hamstrings for patients in a wheelchair
MODALITIES
STRENGTHENING
-Lower extremity flexors
-Trunk rotation
-Gentle cardiovascular activity

21. Impaired coordination,
tremor, and postural
deficits
 Promote postural stability
to improve accuracy of
limb movements.
 Postural training by
challenging dynamic
postures and balance

22. Mobile Arm Supports (MAS)

23.  The adoption of strategies to
reduce overall energy
requirements
 The 4 P’s:
 Planning
 Prioritizing
 Pacing
 Positioning
 Adaptive equipment
 Grab bars
 Reacher
 Shower chair
 Built-up utensils
 Handled cups
 Modifying the task or home
environment

24. Focus on reducing functional
limitations and improving quality of life

25.  Evaluation of environmental factors is ideally achieved
through a home and/or workplace visit with the client and
family.
 Home modifications
 If a visit is not possible, interviews with the patient, family,
or others can be used to obtain the necessary information.

28.  National MS Society  www.nationalMSsociety.org
 Multiple Sclerosis Dot Net 
www.MultipleSclerosis.net
 Multiple Sclerosis Foundation  www.msfocus.org
 Every Day Health  http://www.everydayhealth.com

29. A client with MS who presents with bilateral
proximal weakness identifies a goal of self-feeding.
Which equipment is most beneficial for the OT to
recommend for goal attainment?
A. Extended handled utensils
B. Built-up handled utensils
C. A weighted cup
D. Mobile arm supports

31.  Mother carries the recessive gene and passes
it to her child
 Trait is usually expressed in males only
 Affects one in 3500 - 5000 newborn males
 1/3 of these with previous family history
 2/3 sporadic (spontaneous genetic mutation)

32.  Duchenne’s MD – the most
common form
 DMD strikes boys almost
exclusively (world-wide
about 1 in every 3500 males)
 Age of onset differs with
every type

33.  Interview/family history
 Blood test
 Electromyography
 Muscle biopsy
 Histopathology
 DNA test
 Gene sequencing
 MRI

34.  Delayed developmental milestones
 Loss of motor skills
 Characteristic gait
 Calf hypertrophy
 Cognitive Impairment
 Clumsiness/frequent falls
 Muscle weakness
 Fatigue
 Difficulty climbing stairs or hills
 Difficulty rising (Gower’s sign)
 Difficulty walking/running

37.  Duchenne (most common)
 Becker
 Emery-Dreifuss
 Limb-girdle
 Fascio-scapulo-humeral
 Distal Oculopharyngeal

38.  Stage 1: Early/pre-symptomatic
 Stage 2: Early ambulatory (walking)
 Stage 3: Late Ambulatory (going off feet)
 Stage 4: Early non-ambulatory
 Stage 5: Late non-ambulatory
 Stage 6 Palliative Cares / End of Life.

39. Surgeries
 Tendon releases
 Achilles tendon
 Need KAFO to
walk post-op
 Relieves pain and
allow shoe wear
 Hamstring and
iliotibial band
 Scoliosis – spine
stabilization
 Assisted noninvasive
ventilation
 Assisted ventilation
with tracheostomy
 Overweight and
underweight are
common
problems
 Dysphagia
Breathing & Nutrition

40. Settings:
 Inpatient Rehab
 Outpatient
 Home Health
 Long-term care/SNF
Consideration in the OT
Evaluation Process:
 Motor skills
 Fatigue/endurance
 Functional mobility
 ADL and iADL
performance
 Leisure interests
 School Function
Assessment (SFA)
 Assistive technology needs

41. Treatment
To improve breathing:

42.  Stretching exercises
and postural changing
to maintain functional
performance skills
 Stretching to the most
contracture prone
muscle groups
 AFOs at night to
supplement
Preventing Contractures

43. Goals:
 Maintain or improve muscle strength and
maximize functional ability
 Avoid muscular damage by overwork or injury
 Voluntary active exercise such as
swimming/hydrotherapy or cycling in ambulatory
children currently recommended (supports leisure
pursuits)

44. -Walking orthoses – KAFO
-Standing frames, standing wheelchairs,
walker
-Transfer board
-Wheelchair – power needed for
independence
-Eventually need indoor lift, van with lift,
roll-in shower
-Splinting and therapy to prevent hand
contractures

45.  Toileting- Rails & raised
toilet seat/toilet frame
 Bath board/shower aids
 Hoyer Lift- preferably
ceiling track
 Long-handled
brush/comb
 Shaving, combing hair,
cleaning teeth- weight
and type of grip.
 Basin- wheelchair access

47.  Elevate plate height, rocker knives
to minimize the amount of active
arm, wrist, hand movement.
 Use plate guards/high-rimmed
plates to prevent spillage and assist
loading a fork or spoon.
 For drinking, try sports bottles with
long straws
 Mobile arm supports

48.  Neater Eater
 Neater Snacker

50.  Postural support (seating Systems, Thoracic
Lumbosacral Orthosis)
 Pressure relief
 Tilt systems to reduce effects of gravity
 Arm troughs

51. Making Real Sense
of the Senses
by Mattie Stepanek
Our eyes are for looking at things.
But they are also for crying
When we are very happy or very sad.
Our ears are for listening,
But so are our hearts.
Our noses are for smelling food,
But also the wind and the grass and
If we try really hard, butterflies.
Our hands are for feeling,
But also for hugging and touching so gently.
Our mouths and tongues are for tasting
But also for saying words, like
"I love you" and “Thank you God, for all of

53. Which of the following is a true statement about
Duchenne Muscular Dystrophy?
A. The mother carries the recessive gene and passes it to
her child.
B. The condition is most often diagnosed in middle
aged females.
C. 2/3 of those diagnosed have a previous family history
of the condition.
D. Four types of the disease have been identified.

54.  EndDuchenne Project-
http://www.parentprojectmd.org/site/PageServer?
pagename=understand_about
 Journey of Love: A Parent’s Guide to Duchenne
Muscular Dystrophy [online]. 2004. Available ata
http://www.mdausa.org/publications/journey/5.ht
ml
 Muscular Dystrophy Association (MDA) -
https://www.mda.org

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