Path 2: Nervous System II

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JennieF
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Path 2: Nervous System II
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2013-07-17 12:47:41
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pathology nervous system massage therapy
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  1. Toxoplasmosis
    Parasite in rat intestines, cat eats rat, cat poop, parasite now in cat poop
  2. Neoplasms of the Central Nervous System (definition of a neoplasm)
    • Tumors that originate within the CNS, malignant or benign, can lead to serious complications, even death, as a result of compression of vital structures
    • *Any kind of tumor in brain can be deadly
  3. Astrocytomas
    • Most common tumor occuring in adults
    • Most aggressive & malignant with death usually occuring 1 year after diagnosis
    • Found most often between 40-60 years of age
    • Come from astrocytes
  4. Glioblastoma
    is the most common type of astrocytoma
  5. Astrocytes
    are responsible for the blood/brain barrier
  6. Oligodendrogliomas
    • Rare with a good prognosis
    • Occur within cerebral hemisphere
    • In adults ages 30 to 50
    • Grows slow & often presents with seizures
    • Are responsible for myelin production
  7. Ependymomas
    • uncommon
    • occuring at all ages
    • low grade, slow, malignant tumor that can spread through the CSF
    • triggers hydrocephalus secondary to obstruction of the 4th ventricle
    • ependymal cells are responsible for circulation of CSF
  8. Meningiomas
    • occur in any age, most often in middle aged women (2:1)
    • an encapsulated tumor that arises outside the brain substance & attaches to dura
    • typically benign, found along the external surfaces of the brain & within the ventricles
  9. Multiple Sclerosis (MS)
    • most common demyelingating disease of the CNS
    • most likely an autoimmune disease
  10. MS Incidence
    • geographical residence 1/1000 in the U.S.
    • 2:1 females to males
  11. MS pathology
    relapsing & remitting disease; the incomplete recovery from each episode leads to a progressive deterioration
  12. MS Structural Alterations
    Inflammatory reaction with poor resolution, incomplete remyelination, forming the chronic plaque
  13. MS Clincal Manifestations
    manifestitions include: paresthesias, spasticity, gait abnormalities, and speech problems
  14. MS Prognosis
    average life expectancy 20-30 years after diagnosis
  15. Massage for MS (FYI)
    • massage can be really helpful
    • their symptoms can change, take note of what type of massage (relax, stiff joints etc.)
    • avoid contrast treatments
    • shorter sessions
  16. Dementia
    • is not part of normal aging
    • loss of cognitive function
    • causes can be not enough stimulation
  17. Alzheimer's Disease
    • Unknown etiology
    • most common cause of dementia
    • lose chunks of brain tissue
    • 3% of ages 66-74, 19% of ages 75-84, 47% of ages >85
    • 2:1 female to male
  18. Alzheimer's Disease Pathology
    • characterized by plaques (heuritic) & tangles (neurofibrillary)
    • there is a cortical atrophy & a widening of the venticles
  19. Alzheimer's Disease Functional Significance
    • Progressive impairment of memory and other cognitive features over 5-15 years
    • forgetfulness
    • memory loss
    • speech difficulties
    • leading ultimately to dementia
    • incontinence
    • loss of speech
    • the ability to walk
  20. FYI Massaging Client with Alzheimer's
    • Informed Consent by someone they know
    • Having that person there with them, in case they can't remember why you are working on them
    • relaxation massage
    • be cautious of bed sores
  21. Parkinsonism
    • Depigmentation of the substantia nigra with loss of neurons
    • 2% of population in N. America, affecting more men than women
  22. Parkinsonims functional significance
    • Disturbance of motor functions:
    • rigidity
    • expressionless faces
    • stooped posture
    • gait disturbances
    • slowing of voluntary movements
    • characteristic pill rolling tremor
  23. Massage for Parkinsonism FYI
    • Helps to lengthen flexors
    • good position is prone to counteract flexion
    • rhythmic & repeatative strokes help brake up px cycle
  24. Huntington's Disease
    • disorder involving the extrapyramidal motor system (controls motor activities associated with maintaing balance & posture)
    • characterized by involuntary writhing movements (choreal) and demetia
    • not apparent until adulthood between the ages 40-50
    • relentless progression
    • death occurring within 15 years at onset
    • cognitive & emotional disturbances precede onset of abnormal movements
  25. Huntington's Disease Functional Significance
    • eventually incapsulated by movements with a severe loss of cognitive function & deteroration of intellect.
    • paranoia & delusions are often present
    • increased risk of suicide
    • infections the most common cause of natural death
  26. FYI Massage for Huntington's Disease
    Work closely with a physician
  27. Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrigs Disease
    • Unknown etiology
    • a progressive, degenerative disorder of the pyramidal system (control skeletal muscle movements)
    • 5-10% of cases familial
    • relentless progression
    • begins as weakness of the hands & clumsiness
  28. Amytrophic Lateral Sclerosis Functional Significance
    • median survival 5 yrs
    • death comes secondary to respiratory insufficiency
    • cognitive function often preserved throughout the course of the disease
  29. Acquired Metabolic Deficiences
    • Thiamine Deficiency (vitamin B1)
    • B12 Deficiency
    • Carbon Monoxide
    • Ethanol
  30. Thiamine Deficiency (Vitamin B1)
    • Development of abrupt psychotic symptoms
    • usually associated with alcoholism (alcohol interferes with metabolism)
  31. FYI Subcategory of thiamine deficiency : Wernicke encephalopathy
    fairly rapid onset of confusion, ataxia
  32. FYI Subcategory of thiamine deficiency : Korsakoff syndrome
    permanent memory deficit
  33. B12 Deficiency
    • severe & irreversible injury within the nervous system
    • sensory & motor problems with lower extremities, may ultimately lead to paraplegia
    • *vegetarians, vegans etc need to be super careful
  34. Carbon Monoxide
    Hypoxia
    • CO gets "stuck" on red blood cell, replacing O2
    • exhaust fumes
    • severe cases - blood transfusion
  35. Ethanol (alcohol)
    • directly toxic to CNS tissue
    • chronic alcohol abuse leads to irreversible injury
  36. The Purpose of Pain
    Possible Essay Question
    • Pain is primarly a protective mechanism meant to bring to conscious awareness the fact that tissue damage is occurring
    • accompanied by motivated behavioral responses (such as withdrawal or defense)
  37. Pain Receptors (3)
    • 1. Mechanical nociceptors: respond to mechanical damage such as cutting, crushing, or pinching
    • 2. Thermal nociceptors: respond to temperature extremes, esp heat
    • 3. Polymodal nociceptors: respond equally to all kinds of damaging stimuli, including irritating chemicals released from injured tissues

    • They are all naked nerve endings
    • Do not adapt to sustained or repetitive stimulation
    • all other nociceptors can be sensitized by the presence of prostaglandins
    • FYI: pain medication makes sensor to brain become smaller
  38. The Brain's Opiate System
    • endorphins & enkephalins - neurotransmitters involved with pre and post synaptic px inhibition for up to hrs after release
    • multiple receptor sites within the brain and can partially or totally suppress many px signals entering through the peripheral nervous system.
  39. Types of Pain
    • Fast Pain: felt within 0.1 seconds after stimulus. Described as sharp, acute, electric, and stays within the skin.
    • Slow Pain: felt 1+ seconds after stimulus and grows slowly for up to several minutes. Described as burning, aching, throbbing, nauseating and involves tissue destruction.
  40. Mechanism of Referral Pain
    • Px felt @ site separate from the tissue causing px
    • Px initiated @ visceral organ is referred to an area of the body surface. Important in clinical diagnosis.
    • Branches of px fibers from the viscera (organs) synapse in the spinal cord with the same neurons that receive px from the skin.
  41. Causes of true visceral px
    • Ischemia
    • Chemical Stimuli
    • Spasm of a hollow viscus
    • Over distention of a hollow viscus
  42. Ischemia
    • lack of blood flow
    • leads to px of the viscera in the same way it works in other areas of the body, the acidic metabolic end products
  43. Chemical Stimuli
    Leaks
  44. Spasm of hollow viscus
    mechanical stimulation of px fibers leads to ischemia & cramps
  45. Over distension of a hollow viscus
    extreme overfilling leads to collapse of blood vessels and ischemia
  46. Headache of the Intracranial Origin
    • the brain itelf is almost insensitive to px
    • stretching dura at the base of the brain can lead to a headache
    • any trauma, stretching, crushing of blood vessels of the meninges and brain lead to px
  47. Headache of Meningitis
    • most severe of all headaches
    • inflammation of the meninges and the venous sinuses
  48. Headache Caused by Low CSF Pressure
    brain no longer floats causing the weight of the brain to stretch and distort the dural surfaces
  49. Migraine headache
    • vascular problems
    • begins with various prodromal sensations including: nausea, partial loss of vision, visual aura, and other types of sensory hallucinations (sensitive to light, sound, smell etc.)
    • prodomal symptoms usually begin 1/2 to 1 hr before the headache
  50. Alcoholic headache
    • result of alcohol
    • directly toxic to tissues
    • directly irritating the meninges
    • dehydration factor
  51. Tension headache
    • most common
    • contraction of neck and scalp muscles often as a result of stress, depression and anxiety
  52. Cluster headaches
    • affect one side of the head
    • occur in clusters, often at the same time of day, every day for weeks
  53. Stress
    a change in the environment that is preceived as a threat, challenge, or harm to the person's sense of balance
  54. Relaxation Therapy
    (Possible Essay)
    Breathing
    Muscle Relaxation
    Autogenic training
    Guided imagery
    Distraction
    • Breathing: simple technique, breath slow & deep while avoiding hyperventilation
    • Muscle Relaxation: progressively tense & relax muscle groups until body feels relaxed
    • Autogenic training: replace painful or unpleasant sensations with pleasant ones through autosuggestion
    • Guided Imagery: Take a mental vacation
    • Distraction: use your own interests & activies to divert attention

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