Neurological, Musculoskeletal, and Otologic Disorders: Pathophysiology and Key Interventions

Part one: Neurological Disorders

Parkinson's Disease

· Pathophysiology: Chronic, progressive neurodegenerative disorder caused by the destruction of dopamine-producing neurons in the substantia nigra. Result: Dopamine depletion (inhibitory) and relative Acetylcholine excess (excitatory).

· Classic Tetrad (TRAP):

Tremor (pill-rolling, occurs at rest)

○ Rigidity (cogwheel resistance to passive movement)

○ Akinesia / Bradykinesia (slowness of movement, masked facies)

Postural instability (shuffling gait, propulsive gait)

· Key Interventions:

○ Administer Carbidopa-Levodopa on time (Carbidopa prevents peripheral breakdown of Levodopa). Avoid high-protein meals at the time of dose (competes for absorption).

o Implement fall precautions; encourage a wide-based gait and rocking side-to-side to initiate walking.

Multiple Sclerosis (MS)

· Pathophysiology: Autoimmune, progressive demyelination of the central nervous system (brain and spinal cord), leading to interrupted nerve impulses. Characterized by remissions and exacerbations.

· Key Symptoms:

o Visual disturbances (diplopia, blurred vision, optic neuritis).

Fatigue, muscle weakness, ataxia, and intention tremors.

o Lhermitte's sign: Electric shock-like sensation running down the spine with neck flexion.

· Key Interventions:

During acute exacerbations, administer high-dose Corticosteroids. ○

○ Patient Education: Avoid triggers that cause exacerbations (stress, fatigue, infection, and increased body temperature/hot baths-known as Uhthoff's phenomenon).