100. CCA Study Notes: Nervous System Disorders, Effects, and CCA Support

The Big Picture

The nervous system carries signals between the brain and the body. A nervous system disorder might affect movement, touch, vision, hearing, bowel and bladder control, thinking, learning, memory, or problem solving.

Some disorders affect movement more than thinking. Others affect memory, communication, emotions, senses, or several functions at once. The effects depend on the disorder and the part of the nervous system involved.

For CCA study, focus on what each disorder means, its important signs and effects, emergency situations, and the support a client needs.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

How Nervous System Disorders Affect the Body and Mind

The nervous system sends signals between the brain and the rest of the body.

Physical functions include:

• moving
• touching
• seeing
• hearing
• controlling the bowel and bladder

Cognitive functions involve the mind. They include thinking, reasoning, understanding, remembering, learning, reading, and problem solving. Nervous system disorders affect physical functions, cognitive functions, or both.

Epilepsy and Seizures

Epilepsy is a group of neurological ⓘ disorders involving recurrent episodes such as seizures, sensory disturbances ⓘ, abnormal behaviour, loss of consciousness, or a combination of these features.

A seizure starts when a burst of electrical energy produces temporary changes in the brain. The seizure might affect awareness, movement, or sensations.

Seizures do not all look the same. One person might have sudden muscle contractions, tremors, uncontrolled movements, and loss of consciousness. Another person might have such a subtle seizure that others do not notice it.

A seizure might involve the whole brain or one part of the brain. Some people experience an aura, which acts as a warning before the seizure starts.

Key fact: A single seizure does not mean a person has epilepsy. Epilepsy involves seizures that recur.

Causes Linked With Epilepsy

Known causes include:

• brain injury before, during, or after birth
• lack of oxygen before, during, or after birth
• problems with brain development before birth
• injury or infection during pregnancy
• head trauma from accidents, gunshot wounds, sports injuries, falls, or blows to the head
• chemical imbalance
• poor nutrition
• brain tumour
• childhood fevers
• poisons such as lead and alcohol
• infections such as meningitis and encephalitis
• stroke

Children and young adults commonly experience epilepsy, but it develops at any point in life. Epilepsy can also develop because of a condition affecting the brain, including cerebral palsy, developmental disability, autism, or Alzheimer’s disease.

There is no cure for epilepsy at this time. Medication normally controls it. Surgery has been used for severe, uncontrolled seizures.

When epilepsy stays controlled, it usually does not affect learning or the ability to perform activities of daily living, or ADLs. Severe cases might limit activities or job choices, including driving. Provinces and territories have regulations for driver’s licences for people with epilepsy.

What the CCA Should Do During a Seizure

The CCA’s responsibility is to protect the client from self-injury.

1. Stay with the client and call for assistance.
2. Lower the client to the floor, if possible, and move nearby objects away.
3. Move the client away from sharp edges.
4. Place something soft under the client’s head.
5. If possible, move the client onto their side to reduce the risk of asphyxiation from choking on vomit.
6. If you cannot move the client onto their side, gently try to move the head to the side. Do not force any body part to move.
7. After the seizure ends, place the client in the recovery, or three-quarter prone, position.
8. Check the client for injury.
9. Call emergency services immediately if the seizure lasts longer than 5 minutes or if seizures follow one after another.

Never: Put anything in the client’s mouth during a seizure. This action might injure you or the client. The client will not swallow their tongue, although they might bite it.

After a Seizure

The client might feel exhausted or confused afterward. Some clients do not know that a seizure occurred.

Stay with the client until they return to their normal condition. Some clients need help washing or changing clothes after vomiting, voiding, or soiling themselves. Some fall into a deep sleep or experience a headache.

Document: Record the duration of the seizure, the body parts involved, any mannerisms you noticed, and the client’s behaviour after the seizure ended.

Stroke and TIA

A stroke, also called a cerebral vascular accident or CVA, involves a sudden loss of brain function.

Stroke is the fourth leading cause of death in Canada and the leading cause of nervous system disabilities in adults.

A stroke results from either:

• an interruption of blood flow to the brain, often from a blood clot
• a ruptured blood vessel in the brain

When blood flow stops, the affected brain cells lose oxygen and nutrients. Brain injury follows. Functions controlled by the injured area become lost or impaired.

A transient ischemic attack (TIA) is a temporary interruption of blood flow to the brain. A TIA does not leave permanent brain injury, but it is an important warning sign because it sometimes occurs before a stroke.

Safety: A client experiencing a TIA needs immediate medical attention.

Stroke Risk Factors

Risk increases with age. Most strokes affect people aged 65 years or older.

Other supported risk factors include:

• high blood pressure
• smoking
• diabetes
• heart disease
• high blood cholesterol
• lack of exercise
• high alcohol intake

Men have a slightly higher risk of stroke than women, while more women than men die from stroke.

Warning Signs of a Stroke

A stroke is a medical emergency. Call emergency services.

Watch for sudden:

• weakness, loss of strength, or numbness in the face, arm, or leg, even if temporary
• trouble speaking, understanding, or sudden confusion, even if temporary
• vision problems, even if temporary
• severe and unusual headache
• loss of balance, especially when another warning sign appears

Early detection and treatment reduce the risk of lasting effects.

Effects of a Stroke

The effects depend on the area of brain injury.

Possible effects include:

• hemiplegia, which means paralysis on one side of the body
• weakness on one side
• loss of facial muscle control
• changing emotions
• difficulty swallowing, called dysphagia
• dimmed or lost vision
• aphasia, involving loss of speech or difficulty speaking or understanding others
• changes in sight, touch, movement, and thought
• impaired memory
• urinary frequency, urgency, or incontinence

A client might ignore the affected side because movement and feeling on that side have changed. If vision is affected, the client might miss one side of the visual field. The client might eat from only one side of a plate or read only one side of a page.

Some clients no longer recognize familiar objects or know how to use them. They might struggle to tell time, recognize people, learn new information, remember tasks, or perform ADLs.

Emotional and Behavioural Changes After a Stroke

Depression commonly follows a stroke.

Clients might have anger, moaning, laughing, or crying that seems exaggerated or unrelated to what is happening. These reactions sit outside the client’s control.

The CCA should:

• encourage the client to share feelings
• stay patient and kind
• report changes in behaviour or mood to the supervisor

Rehabilitation and Daily Support

Rehabilitation usually starts immediately after a stroke. Many clients improve or regain lost functions.

A physician usually orders speech therapy, physiotherapy, and occupational therapy. A swallowing assessment might provide care-plan directions that reduce the risk of choking and aspiration.

Some clients need self-help devices or partial or total help with care. Most stroke survivors return home and need home care. Others need subacute ⓘ or long-term care.

Clients who need help with ADLs should still do as much as possible for themselves.

Clients who are immobile need skin care to prevent pressure ulcers. Some also follow bowel or bladder control training programs and range-of-motion exercises. Clients with language impairments use established communication methods.

Aneurysms

An aneurysm is a localized expansion and weakness in the wall of an artery or heart chamber.

Aneurysms form in different parts of the body. They often occur in the aorta and also occur in peripheral blood vessels. In older people, the popliteal artery is another common site.

The effect depends on the area that becomes damaged.

Causes include atherosclerosis and hypertension. Less frequent causes include trauma, infection, and a congenital weakness in the vessel wall. Aging and an inherited tendency also relate to aneurysm development.

Clients with aneurysms usually have no symptoms. Many aneurysms get identified during a routine physical examination or X-ray.

Once an aneurysm gets diagnosed, treatment focuses on preventing rupture. A ruptured aneurysm requires surgical repair to stop bleeding.

Brain Aneurysm

A brain, or cerebral, aneurysm is a bulging weak area in an artery that supplies the brain.

Most brain aneurysms cause no symptoms. In rare cases, the aneurysm ruptures and blood escapes into the brain. This bleeding is called a hemorrhage. A rupture might cause a stroke, brain damage, or death.

The most common location is the network of blood vessels at the base of the brain.

Risk factors include:

• family history of brain aneurysm
• a previous brain aneurysm
• being a woman
• African descent
• high blood pressure
• smoking

A ruptured brain aneurysm often produces sudden symptoms. Call emergency services immediately for:

• a sudden severe headache that differs from previous headaches
• neck pain
• nausea and vomiting
• sensitivity to light
• fainting or loss of consciousness
• seizures

Acquired Brain Injury

An acquired brain injury (ABI) is sudden brain damage from an injury or illness. The damage might be temporary or permanent. It is also called traumatic brain injury in Sorrentino.

Causes include disease, medical conditions, head trauma, falls, collisions, assault, concussion, stroke, tumour, lack of oxygen, and illnesses such as meningitis.

Motor vehicle accidents account for most ABIs. Other causes include falls, sports and recreational injuries, violence, work accidents, birth-related conditions, near drowning, choking, suffocation, stroke, and other nervous system injuries.

Brain injury also occurs without visible external injury. Violently shaking a baby is one example. Lack of oxygen destroys brain cells and results in permanent brain injury.

ABI is the fourth leading cause of disability in Canada. More than 160 000 Canadians sustain a brain injury each year. Brain injury is the leading cause of death and disability among Canadians under age 40.

Cognitive Difficulties With ABI

A person with ABI might struggle with:

• attention and concentration
• memory
• orientation to person, place, or time
• decision making
• problem solving
• learning new ideas
• recalling simple words

Physical Changes With ABI

Physical symptoms include:

• headache
• fatigue
• dizziness
• uneven gait
• nausea
• blurred vision or other visual disturbances
• seizures
• changes in sleep patterns
• changes in eating patterns
• impaired senses such as sight or hearing

Behavioural and Emotional Changes

A client with ABI might experience:

• depression
• anxiety
• irritability
• difficulty controlling emotions or impulses
• decreased initiative or motivation
• moodiness
• difficulty sitting still

A severe brain injury might lead to intellectual disability, speech challenges, breathing difficulties, and loss of bowel and bladder control.

ABI affects the client and the family. Some clients need ongoing physiotherapy, speech therapy, occupational therapy, or psychotherapy. Rehabilitation is required, and care depends on the person’s needs and abilities.

Parkinson’s Disease

Parkinson’s disease is a progressive neurological disorder in which cells in certain parts of the brain gradually break down. There is no cure at this time.

The disease usually appears in people over 50 years of age, and symptoms worsen over time.

Major signs and symptoms include:

• tremors that often begin in one finger and spread through the arm
• pill-rolling movements involving the thumb and index finger
• tremors that progress to the legs, jaw, and face
• stiffness in the arms, legs, neck, and trunk
• a masklike facial expression with difficulty blinking or smiling
• a fixed stare
• slow movement
• a slow, shuffling walk
• difficulty lifting the feet
• stooped posture, impaired balance, inability to walk, and increased risk for falls

Other changes include difficulty swallowing and chewing, constipation, bowel and bladder issues, sleep disturbances, depression, and dementia involving memory loss, slow thinking, and emotional changes.

Speech might become slurred, soft, or monotone. Some clients speak too fast or repeat themselves.

CCA action: Give the client enough time to communicate.

Supporting a Client With Parkinson’s Disease

Treatment includes prescribed medications, exercise, and physiotherapy to improve or maintain strength, posture, balance, and mobility.

The client needs regular rest periods. Tiredness and stress worsen symptoms.

The client might need help with ADLs. Care also includes measures that promote normal elimination and safety practices that prevent falls and choking.

Treat the client with dignity and respect. A masklike facial expression does not show the client’s true feelings.

Huntington’s Disease

Huntington’s disease is an inherited neurological disorder. It destroys brain cells and causes uncontrolled movement, emotional changes, and cognitive losses.

Signs and symptoms appear between 20 and 60 years of age.

Early changes include twitching, fidgeting, and clumsiness. Over time, the arms and legs move constantly and walking becomes impossible.

Clients also experience:

• difficulty eating and swallowing
• difficulty completing many ADLs
• slurred speech
• depression
• irritability
• apathy ⓘ
• slower intellectual processing
• loss of attention
• loss of short-term memory
• growing difficulty concentrating on intellectual tasks

There is no cure at this time. There are no treatments that prevent or control the disease.

Support depends on the client’s needs. Follow safety practices to prevent falls, choking, and other accidents. Emotional support has special importance because many clients are relatively young and live in long-term care. More than one person in the same family often has the disease.

Multiple Sclerosis

Multiple sclerosis (MS) is a persistent, slowly progressive disease. The immune system attacks the protective myelin sheaths around nerve cells in the brain and spinal cord.

This process is called demyelination. Damaged areas lose the ability to transmit nerve impulses properly.

Canada has one of the highest rates of MS in the world. Symptoms usually begin between 15 and 40 years of age, and women experience MS more often than men.

The onset is gradual. Symptoms differ greatly between clients and also change within the same client over time. Symptoms improve during periods of remission.

Common Symptoms of MS

Symptoms include:

• blurred vision, double vision, or blindness
• extreme fatigue
• loss of balance
• dizziness
• difficulty walking
• clumsiness
• muscle weakness and stiffness
• tingling, numbness, or a burning feeling in one area
• sensitivity to heat
• difficulty speaking
• difficulty swallowing
• bladder and bowel issues
• impotence or diminished sexual arousal
• short-term memory loss
• difficulty concentrating
• impaired judgement or reasoning

There is no cure at this time. Some medications keep clients in remission for longer periods. Some clients seek alternative treatment methods, including procedures outside Canada.

Support depends on the client’s condition and needs. Early in the disease, home care and help with housekeeping reduce fatigue. As mobility decreases, clients depend more on others. Care includes measures to prevent injury and promote bowel and bladder elimination. Some clients eventually need long-term care.

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a degenerative disease involving loss of motor neurons.

Weakness and muscle wasting begin in areas such as the hands, forearms, and legs, then spread through more of the body and face.

About 3 000 people in Canada live with ALS. It occurs most often between 40 and 70 years of age.

ALS progresses as nerve cells in the brain and spinal cord gradually break down. The rate differs between clients.

The first sign is usually difficulty using the fingers and hands. A client might struggle to pick up a cup, lace shoes, pull a zipper, or fasten buttons.

Walking becomes difficult later, and stumbling and falling become common. Eventually, the person loses muscle control and becomes unable to speak, swallow, move, or breathe independently. Death eventually occurs.

Communication and Support With ALS

Clients with ALS stay alert and think clearly throughout the disease.

Key fact: A client who no longer speaks still understands what other people say.

A speech pathologist might recommend new communication methods. Follow the care plan ⓘ.

Emotional support has major importance because clients remain aware of the disease and its progression. Eventually, clients become confined to bed and are usually placed in a side-lying position.

Spinal Cord Injuries and Paralysis

The spinal cord carries communication between the brain and the rest of the body.

When the spinal cord becomes damaged, nerves stop sending messages normally between the brain and affected body parts. Partial or total paralysis results.

Paralysis means complete or partial loss of the ability to move a body part or muscle group.

Most spinal cord injuries are permanent. Motor vehicle accidents often cause these injuries.

Injury Level and Loss of Function

The location of the spinal cord injury determines which body parts become paralyzed.

Key fact: The higher the injury occurs on the spine, the greater the loss of function.

An injury at the thoracic, or chest, level or lower might cause paraplegia, which means paralysis from the waist down.

An injury in the cervical, or neck, region might cause quadriplegia, which means paralysis of all four limbs and the trunk. Depending on the injury’s location and severity, the client might have paralysis from the neck down.

These clients often need cervical traction and a special bed that keeps the spine straight at all times.

Recent spinal cord injuries require rehabilitation. The rehabilitation program depends on the client’s needs and remaining abilities.

Supporting a Client With Paralysis

Follow the care plan closely.

CCA support includes:

• assisting with ADLs and home management tasks
• following safety measures to prevent falls
• following care-plan directions for bed rails
• keeping the call bell within reach in facilities
• checking the client often when they cannot use the call bell
• encouraging the client to call out for help when unable to use the call bell
• preventing burns by checking bathwater, heat applications, and food temperatures
• turning and repositioning the client at least every 2 hours
• maintaining good alignment
• using supportive devices according to the care plan
• preventing pressure ulcers
• assisting with transfers
• following bowel and bladder training programs
• assisting with range-of-motion, or ROM, and other exercises ordered by the physician
• assisting with food and fluids as needed
• providing ordered self-help devices
• feeding the client when necessary
• following the rehabilitation plan
• giving emotional support

General CCA Support for Nervous System Disorders

Clients living with nervous system disorders might feel frightened about what will happen, experience pain, or feel frustrated when the disorder changes their activities and lifestyle.

Communication and Emotional Support

Listen to the client and communicate with empathy ⓘ. This shows respect.

A client who struggles to move, speak, or show facial expression still deserves patient, respectful communication.

Comfort and Positioning

Use pain-reducing comfort measures.

Keep the client in good body alignment. Make sure the surface where the client sits or lies stays clean, dry, and wrinkle-free.

Report and document: Report and record pain so the client stays comfortable and receives medication according to the care plan.

Confidentiality

Always follow confidentiality rules.

Never discuss the client or details about the client with anyone who is not involved in the client’s care.

Common Mix-Ups

Wrong Idea	Better Idea
One seizure means epilepsy.	Epilepsy involves recurrent seizures.
A TIA leaves permanent brain injury.	A TIA is temporary, but it is an important warning sign and needs immediate medical attention.
Hemiplegia means paralysis from the waist down.	Hemiplegia affects one side of the body.
Paraplegia and quadriplegia mean the same thing.	Paraplegia affects the body from the waist down. Quadriplegia affects all four limbs and the trunk.
A client with ALS who cannot speak cannot understand you.	Clients with ALS remain alert and think clearly, even after speech is lost.