(1) Polyneuropathies

Question 1

What are neuromuscular diseases?

Answer 1

They are a group of diseases that originate from the anterior horn of the spinal cord to muscle (i.e motor unit)

Question 2

What structures are involved in neuromuscular disease?

Answer 2

• anterior horn sc
• nerve
• neuromuscular junction
• muscle

Question 3

What are polyneuropathies and where do they occur?

Answer 3

they are damage to multiple nerves and occur in the nerve fibre

Question 4

What is poliomyelitis and where does it occur?

Answer 4

It is a viral infection in the anterior horn of the sc causing nerve injury leading to partial or complete paralysis

Question 5

Where does motor neurone disease (MND) occur?

Answer 5

Anterior horn cell of the spinal cord

Question 6

What are motor features of a polyneuropathy?

Answer 6

• LMNL distal to proximal
• Hypotonia
• muscle wasting
• decreased/absent reflexes
• fasciculation
• ataxia and deformity
• decreased motor nerve conduction velocity

Question 7

What are sensory features of a polyneuropathy?

Answer 7

• proprioceptive deficit
• charcot joints
• painful or painless
• decreased sensory nerve conduction velocity

Question 8

What are some autonomic features of a polyneuropathy?

Answer 8

• Trophic changes to the skin
• postural hypotension
• gastroparesis

Question 9

What is involved in the neuro Ax for a polyneuropathy?

Answer 9

• observation
• ROM
• muscle strength
• sensation
• functional ability
• balance
• gait

Question 10

What is some treatment for the motor symptoms of polyneuropathies?

Answer 10

• strengthening & endurance
• advice and educate (overuse)
• positioning
• splints

Question 11

What is some treatment for sensory symptoms of polyneuropathies?

Answer 11

• desensitisation
• TENS
• regular foot checks
• joint protection/splints
• balance training

Question 12

What are the two types of Diabetic Neuropathy?

Answer 12

1. Distal Symmetrical Polyneuropathy
2. Mononeuropathy

Question 13

What are the symptoms of distal symmetrical polyneuropathy?

Answer 13

• weakness and sensory impairment distally
• LL numbness
• tropic changes
• loss ankle jerk
• ulceration and amputation
• ataxic gait

Question 14

What are the signs of mononeuropathy?

Answer 14

• older patients
• muscle weakness
• nerve trunk supplying pelvis & legs
• atrophy proximally
• sharp, stabbing pain
• mild sensory changes

Question 15

What is the pathology of diabetic neuropathy?

Answer 15

• alters metabolic activity of schwann cells
• ischaemic changes
• demyelination of peripheral nerves

Question 16

What is the physio treatment of diabetic neuropathy?

Answer 16

• skin care and protection
• strengthening
• reduce/prevent deformities
• improve gait pattern

Question 17

What does rehab look like for diabetic neuropathy?

Answer 17

• strengthening
• standing balance
• stretching
• sensory rehab

Question 18

What is Guillain-Barre Syndrome?

Answer 18

• acute ascending demyelinating polyneuropathy
• 20-50 yrs
• body’s immune system attacks itself
• appears days/weeks after infection

Question 19

What are symptoms of Guillain-Barre Syndrome?

Answer 19

-paralysis of both sides body
- ascending symmetric limb weakness
- hypotonia
- dysarthria & dysphagia
- loss reflexes
- resp weakness
- muscle tenderness & pain
- paraesthesia

Question 20

What is the course of Guillain-Barre Syndrome?

Answer 20

• worsens from several days to 3 weeks
• periods stability
• rapid deterioration motor
• viral type illness
• resp compromise
• acute vs recovery phase
• length illness unpredictable

Question 21

What are investigations that lead to a suspected Guillain Barre Syndrome?

Answer 21

• Nerve velocities reduced
• CSF protein content raised
• demyelinisation

Question 22

What is the physio management for Guillain Barre Syndrome?

Answer 22

• maintain clear airways, ROM, circulation
• pain management
• consider comms
• prevent resp complications, deformity, pressure sores

Question 23

What is involved in the recovery phase from Guillian Barre Syndrome?

Answer 23

• Resp & CV care
• ROM & muscle length
• Strength
• Transfers & bed mobility
• Standing
• Sit to stand
• Mobilisation
• ADLs & independence

Question 24

What is chronic inflammatory demyelinating polyneuropathy (CIDP)?

Answer 24

• gradual autoimmunological onset
• common 50s & 60s
• 65% relapsing & remitting
• hx preceding infection or immunisation

Question 25

What are the signs of CIDP

Answer 25

• symmetrical motor & sensory loss
• proximal to distal weakness
• loss tendon reflex
• severe fatigue

Question 26

What are the investigations for CIDP?

Answer 26

• raised CSF protein
• slowing motor conduction velocities
• demyelination

Question 27

What is the physio treatment for CIDP?

Answer 27

• maintain clear airways, ROM, circulation
• pain management
• consider comms
• prevent resp complications, deformity, pressure sores

Question 28

What is Charcot Marie Tooth Disease?

Answer 28

• aka peroneal muscle atrophy
• genetic disorder
• demyelination

Question 29

What is the clinical course of Charcot Marie Tooth Syndrome?

Answer 29

• begins usually childhood
• first signs claw foot & wasting
• clumsiness gait
• symmetrical wasting leg muscles
• muscle imbalance
• severe sensory loss
• postural sway
• cramps & paraesthesia
• ulceration
• hands affected later

Question 30

What are the signs of Charcot Marie Tooth Disease?

Answer 30

• wasting spreads proximally stops at elbow & mid thigh
• fasciculations
• loss tendon reflexes
• stocking/glove distribution
• problems with ambulation

Question 31

What is the physio treatment for Charcot Marie Tooth Disease?

Answer 31

• Maintain ROM, strength, balance, function
• orthoses
• joint protection
• skin care & protection
• footwear