(1) Polyneuropathies Flashcards
What are neuromuscular diseases?
They are a group of diseases that originate from the anterior horn of the spinal cord to muscle (i.e motor unit)
What structures are involved in neuromuscular disease?
- anterior horn sc
- nerve
- neuromuscular junction
- muscle
What are polyneuropathies and where do they occur?
they are damage to multiple nerves and occur in the nerve fibre
What is poliomyelitis and where does it occur?
It is a viral infection in the anterior horn of the sc causing nerve injury leading to partial or complete paralysis
Where does motor neurone disease (MND) occur?
Anterior horn cell of the spinal cord
What are motor features of a polyneuropathy?
- LMNL distal to proximal
- Hypotonia
- muscle wasting
- decreased/absent reflexes
- fasciculation
- ataxia and deformity
- decreased motor nerve conduction velocity
What are sensory features of a polyneuropathy?
- proprioceptive deficit
- charcot joints
- painful or painless
- decreased sensory nerve conduction velocity
What are some autonomic features of a polyneuropathy?
- Trophic changes to the skin
- postural hypotension
- gastroparesis
What is involved in the neuro Ax for a polyneuropathy?
- observation
- ROM
- muscle strength
- sensation
- functional ability
- balance
- gait
What is some treatment for the motor symptoms of polyneuropathies?
- strengthening & endurance
- advice and educate (overuse)
- positioning
- splints
What is some treatment for sensory symptoms of polyneuropathies?
- desensitisation
- TENS
- regular foot checks
- joint protection/splints
- balance training
What are the two types of Diabetic Neuropathy?
- Distal Symmetrical Polyneuropathy
- Mononeuropathy
What are the symptoms of distal symmetrical polyneuropathy?
- weakness and sensory impairment distally
- LL numbness
- tropic changes
- loss ankle jerk
- ulceration and amputation
- ataxic gait
What are the signs of mononeuropathy?
- older patients
- muscle weakness
- nerve trunk supplying pelvis & legs
- atrophy proximally
- sharp, stabbing pain
- mild sensory changes
What is the pathology of diabetic neuropathy?
- alters metabolic activity of schwann cells
- ischaemic changes
- demyelination of peripheral nerves
What is the physio treatment of diabetic neuropathy?
- skin care and protection
- strengthening
- reduce/prevent deformities
- improve gait pattern
What does rehab look like for diabetic neuropathy?
- strengthening
- standing balance
- stretching
- sensory rehab
What is Guillain-Barre Syndrome?
- acute ascending demyelinating polyneuropathy
- 20-50 yrs
- body’s immune system attacks itself
- appears days/weeks after infection
What are symptoms of Guillain-Barre Syndrome?
-paralysis of both sides body
- ascending symmetric limb weakness
- hypotonia
- dysarthria & dysphagia
- loss reflexes
- resp weakness
- muscle tenderness & pain
- paraesthesia
What is the course of Guillain-Barre Syndrome?
- worsens from several days to 3 weeks
- periods stability
- rapid deterioration motor
- viral type illness
- resp compromise
- acute vs recovery phase
- length illness unpredictable
What are investigations that lead to a suspected Guillain Barre Syndrome?
- Nerve velocities reduced
- CSF protein content raised
- demyelinisation
What is the physio management for Guillain Barre Syndrome?
- maintain clear airways, ROM, circulation
- pain management
- consider comms
- prevent resp complications, deformity, pressure sores
What is involved in the recovery phase from Guillian Barre Syndrome?
- Resp & CV care
- ROM & muscle length
- Strength
- Transfers & bed mobility
- Standing
- Sit to stand
- Mobilisation
- ADLs & independence
What is chronic inflammatory demyelinating polyneuropathy (CIDP)?
- gradual autoimmunological onset
- common 50s & 60s
- 65% relapsing & remitting
- hx preceding infection or immunisation
What are the signs of CIDP
- symmetrical motor & sensory loss
- proximal to distal weakness
- loss tendon reflex
- severe fatigue
What are the investigations for CIDP?
- raised CSF protein
- slowing motor conduction velocities
- demyelination
What is the physio treatment for CIDP?
- maintain clear airways, ROM, circulation
- pain management
- consider comms
- prevent resp complications, deformity, pressure sores
What is Charcot Marie Tooth Disease?
- aka peroneal muscle atrophy
- genetic disorder
- demyelination
What is the clinical course of Charcot Marie Tooth Syndrome?
- 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
What are the signs of Charcot Marie Tooth Disease?
- wasting spreads proximally stops at elbow & mid thigh
- fasciculations
- loss tendon reflexes
- stocking/glove distribution
- problems with ambulation
What is the physio treatment for Charcot Marie Tooth Disease?
- Maintain ROM, strength, balance, function
- orthoses
- joint protection
- skin care & protection
- footwear
