3.1 Transverse Myelitis

Question 1

PT treatment for someone on a vent

Answer 1

• PROM
• positioning
• education of family, nursing

Question 2

PT for someone awake on a vent

Answer 2

• early mobilization
• getting them to a chair and sitting on the edge of the bed if they’re too weak to walk
• prevention of skin breakdown

Question 3

PT for someone on a vent: What should you remember if they’re below a 3/5?

Answer 3

don’t push them too hard

• could create additional problems
• can’t go against gravity
• do AAROM exercises or isometrics

Question 4

What type of injury is transverse myelitis?

Answer 4

• SCI

- typically have better outcome than SCI pts

Question 5

What is inflamed with TM?

Answer 5

spinal cord

Question 6

causes of TM

Answer 6

• don’t really know why it happens
• once you have it once, higher likelihood of getting it again
• viruses (epstein barr)
• autoimmune
• could be virus/bacteria that causes autoimmune, etc.

Question 7

diagnosing TM

Answer 7

• MRI, CT will show inflammation
• ASIA scale will show the point of most inflammation
• spinal tap

Question 8

purpose of spinal tap

Answer 8

• pull fluid out and see what’s going on with CSF

- start ruling out

Question 9

TM onset

Answer 9

• some pts have gradual onset

- some have rapid onset

Question 10

TM age range

Answer 10

• teens to 40s, 50s

- 1500 new cases per year

Question 11

progression of healing of TM

Answer 11

• period of weakness, get better over time
• the sooner we get things back initially, gives us an idea that they’re going to get better
• window for healing gets smaller if there’s long periods at beginning with no change

Question 12

treatment for TM

Answer 12

steroids to deal with inflammation

Question 13

spinal tap process

Answer 13

laid on the side, flexed to open space, big needle shoved in to suck out fluid

Question 14

What can happen as a result of spinal tap?

Answer 14

sometimes get a CSF leak because of the hole

• may have some yellowish leakage
• severe headache, worst sitting up (CSF pools down)

Question 15

treatment for CSF leak

Answer 15

blood patch: to fill up the hole that was made

Question 16

CIDP

Answer 16

chronic inflammatory demyelinating polyneuropathy

Question 17

What is CIDP?

Answer 17

long term version of GBS

• not a constant chronic, waxing and waning presentation
• demyelination of nerves and get weakness, just like GBS

Question 18

treatment for CIDP

Answer 18

plasmapheresis

Question 19

How is CIDP most commonly diagnosed?

Answer 19

most are dx with GBS and get symptoms again

Question 20

CIDP plateau phase

Answer 20

plateau phase isn’t as long as with GBS

• more rapid recovery
• may or may not get back to where they were before
• slow tapering and loss

Question 21

Does CIDP ever go away?

Answer 21

no

Question 22

critical illness polyneuropathy

Answer 22

• changes in nerves in people who are laid up in an ICU bed beyond atrophy
• pts in ICU bed more than 7 days are having changes at the nerves

Question 23

What is the cause of critical illness polyneuropathy?

Answer 23

• muscles have been denervated

- smaller motor units

Question 24

critical illness polyneuropathy recovery

Answer 24

most people recover fully, but it takes a long time

Question 25

PT for critical illness polyneuropathy

Answer 25

• typically do functional activities, not one muscle at a time
• there’s a lot to work on, get the most out of a session