Additional Neuromuscular conditions Flashcards
HEALTH CONDITION and BSF IMPAIRMENTS (Bells Palsy)
- Affects CN VII due to infection
- Motor loss is more marked than sensory loss
- Peripheral nerve damaged
- Full or near full recovery expected
- Not progressive
- Results in hemifacial paralysis
- Presents unilaterally
Medications (Bell’s Palsy)
- Steroids
- Anti-virals
HEALTH CONDITION and BSF IMPAIRMENTS (Trigeminal Neuralgia)
- Brief intense bursts of pain within a distribution of the nerve (typically V2)
- Affects CN V
- Sensory affected only
- Peripheral nerve damaged
- Not progressive
- Full or near full recovery expected
- Results in severe hemifacial pain
- Pain control needed
- Presents unilaterally
Medications (Trigeminal Neuralgia)
- Neuropathic pain meds are used (Gabapentin)
HEALTH CONDITION and BSF IMPAIRMENTS (Diabetic Neuropathy)
- The most common metabolic neuropathy
- Peripheral nerve is damaged
- Progressive disorder from distal to proximal
- Symmetrical sensory and motor loss
- LEs affected more than UEs
- May develop a “Charcot foot” described as severe pes cavus, clawed toes and potential bony collapse
Pathogenesis of Diabetic Neuropathy
- Vascular changes affect peripheral nerves
- Chronic metabolic disturbances affect neurons and Schwann cells
Medications (Diabetic Neuropathy)
- Glucose control
- Insulin if needed
Interventions (Diabetic Neuropathy)
- Prevent foot deformity and skin breakdown
- Fall prevention
- Remediate strength and balance
- Pre-exercise considerations:
- blood glucose, blood pressure, physician clearance
- Proper footwear for support
- Joint mobs and stretching - 1st toe and ankle
- Footdrop:
- Gait and balance training
- Compensate with orthotics and gait aids
HEALTH CONDITION and BSF IMPAIRMENTS (Guillain-Barre Syndrome)
- Typically presents weeks after viral infection
- Immune-mediated disorder
- Peripheral nerve damage (includes myelin sheath and possibly axon)
- First symptom is often paresthesia in toes, followed within hours or days by weakness distally in the legs
- May cause paralysis of respiratory muscles
- Distal to proximal, symmetrical progression
- Progresses initially (ascending phase) but then recovers (descending phase)
- Full or near full recovery expected
- Symmetrical motor loss more than sensory loss
- Schwann cells are the primary targets of attack
Diagnosis of Guillain-Barre Syndrome
- Lumbar puncture for CSF analysis - elevated albumin, mononuclear leukocyte count
- Electrophysiologic studies - Slowed NCVs indicate damaged myelin
- Fibrilations indicate damaged axons
- May have tachycardia, cardiac arrhythmias, and labile blood pressure
Medications (Guillain-Barre Syndrome)
- IV immunoglobulins
- Plasmaheresis
Interventions (Guillain-Barre Syndrome)
- Possible acute rehab
- Prevention and compensation in ascending phase
- Remediation in descending phase
- Progression of more independent mobility
- Recovery takes weeks or months
- Prepared to protect airway if needed
SPECIAL CONSIDERATIONS and BONUS QUESTIONS (Guillain-Barre Syndrome)
CIDP: Chronic Inflammatory Demyelinating Polyneuropathy
HEALTH CONDITION and BSF IMPAIRMENTS (HEREDITARY MOTOR AND SENSORY NEUROPATHY (HMSN)
- Hereditary disorder of the PNS
- Peripheral nerve damage
- Progressive disorder symmetrical distal to proximal
- LEs affected more than UEs
- Begins with a peroneal nerve disorder progressing to the foot and leg - ankle DF and EV affected
- Progresses to weakness and wasting of intrinsic hand muscles then forearms
- Significant disability results
- Sensory and motor loss
- May develop a “Charcot foot” describes as severe pes cavus, clawed toes and potential bony collapse
- Abnormal DTRs
Interventions (HEREDITARY MOTOR AND SENSORY NEUROPATHY (HMSN)
- Prevent foot deformity and skin breakdown, falls, contractures
- Remediate strength and balance
- Strengthen at 40-60% 1RM
- Aerobic training at 70-90% HRMax with intervals
- Muscle flexibility
- Maximize QOL
- Reduce pain
- Supportive footwear
- Compensate with orthotics, gait aids, splinting, wheelchair
Another name for Guillain-Barre Syndrome
Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Another name for Charcot Marie Tooth
Hereditary Motor and Sensory Neuropathy (HMSN)
HEALTH CONDITION and BSF IMPAIRMENTS (Poliomyelitis)
- Infectious disease of the anterior horn cell in the spinal cord
- Initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in limbs
- Distal to proximal
- May cause paralysis of respiratory muscles
- Affects the whole LMN
- Motor loss only
- Significant disability results
- Asymmetrical weakness
- LEs affected more than UEs
Interventions (Poliomyelitis)
- Prevent deformity, contractures, falls, skin breakdown, deconditioning
- Remediate aerobic conditioning, functional strengthening at submaximal intensity and avoid fatigue
- Compensate with orthotics, gait aids, wheelchair, energy conservation
HEALTH CONDITION and BSF IMPAIRMENTS (Postpolio Syndome)
- Caused by a loss of motor units that became too large and metabolically taxing after initial recovery from an infectious disease
- New neuromuscular weakness decades after initial infection
- Anterior horn cell initially damaged, affecting the whole LMN
not technically progressive, but occurs with age - Significant disability results
Interventions (Postpolio syndrome)
- Prevent deformity, contractures, falls, skin breakdown, deconditioning
- Remediate aerobic conditioning, functional strengthening at submaximal intensity and avoid fatigue
- Compensate with orthotics, gait aids, wheelchair, energy conservation
HEALTH CONDITION and BSF IMPAIRMENTS (Myasthenia Gravis)
- Chronic peripheral autoimmune disease of the neuromuscular junction
- Fatigue major limiting factor
- Skeletal muscle weakness that worsens after periods of activity
- Number of Acetylcholine receptors is decreased and those present are flattened and less efficient
- Typically mild disability results
- Causes skeletal muscle weakness with intact DTRs and intact sensation
Medications (Myasthenia Gravis)
AChE inhibitors
Plasmapheresis
Interventions (Myasthenia Gravis)
- Aerobic exercise in intervals
- Strengthening
- Monitor vital signs with exercise
SPECIAL CONSIDERATIONS and BONUS QUESTIONS (Myasthenia Gravis)
- Fatigue is common
- Classically presents with ptosis
- Myasthenic crisis possible - medical emergency requiring ventilation
