MOTOR NEURON DISEASES Flashcards
Where are the cell body of LMN’s
Anterior/Ventral horn
What occurs in amyotrophic lateral sclerosis
unknown aetiology; progressive degeneration of corticospinal tracts, anterior horn cell (UMN and LMN)
What is polyneuropathies
Damage occuring to axon, myelin sheath, cell body, supporting CT, nutrient blood supple to nerves, and effect sensory or motor nerves
What is an examply of polyneuropathies
Guillain Barre Syndrome
HIV/AIDS
What is mononeuropathies? ex?
Damage of a single peripheral nerve; motor and sensory
Peripheral nerve injury
Nerve entrapment
what is guillain-barre syndrome?
- Rare rapid-onset autoimmune disorder, attaching the myelin sheath and axons themselves of the peripheral nerve system
What nerve types are affected in guillain-barre syndrome?
- Peripheral sensory and LMN
guillain-barre syndrome Cause?
unknown
often preceded by an infectious illness
guillain-barre syndrome presentation?
Weakness and tingling in your extremities (1st) eventually paralyzing your whole body
guillain-barre syndrome treatment?
Plasmaphoresis and high dose immunoglobulin therapies
When does point of greatest weakness or paralysis occur in guillain-barre syndrome?
days or weeks after first symptom
guillain-barre syndrome prognosis?
- Better in <40
- ~1/5 individual unable to walk unaided after 6month
- Chronic pain and fatigue
- ~30% have residual weakness after 3 years
Poliomyelitis cause?
Viral infection of the PNS leading to destruction at the anterior horn and in turn muscle weakness (most often in legs)
in Poliomyelitis __% have minor symptoms that remain
25%
Many recover completly
relevance of Poliomyelitis?
rare 37 cases in 2016
cure Poliomyelitis?
no cure prevention through vaccine
Post Polio Syndrome prevalence
affects 25-40% of individuals who suffered an acute attach of poliomyelitis
When do symptoms appear in Post Polio Syndrome
15-30 years after original disease
Post Polio Syndrome presentation
slow, progressive onset of lasting muscle weakness
ALS cause?
unknown
ALS? whats happening?
Progressive, ultimately fatal disorder that disrupts signals to all muscles
UMN and LMN signs
Symptoms notices first in arms and hands, legs or swallowing mscles
Bilateral distribution of muscle weakness + atrophy
Speech and respiratory muscles effected
Sensation + bladder + ocular muscles is spared
Average survival of ALS
2-5 years. 25% of cases survive 5-10 years especially if ventilated
ALS Incidence
40-60 yr old men (2:1 to women
How many stages in ALS
1-6
1 least progression
6 most
which stages of ALS are wheelchair dependent
4,5,6
which stages of ALS are ventilated
6
is PD UMN or LMN
UMN
Cardinal features of PD
Rigidity
Bradykinesia
Tremor
Later stages: postural instability
PD is the ___ most common neurodegenerative disorder
2nd
Average age of onset for PD
50-60 years
PD PT management
- Medications - treat when on
- CV fitness
- Posture
- Use of external cues (visual, auditory, tactile)
- Use of internal cues
- Momentum
- relaxation
Minimize mm inbalance/maintain strenth - Movement reeducation - reinforce biomech essentials
- Maintain PROM/extensibility
- Educate
What is multiple sclerosis
An autoimmune disease of the CNS of unknown cause
What occurs physiologically in MS
Damage targeted to myelin sheath causes inflammation and interruption of nerve impulses
Is MS Progressive? Reversible?
yes
no
4 types of MS
- Progressive relapsing
- Secondary progressive
- Primary progressive
- Relapsing remitting
Does canada have a high incidence rate of MS?
Yes on of highest in world
1000 new cases each year
Incidence of MS increases with…
Distance from equator
Age of onset for MS?
20-40 3:1 ratio of women>men
Symptoms of MS
- Variable
- Chronic, disabling, unpredictable
- May efect mental function, strength, sensation, balance, functional mobility, ADLs
- Visual, vestibular, and cerebellar disturbances
First symptom reported in MS
Sensory
Motor
Visual
Fatigue
How do we intervene with degenerative disease
- Be sensitive to client’s health care status and prognosis
- Be aware of course of disease/progression
- be aware of where client is at mentally/physically/emotionally
- Client-centered goal setting
- QOL
- Activity and participation goals
- Maintenance of function for as long as appropriate
- CV health, positioning, comfort in later stages
- Be aware of medication and timing of intervention
PT management of later stage chronic deteriorating neurological conditions is similar to …
the earlier stage management of acute recovering neurological conditions
PT management of earlier stage chronic deteriorating neurological conditions is similar to …
later stage management of acute recovering neurological conditions
UMN in the facial nerve (CNVII) lesion above the pons leads to…
paralysis of the inferior 1/4 of the face contralateral to the lesion
LMN lesion in the facial nerve below the pons leads to
paralysis of the ipsilateral half of the face (upper + lower quadrants) ipsilateral to the lesion
What is the treatment for complete peripheral nerve lesions of the facial nerve
Recovery not possible Maintain range Maintain circulation Mouth care Eye care
What is the treatment for a incomplete peripheral nerve lesion of the facial nerve
recovery possible Maintain range Maintain circulation Mouth care Eye care Muscle retraining exercises Goal = symmetry
What is the treatment for a upper motor neuron lesion of the facial nerve
Recovery cannot be predicted
Incorporate treatment from complete/incomplete peripheral nerve lesions
