Neuromus Disorders 3

Question 1

Peripheral Neuropathies Causes

Answer 1

Single: trauma, pressure paralysis, forcible overexten of joint, hemorrhage into nerve, exposure to cold/radiation or ischemic (restriction of blood flow) paralysis. Multiple: collagen vascular disease, metabolic diseases (DM) or infectious agents (Lyme). Other: alcohol, nutritional deficiencies, malignancy, toxic agents/microorganism

Question 2

Peripheral Neuropathies Symptoms

Answer 2

A syndrome of sensory/motor/reflex/vasomotor symptoms. Pain, weakness, parasthesis (pins/needles) in distribution of affected nerve

Question 3

Guillan-Barre Syndrome

Answer 3

Unknown etiology but may occur after infectious d/o, surgery or immunization. Affects both sexes/any age. Onset of recovery is 2-5wks after inital symptoms

Question 4

Long term prognosis of Guillan-Barre Syndrome

Answer 4

50% exhibit mild neurolog deficits, 15% exhibit residual fx’al deficits, 80% are ambulatory after 6mo and only 5% die of complications

Question 5

Guillan-Barre Syndrome Symptoms

Answer 5

Acute, rapidly progressive form of polyneuropathy characterized by symmeteric muscular weakness and mild distal sensory loss/parasthesias. Weakness always most predominant. Sensory symptoms are relatively mild. Deep tendon reflexes are lost/sphincter control spared.

Question 6

Myasthenia Gravis

Answer 6

Diseased caused by autoimmune attack on ACT receptor of postsynaptic neuromus junction; considered disorder of neuromus transmission. Onset at any age: most often older men/younger women. Usually progressive & death may occur from respiratory comps.

Question 7

Myasthenia Gravis Symptoms

Answer 7

Characterized by episodic mus weakness - chiefly mus innervated by CNs. Ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia, prox limb weakness. Symptoms fluctuate over the day. Deep tendon reflexes/sensation in tact. Ability to relapse w quadriparesis

Question 8

Post-Polio Syndrome

Answer 8

Some MN infected w Polio virus die, others survive. Recovered develop new terminal axon sprouts that reinnervate muscle cells. After years of stability, motor units breakdown cause muscle weakness. Typ occurs 15yrs after Polio recovery. Slow to progress and good prognosis.

Question 9

Post-Polio Syndrome Symptoms & Tx

Answer 9

New onset of weakness, easily fatigued, muscle pain, joint pain, cold intol, atrophy, loss of fx’al skills > Bracing, stretching/exercise programs

Question 10

Multiple Sclerosis (MS)

Answer 10

Slowly progressive CNS disease characterized by patches of demyelination of brain and SC. Occurs most often between 20-50yrs. Overall prognosis is variable w unpredictable disease course > multiple CNS lesions & at least 2 episodes of neurolog disturbance. remissions and exacerbation

Question 11

MS Symptoms

Answer 11

Onset usually insidious (gradual but harmful). Parasthesias in one+ extremities/trunk/face. Weakness of hands/legs. Visual/emotional/cog disturbances. Balance loss/vertigo. Bladder dysfunction. Sensorimotor findings.

Question 12

MS Patterns

Answer 12

Relapsing remitting, secondary progressive, primary progressive, progressive relapsing

Question 13

Eval for Neurolog D/o

Answer 13

Determine sensory/motor dysfunction strengths: paralysis/weakness, GM/FM, spasticity, sensory, postural control, ROM, MMT, skin integrity, foundation visual skills, pervasive impairments, psychosoc. Impact of deficits on ADLs/occs

Question 14

General Intervention/Tx for Neurolog D/o

Answer 14

Positioning, pressure reduction, postural control, motor learning approaches, motor control retraining/relearning, specific ADL training/retraining/adaptations, AT, splinting for contractures, fam/caregiver edu, cog retraining, visual skills retraining, sexual dysfunction help, B&B training, skin care edu, DME, sensory re-edu, community re-integration, return to work/work hardening

Question 15

Work Hardening Program

Answer 15

Highly structured, goal oriented, individualized treatment program designed to maximize the indiviual’s ability to return-to-work.

Question 16

Fast Pain

Answer 16

Transmitted over A Delta fibers. Processed in SC dorsal horn lamina. Crosses to excite lat spinothalamic tract & terminates in BS reticular formation. Functions for discrimination of pain/localization

Question 17

Slow Pain

Answer 17

Transmitted over C fibers. Processed in SC lamina. Crossed to excite ant spinothalamic tract. Terms in BS reticular formation > excites Reticular Activating System (RAS)/ Functions for diffuse arousal, affective & motivational aspects of pain

Question 18

Acute Pain

Answer 18

Sharp pain, sympathetic changes (increased HR, BP, pup dilation, sweating, hyperventilation, anx, escape/protective behaviors

Question 19

Chronic Pain

Answer 19

Pain that persists beyond usual healing course. Symptoms present for longer than 6mo for which underlying pathology is no longer identifiable or may never have been present

Question 20

Neuropathic Pain

Answer 20

Pain as result of lesions in some part of nervous system; usually accompanied by some degree of sensory deficit.

Question 21

Thalamic Pain

Answer 21

Continuous, intense, occurring on contralat hemiplegic side > result of stroke involving vent postlat thalamus; poor rehab potential

Question 22

Complex Regional Pain Syndrome Type I

Answer 22

Formerly known as Reflex Sympathetic Dystrophy (RSD).; pain maintained by efferent activity of sympathetic nervous system. Characterized by abnorm burning pain, hypersensitivity to light touch & sympathetic hyperfunction (sweating/coldness) > usually associated w traumatic injury

Question 23

Complex Regional Pain Syndrome Type II

Answer 23

Formerly known as Neuralgia. Pain occurring along branches of a nerve.

Question 24

Herpes Zoster (Shingles)

Answer 24

Acute, painful mononeuropathy caused by varicella virus. Vesicular eruption and marked inflam of post root gang if affected SN or sensory gang of CN - vent root involvement (motor weakness). Can last 10days- 5wk > pain may persist for months

Question 25

Psychosomatic Pain

Answer 25

origin of pain experience is d/t mental/emo disorder

Question 26

Referred Pain

Answer 26

Pain arising from deep visceral tissues that is felt in body region remote from the site of pathology resulting in tenderness & cutaneous hyperalgesia (abnorm heightened pain sensitivity)

Question 27

Postural Stress Syndrome (PSS)

Answer 27

Chronic mus lengthening/shortening that causes postural malalignment and stress to soft tissue > check for during pain eval

Question 28

Eval for Chronic Pain

Answer 28

Hx, localization, nature of pain (constant/intermittent), subject pain intensity scale, physical assessment, PSS, autonomic changes (sympathetic activity), abnorm mvmts, degree of suffering, fx’al changes, emo changes, precrip drug misuse, dependence on health care system, responsiveness to pain, motivation/affective components

Question 29

Chronic Pain Tx

Answer 29

Edu on contributing factors, edu on responding adaptively to pain behaviors, develop strategies/techniques to manage pain (relaxation training), refer to other professionals, estab realistic daily activity program, improve overall fx’al capacity, fam edu

Question 30

Sensory Processing D/o

Answer 30

Subtle, prim subcorticala, neural dysfun w impaired processing of sensory info and modulation of multisensory systems

Question 31

Dunn’s Model of Sensory Processing Symptom Classification

Answer 31

classified according to interaction of sensory stim that are needed to stim behavioral response. High/low threshold & passive/active response

Question 32

Sensory Modulation D/o

Answer 32

Sensory Overresponsitivity, Sensory Underresponsitivity or Sensory Seeking/Craving

Question 33

Sensory Based Motor D/o

Answer 33

Includes underlying sensory discrim d/o as well as possible sensory mod d/o: dyspraxia (developmental coordination disorder variation) or sensory-based postural disorders

Question 34

Eval for Sensory Processing D/o

Answer 34

Hx, fam/teacher interview, informal observation followed by formal assessment of clinical observations, standardized testing

Question 35

Seizure D/o vs Epilespy

Answer 35

Epi= chronic state of recurrent seizures. Seizure D/o= temp disturbance in brain activity causing a group of nerve cells to fire excessively, interfering with norm brain fx

Question 36

Seizures are often associated w these other conditions

Answer 36

O deprivation, severe head injury or brain hemorrhage, CP, stroke, brain tumor, other neurolog d/o, hydrocephalus, metabolic d/o, infections, meningitis, encephalitis, rubella

Question 37

Prim Gen Seizures]

Answer 37

Begin w widespread involv of both sides of brain

Question 38

Partial Seizures

Answer 38

Involv of smaller/localized area > can still spread within seconds/mins to gen (secondary gen seizure)

Question 39

Tonic-Clonic Seizures (grand-mal)

Answer 39

Most common type of seizure d/o in children. Brief warning/aura (numbness, taste, smell). Tonic phase includes LOC, stiff of bod, heavy/irreg breathing, drooling, skin pallor, occasional incontinence. Clonic phase includes alternating rigidity/relax of muscles. Following= Postictal State which includes drowsiness, disorientation or fatigue

Question 40

Myoclonic-Akinetic Seizures

Answer 40

*Not the same as infantile. Brief, invol jerking of extem w or w/o LOC, include loss of tone - difficult to control.

Question 41

Petit-Mal Seizures

Answer 41

Absent seizures. Typically between 4-12y/o, LOC w/o loss of mus tone. Rapid blinking or staring into space - does not fall but does not recall episode

Question 42

First Aid Seizure Procedures

Answer 42

Remain calm and if status elepticus call for immediate med attn, remove all dangerous objects from area, do not interfere w mvmts, raise bed rails, make sure nothing is in the mouth, turn to side if aspiration risk (recovery position), allow seizure to happen while protecting head, monitor for improved mental state

Question 43

Call for med attn during seizure if

Answer 43

Individual’s first, in H2O, if has second seizure, if consciousness is not regained after 5-10min, if seizure last 5min or more, if individual is diabetic or pregs

Question 44

Post Seizure Care

Answer 44

Allow individual to rest/sleep, inform parents/caregiver, observe safety precautions

Question 45

Seizure Eval and Intervention

Answer 45

Assess/intervene for DD as necessary. Observe all med/safety precautions. Doc/report any seizure activity, med side effects or behavioral changes.