Neuromuscular Disorders

Question 1

what is the other crazy name for Guillain-Barre?

Answer 1

acute inflammatory demyelinating polyneuropathy - basically describes what it is

Question 2

Guillain-Barre has an unknown cause, but when might it occur?

Answer 2

after a bacterial or viral infection or after surgery

Question 3

how does one diagnose GB?

Answer 3

• take history
• lumbar puncture (more protein in CSF)
• nerve conduction velocity slowed

Question 4

what would be assess with GB? (4 main impairment categories and two activity categories)

Answer 4

impairments:
=> motor - weakness all over, pulmonary function and swallowing also assessed
=> sensory - often seen as a sock-glove deficit
=> autonomic - can have sudden changes in bp, arrhythmia.
=> pain

Activities: - endurance and functional status

Question 5

when do most people reach their lowest point with GB? when are most ambulatory again?

Answer 5

lowest point in three weeks

ambulatory in six months

Question 6

what is the major thing to avoid when treating GB with PT?? how long should one avoid this?

Answer 6

do not fatigue the patient! Avoid fatiguing exercises for one year.

Question 7

in the acute phase, what is to be done?

Answer 7

• PROM to prevent contractures, pain relief
• avoid pressure sores
• tens for pain releif
• chest physio
• monitor status

Question 8

When someone with GB is recovering, what could be some treatment goals? is this evidence based?

Answer 8

resolve resipatory problems
minimize pain
prevent effects of immob.
increase strength and function

can use short periods of non-fatiguing exercise, PNF etc but watch for deterioration of status!

Question 9

what is the criteria for being diagnosed with post polio?

Answer 9

had a confirmed attack of acute paralytic polio followed by recovery and stability for at least 15 years.

new muscle weakness, possibly from disintegration of the enlarged motor units present because of original polio attack.

Question 10

what would be some factors that make it more likely to develop post polio?

Answer 10

more severe acute attack followed by large recovery

long time since first episode and maybe old age

Question 11

what are the three main things to assess/treat with post polio?

Answer 11

weakness - be careful not to overtire
pain - teach less overhead reaching, treat other painful comorbidities
fatigue - assess and monitor, teach energy conservation techniques

Question 12

what are the four rates of evolution of MS?

Answer 12

relapse-remit - worse then better
secondary progressive - usually relapse-remit turns into this, things get steadily worse but can also have relapse-remit
primary progressive - just slowly gets worse
progress-relapse - gets worse and sometime relapses as well but with no recovery

Question 13

which person has a more favourable outcome?

• a 23 yr old woman with localized attacks that recover completely
• a 53 yr old man with generalized attacks that include brainstem symptoms like nystagmus and tremors which he recovers poorly from.

Answer 13

seriously this one is obvious

Question 14

where will your MS patient be more comfortable - in a nice hot bath or walking in a park on a brisk day

Answer 14

brisk day - ms patients tend to be heat intolerant.

Question 15

what needs to be present in order to be diagnosed with MS?

Answer 15

evidence of at least 2 lesions in the CNS, and two distinct episodes of neurological disturbances btw 10-59 yrs old

can look for WBCs in CSF, but this is not criteria

Question 16

list a few common symptoms of MS

Answer 16

fatigue
weakness
sensory changes
altered gait
visual changes
tremor
bladder/bowel problems
cognitive changes

Question 17

how do patients usually respond to training in balance, conditioning, and mobility?

Answer 17

good!

Question 18

if fatigue gets worse with heat, what kind of fatigue is this? (MS)

Answer 18

primary

Question 19

would endurance training benefit primary or secondary fatigue more? (MS)

Answer 19

secondary

Question 20

what kind of parameters would you give to an exercise program for someone with MS?

Answer 20

progress slowly - use submaximal resistance and frequent repetitions.

Question 21

what are some ways to measure activity limitations for MS?

Answer 21

ADL index
9 hole peg test
timed walking
functional independence measure

Question 22

what scale could be used to assess fatigue?

Answer 22

fatigue severity scale

Question 23

does spasticity follow a pyramidal pattern for MS? what can be done to temporarily relieve spasticity?

Answer 23

yes - UE flex/LE ext

can use meds, stretching, TENS (high freq low int), cold

Question 24

what are two things to watch for when doing aerobic exerrcise with a MS patient?
When is the best time of day to be doing aerobics?

Answer 24

• fatigue
• too much heat
  best in morning since has a lower body temperature

Question 25

Does ALS affect upper or lower motor neurons?

Answer 25

trick question!

It affects BOTH - anterior horn cells, motor neurons in pyramidal tract, axons in descending corticospinal tract (lateral column)

Question 26

what are some signs and symptoms of ALS?

Answer 26

weakness & fasiculations (LMN signs)
babinski & clonus (UMN signs)

hyperreflexia, cramps and bulbar involvement also common

Question 27

what will be the focus of the treatments in PT?

Answer 27

QOL

Question 28

how many phases and stages are there in ALS?

Describe each one and what you might do…

Answer 28

3 phases, 6 stages.
phase I - stages 1-3 - pt is independent, but DO NOT FATIGUE PATIENT. Can do breathing exs, mild strengthening, incr ROM, AFOs
phase II - stages 4-5 - pt is partially dependent. Turn to comfort a bit so heat, massage, isometrics, assistive devices, transfers, home adaptations.
phase III - stage 6 - bedridden, soft diet if bulbar involvement, suctioning, electronic speech ampl, meds, etc.