Neuromuscular Disorders Flashcards
what is the other crazy name for Guillain-Barre?
acute inflammatory demyelinating polyneuropathy - basically describes what it is
Guillain-Barre has an unknown cause, but when might it occur?
after a bacterial or viral infection or after surgery
how does one diagnose GB?
- take history
- lumbar puncture (more protein in CSF)
- nerve conduction velocity slowed
what would be assess with GB? (4 main impairment categories and two activity categories)
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
when do most people reach their lowest point with GB? when are most ambulatory again?
lowest point in three weeks
ambulatory in six months
what is the major thing to avoid when treating GB with PT?? how long should one avoid this?
do not fatigue the patient! Avoid fatiguing exercises for one year.
in the acute phase, what is to be done?
- PROM to prevent contractures, pain relief
- avoid pressure sores
- tens for pain releif
- chest physio
- monitor status
When someone with GB is recovering, what could be some treatment goals? is this evidence based?
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!
what is the criteria for being diagnosed with post polio?
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.
what would be some factors that make it more likely to develop post polio?
more severe acute attack followed by large recovery
long time since first episode and maybe old age
what are the three main things to assess/treat with post polio?
weakness - be careful not to overtire
pain - teach less overhead reaching, treat other painful comorbidities
fatigue - assess and monitor, teach energy conservation techniques
what are the four rates of evolution of MS?
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
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.
seriously this one is obvious
where will your MS patient be more comfortable - in a nice hot bath or walking in a park on a brisk day
brisk day - ms patients tend to be heat intolerant.
what needs to be present in order to be diagnosed with MS?
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
list a few common symptoms of MS
fatigue weakness sensory changes altered gait visual changes tremor bladder/bowel problems cognitive changes
how do patients usually respond to training in balance, conditioning, and mobility?
good!
if fatigue gets worse with heat, what kind of fatigue is this? (MS)
primary
would endurance training benefit primary or secondary fatigue more? (MS)
secondary
what kind of parameters would you give to an exercise program for someone with MS?
progress slowly - use submaximal resistance and frequent repetitions.
what are some ways to measure activity limitations for MS?
ADL index
9 hole peg test
timed walking
functional independence measure
what scale could be used to assess fatigue?
fatigue severity scale
does spasticity follow a pyramidal pattern for MS? what can be done to temporarily relieve spasticity?
yes - UE flex/LE ext
can use meds, stretching, TENS (high freq low int), cold
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?
- fatigue
- too much heat
best in morning since has a lower body temperature
Does ALS affect upper or lower motor neurons?
trick question!
It affects BOTH - anterior horn cells, motor neurons in pyramidal tract, axons in descending corticospinal tract (lateral column)
what are some signs and symptoms of ALS?
weakness & fasiculations (LMN signs)
babinski & clonus (UMN signs)
hyperreflexia, cramps and bulbar involvement also common
what will be the focus of the treatments in PT?
QOL
how many phases and stages are there in ALS?
Describe each one and what you might do…
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.
