Neuromuscular Health Conditions Flashcards
What is the difference between neuropathy and myopathy?
Neuropathy- soma/axons are involved
- there is distal involvment (more symmetrical than asymmetric)
- stocking-glove pattern
- longest nerves affected first
Myopathy- end plate/mm involved
- proximal symmetrical involvement
- difficulty arising
- overhead activities
What would the difference be between an LMN and an UMN as it pertains to:
Stiffness Tone Reflexes Atrophy Fasciculations sensory disturbances
LMN will have reduced stiffness, UMN is very stiff
LMN decreases tone, UMN increases tone
LMN decreases reflexes, UMN increases reflex
LMN has profound atrophy, UMN has minimal atrophy
LMN has fasciculations, UMN does not
Sensory disturbances are equal for both
What nueromuscular conditions affect the motor neuron (LMN-Anterior horn cell)?
Progressive Spinal Muscular Atrophy
Post-Polio Syndrome
Amyotrophic Lateral Sclerosis
What structure does Guillian Barre and Charco Marie Tooth affect?
Peripheral nerves
What structure does Myasthenia gravis affect?
Motor End Plate
What goes into forming a prognosis for a NM disease?
- making long and short term goals
- describing natural progression of the condition (onset period, progression rate, recovery potential)
- identify contextual factors that would help and/or harm
finally based on these factors you form a prognosis which is the likely time frame for achieving the goals
What does PT intervention for NM conditions depend on?
Depends on the stage of the disease
What PT interventions are applicable for when you want to optimize function for a patient with a NM condition?
Education, encouraging activity and participation, strengthening (mod intensity), aerobic training (mod intensity), flexibility
What PT interventions are applicable for when you want to adapt a patient to their limitations due to a NM condition?
Prevent overuse, prevent respiratory dysfunction (breathing techniques and coughing), prescribe assistive technology (orthotics, assistive devices, w/c) to support participation
What PT interventions are applicable for when you want to maximize quality of life for a patient with a NM condition?
Addressing respiratory dysfunction (postural drainage and assistive coughing), positioning, supporting and training the caregiver
What is Spinal Muscular Atrophy?
What causes it?
Premature death of alpha motor neurons in spinal cord and brainstem which causes weakness and wasting of voluntary muscles (often more severe in legs than arms)
It is a genetic disorder due to a 5q gene deletion
What is the onset, progression, movement system, and prognosis for type 1 spinal muscular atrophy?
Type 1 is acute infantile (werdnig-hoffman)
onset is from birth to 6 months
progression is rapid
common movement system is patient never sit, poor head control/suck/swallow/cry
prognosis is usually fatal within 2 yrs
What is the onset, progression, movement system, and prognosis for type 2 spinal muscular atrophy?
Type 2 is chronic infantile (Dubowitz Disease)
Onset is from 6 months to 18 months
Progression is slower
movement system: delayed motor milestones and is able to sit but not stand or walk
Prognosis is variable
What is the onset, progression, movement system, and prognosis for type 3 spinal muscular atrophy?
Type 3 is chronic juvenile
Onset is after 18 months
Progression is slower
Movement System: most can stand and walk, but have trouble going up/down stairs and can lose ability to walk later on, in w/c develop scoliosis; bulbar dysfunction later in life
Prognosis: typical life expectancy
What is the onset, progression, movement system, and prognosis for type 4 spinal muscular atrophy?
Type 4 happens to adults
onset is in the 30s
Patients lose ability to walk
Will have typical life expectancy
What are the conditions for a medical diagnosis for spinal muscular atrophy?
What are the common impairments in this condition?
- genetic testing (5q deletion)
- EMG (reduced amplitude, fibrillations)
- Muscle biopsy (to detect atrophy)
Impairments:
- severe proximal muscle weakness
- flaccidity
- bulbar dysfunction in more severe cases, as in type 1 or in late progression of type 2 or 3
What are the intervention guidelines for spinal muscular atrophy?
- strength training of proximal muscle groups: shoulder flexors/extensors, elbow flexors/extensors, hip flexors, extensors, and knee extensors
- 2 sets of 15 reps for each muscle group w/ 5 minute rest between sets
- initial intensity should emphasize biomechanics using body weight as resistance and progressed by adding light resistance
- monitor w/ physical exertion (RPE); goal is under “somewhat hard” to “hard”
What is post-polio syndrome?
How does it distribute?
How does a patient recover from polio?
Late manifestation of acute poliomyelitis that degenerates larger motor neuron pools and slowly progresses new muscles weakness in previously affected areas
usually distrbutes asymmetrically and can be distal, proximal or patchy
Sprouting of spared motor units