Neuropathies + Developmental/birth injuries Flashcards
Peripheral neuropathy causes
o diabetes (most common) o Lyme disease o HIV o Shingles o Guillain-Barre
What is a peripheral neuropathy
injury to peripheral N due to injury or illness
Are diabetic neuropathies focal, diffuse, or both
Can be either
What nervous systems do diabetic neuropathies effect
Somatic or autonomic PNS
Diabetic neuropathy Presentation
symmetrical distal pattern (diabetic polyneuropathy)
Diabetic neuropathy Causes
- hyperglycemia leading to abnormal microcirculation
- change in insulin levels alter gene-regulation
- loss of myelinated + non-myelinated fibers
- vascular changes
- nerve growth reduced
Diabetic Neuropathy S&S
- burning pain
- symmetrical sensory changes (paresthesia, burning)
- can be slow or rapid onset (people may not notice it)
- paresthesia: impaired proprioception, touch, pressure
- minimal motor weakness
Diabetic neuropathy Rx
- control hyperglycemia
- symptoms management
- skin care checks* (risk of wound and amputation)
- exercises:
• strength (ankle, hips: strategies for prevention of falling)
• balance
• prevention of damage to skin, joint, muscle, CT
What is complex regional pain syndrome (CRPS)
chronic pain condition
What may cause CRPS
Dysfunction in central or peripheral NS
CRPS presentation
o change in color/temp of the skin over the affected limb or body part
o intense burning pain
o skin sensitivity
o sweating
o swelling
o stiffness
o usually occurs after trauma or immobilization (cast)
CRPS Stages + corresponding presentation
Stage 1 (0-3 months) puffy swelling, redness, warmth, stiffness, allodynia, pos bone scan
Stage 2 (3-6 months) Increased P and stiffness, firm edema, cyanosis, atrophy, osteopenia on xray
Stage 3 (6 months +) tight, smooth, glossy, cool, pale skin
- stiffness and contractures, nail and hair changes, severe osteopenia
CRPS Rx
Prevention and early detection
- early ROM, P/edema management (desensitization, contrast baths, modalities), education
What is cerebral palsy (CP)?
Non-progressive lesion of brain, occurs before 2yrs
CP Comorbities
o hearing and speech problems o hydrocephalus o microcephaly o scoliosis o hip dislocation o mental retardation
CP Risk Factors
o prenatal (maternal infection, malnutrition, maternal seizures)
o perinatal (prematurity 27-30 weeks gestation, obstetric complications (breech)
o small for gestational age
o rupture of membranes
o intrauterine infection
o low APGAR
o multiple births
o post-natal: infection, environmental toxins, brain tumor, anoxia, CVA
o loss of autonomic regulation of CNS blood flow until full term
• (cycle of perfusion and reperfusion)
What are the 5 CP classification
Spastic Ataxic Dystonic Hypotonia Athetoid
What are the key features of spastic CP
stiffness, dec. ROM, movements limited to synergies primitive movement patterns- trouble start/stop movement
What are the key features of ataxic CP
- difficulty with rapid movements
- coordinated gait
- fine motor
- balance
What are the key features of dystonic CP
- Inc. tone, can’t relax muscles easy
- long sustained involuntary movements and postures
- tend to lock joints at end range
- usually have full ROM
- mid control difficult
What are the key features of hypotonia CP
Lack of tone
Weakness
What are the key features of Athetoid CP
Writhing movement
Snake like
What are 3 causes of CP
- intraventricular hemorrhage - below - periventricular leukomalacia - common ischemic injury
- small holes surrounding ventricles - death of small areas of brain tissue
CP Rx
Medical:
- baclofen pump
- dorsal rhizotomy (cut dorsal roots of SC)
- Botox to ADDs
- serial casting
- tendon release
- osteotomy
PT Management
- manage atypical mm - ROM, orthotics
- habituation, not rehab
- positioning, sitting modifications - put pummel between legs
What is spinal bifida?
Neural tube defect leading to vertebral and/or spinal cord malformation
What are 4 types of Spina bifida
- Spina Bifida Occulta - no spinal cord involvement, may be indicated by hair tuft
- Spina Bifida Cystica - visible or open lesion
- Meningocele - cyst includes cerebrospinal fluid cord intact
- Myelomeningocele - cyst includes CSF and herniated cord tissue
What is Spina Bifida Occulta
no spinal cord involvement, may be indicated by hair tuft
What is Spina Bifida Cystica
-visible or open lesion
What is Meningocele
cyst includes cerebrospinal fluid cord intact
What is Myelomeningocele
-cyst includes CSF and herniated cord tissue
There is a link between spina bifida and what maternal factors
maternal decreased folic acid + infection + exposure to teratogens (alcohol)
Spina Bifida S&S
- flaccid or spastic muscles
- muscle weakness
- contractures
- muscle wasting
- decreased/absent DTR
- rectal/bladder incontinence
- hydrocephalus (Chiari malformation)
- osteoporosis, lordosis, scoliosis, kyphosis
- foot deformities talipes equinovarus (club foot) especially with L4, L5 level
Spina Bifida Rx
- ROM, strengthen functional muscles
- teach transfers
- equipment (orthotics, early mob, standing and ambulation)
- encourage awareness of sensory deficits (protection of feet, position of legs, check for sores)
What is Erbs palsy?
What is the presentation for Erbs Palsy?
Most common brachial plexus injury (73%), paralysis of UE muscles + sensory loss, grasp intact
- C5, C6 injury in infants: usually coming out of birth canal
shoulder ext/IR/add + elbow ext + forearm pronation + wrist/fingers flexed) (waiters position)
What muscles are effected in erbs palsy
- Rhomboids, levator scapulae, serratus anterior, delts, supraspinatus, infraspinatus
- biceps, brachioradialis, brachialis, supinator, long extensors of wrist, fingers, thumb
Erbs palsy Rx
- immobilization initially, positioning, splinting
- gentle ROM
- play exercises - functional training + facilitation of normal movement (age appropriate)
What spinal levels are injured in Klympke’s palsy?
C7/8-T1
What muscles are effected in Klumpkes palsy ?
What is another term for this injury?
Intrinsics hand mm, flex+ext of wrist/fingers
Clar hand
What spinal levels are injurd in Median N Palsy
C6-C8, T1, Median nerve
What muscles are effected in Median N palsy ?
What is another term for this injury?
Thenar mm - no thumb abduction or opposition
Ape hand
