Peripheral Neuropathies

Question 2

What are peripheral neuropathies and what are they also known as?

Answer 2

Peripheral nerve damage causing motor, sensory and or autonomic dysfunction, also known as polyneuropathies

Question 3

Name 3 inherited peripheral neuropathies

Answer 3

1. MND
2. Charcot-Marie Tooth
3. SMA

Question 4

Name 3 acquired peripheral neuropathies

Answer 4

1. GBS
2. Diabetic
3. Associated with infection/disease

Question 5

What is Guillain Barres Syndrome (GBS)?

Answer 5

Acute demyelination of peripheral nerves (autoimmune inflammatory condition)

Idiopathic

Question 6

How can GBS result in paralysis?

Answer 6

Multiple adjacent nerve fibres become demyelinated (nerve block)

Question 7

What are common symptoms of GBS?

Answer 7

Paralysis (rapid onset - hours)
Loss of strength
Altered sensation

Question 8

What usually precedes onset of GBS?

Answer 8

Respiratory tract or GI infection

Question 9

What is the prognosis for GBS?

Answer 9

Generally recoverable (80% of Pts have complete recovery in 12 months)

Some (5-15%) have relapses
- chronic inflammatory demyelinating polyneuropathy (CIPD)

Question 10

Is there spasticity or dexterity loss in GBS?

Answer 10

No as it only affects lower motor neurons

Question 11

What are the impairments of GBS? (Primary and secondary)

Answer 11

Primary Impairments:

• Strength loss
• Sensation loss
• Autonomic dysfunction

Secondary Impairments:

• Contracture
• Loss of function

Question 12

What are the main physiotherapy principles for treating GBS? (3)

Answer 12

1. Restore motor function
2. Maintain cardiorespiratory and neuromuscular system while waiting for remyelination to occur
3. Use principles of specificity, repetition and feedback

Question 13

What are treatment options for GBS? (Rx = 4 categories; 3 notes)

Answer 13

Strength/ROM

• Positioning
• Tilt table
• Serial casting ? to prevent contracture due to extreme weakness

Respiratory physiotherapy
Sensory retraining
Task training

Note:

• Don?t use ES (sensation loss)
• Dexterity is not a problem so don’t do early modified task practice
• Focus on strength

Question 14

What does the research say about strength training in GBS?

Answer 14

Mild strengthening, stretching and aerobic exercise over 6 weeks
= significant strength and QoL increase

Overwork weakness doesn’t seem to be the case

Question 15

Research about general exercise in GBS

Answer 15

12 week cycling, 30mins 3x/week

= less fatigue, mobility, perceived physical/mental function

Question 16

What is Motor Neurone Disease? (MND)

Answer 16

Terminal progressive degenerative disease affecting:

• Anterior horn cells
• Corticospinal tract
• Motor nuclei of brain stem

Question 17

What are the results of MND?

Answer 17

Upper and lower motor lesions
Bulbar palsy (dysarthria and dysphasia)

Question 18

What is the difference between dysarthria and dysphasia?

Answer 18

Dysarthria - problems with articulation and pronunciation

Dysphasia = receptive or expressive

• receptive: difficulty with comprehension
• expressive: difficulty putting words together to make meaning

Question 19

What are the 3 main forms of MND?

Answer 19

Amyotrophic lateral sclerosis ? 65% (UMN, LMN and bulbar)

Progressive bulbar palsy - 25% (speech and swallowing)

Progressive muscular atrophy ? 10% (only LMN, slower progress, 5-10 years)

Question 20

Additional problems involved with MND (8)

Answer 20

Problems

• Pain
• SOB
• Eye soreness
• Insomnia
• Fatigue
• Pressure areas
• Constipation
• Urinary retention

Question 21

Physiotherapy role in MND (6)

Answer 21

Educate and reassure
Pain management

Maintain (strength, ROM)
Promote mobility and independence (aids and adaptive)
Fatigue management
Manage respiratory dysfunction

Question 22

Should people with MND exercise?

Answer 22

Yes (likely to help improve QoL)

• safe, low intensity (minimise fatigue)
• stretching, strengthening and aerobic

Question 23

What assistive devices are common with MND?

Answer 23

Devices

• Seats (mm length, comfort, social interaction)
• Orthoses
• Neck collars (cervical weakness)
• Mobile arm supports/splints
• Communication systems