PNS Pathology Flashcards
Acute inflammatory demyelinating polyneuropathy ; Autoimmune disease that attacks the myelin around the axon slowing or impeding nerve conduction; Lesions occur throughout PNS from spinal nerve roots to distal end of motor and sensory fibers; Characterized by motor, sensory, and autonomic dysfunction; May be related to bacterial or viral infection
Guillain-Barre Syndrome
- Acute inflammatory demyelinating polyneuropathy – AIDP, most common form
What are the S and S of GBS?
- Characterized by ascending symmetrical motor and sensory impairments and autonomic symptoms
- Motor: Distal weakness more than proximal, LE’s usually before UE’s, Can affect cranial nerves, May affect respiratory muscles
- Sensory: Absence of DTR’s, Paresthesias
- Autonomic: BP, HR, arrhythmia, tachycardia, fatigue
What are PT treatments for myasthenia gravis?
- Energy conservation techniques
- Isometric strength training
* Avoid fatigue - frequent rest breaks
What are medical treatments for myasthenia gravis?
- AChE (acetylcholinesterase) inhibitor medication
- Surgical removal of thymus - Stops production of antibodies to ACh
- Immunosuppressives
- Plasmapheresis
What is the time course of Guillan-Barre?
- Time from onset to peak impairment is 4 weeks or less followed by gradual recovery over approx. 2 years
- 90% of cases the progression ends by 4 weeks
- 80% ambulatory within 6 months
- 20% have long term neurologic deficits
- 5% mortality rate; prognosis is poorer when it reaches respiratory symptoms
What is the medical tx for GBS?
- Intravenous immunoglobulin (IVIg)
- Plasmapheresis
- Steroids have NO benefit
What is the PT tx for GBS?
- # 1 focus is toward prevention of complications associated with immobilization
- Maintain joint ROM
- Monitor muscle strength - can change daily
- Proper skin care
- Coughing and deep breathing
- Orthotics or splinting devices
- Educate pt. and family
- Take extreme care to not over fatigue patients***
What are S and S for myasthenia gravis?
- Cranial muscle weakness: Ptosis of eyelids, Double vision, Difficulty holding head upright, Difficulty chewing meat, lips do not close, Difficulty swallowing
- Limb weakness: Proximal weakness more than distal
Motor endplate disorder; Acetylcholine receptors are decreased - Decreased efficiency of neuromuscular transmission; Autoimmune disease; Skeletal muscle weakness and fatiguability (Repetition of activity causes more fatigue; 85% have generalized weakness)
Myasthenia Gravis
Compensated muscle no longer have the metabolic ability to support all the fibers; New denervation results; Slowly progressive with stable periods; Those diagnosed with this will be older than 65 years old
Post-Polio Syndrome (PPS)
-20-50% polio survivors
What is the medical tx for post polio syndrome?
- Symptomatic treatment and modification of lifestyle
2. Surgery/tendon transfers
What is the PT tx for post polio syndrome?
- General conditioning
- Never exercise to point of fatigue
- Energy conservation techniques
- Orthotics