Q4: SCI, GBS/Transverse Myelitis, & ALS/PD Flashcards
Etiology
SCI
Usually blunt trauma (MVA, Falls, Sports, GSW)
- 60% Male
- 50% of cases involve neuro- deficit
- Cervical Injury most common
Diagnosis
SCI
Can be difficult to originally diagnose (inflammation & spinal shock)
* Imaging (MRI, CT, xray)
* Sensory - highest dermatome intact
* Motor - level at which pt scores 3/5 MMT
Classification - Fx
SCI
Fx type:
* compression
* burst
* chance
* dislocation
Classification - ASIA Impairment Scale
SCI
A - Complete (M&S)
B - Sensory Incomplete (sense intact)
C - Motor Incomplete (motor intact)
D - Motor Incomplete (motor intact and more fucntional than “c”)
E - Normal
Worst Type of Incomplete SCI (prognosis)
SCI
Anterior Cord Syndrome
Clinical Presentation
SCI
Depends on the level of injury
Complications
SCI
Autonomic Dysreflexia
* usually in LOI T6 or higher
* increase in BP
* rapid symptoms
* will resolve if stimulus is removed
More susceptible to clots and ulcers
Non-Ox Treatment
SCI
- Corticosteroids (3-8 hrs post injury)
- PT/OT
- Mental health
Depends on LOI
Ox Intervention
SCI
Depends:
* how proximal?
* goals?
* sensation status?
* UE involvement?
anywhere from AFO to FES to HKAFO…or Exoskeletons
Etiology
Guillain Barré Syndrome (GBS)
Most common cause of acute flaccid neuromuscular weakness in the world
- post viral infection neuropathy
- rare
- most commonly present in young adult (males > females)
- 20% mortality
Clinical Presentation (acute phase)
Guillain Barré Syndrome (GBS)
- 1-6 weeks after initial illness
- progressive weakness (max. at 4 weeks)
- paresthia in hands/feet
- pain is common
- symmetrical lower motor neuron paralysis
ventilators are commonly needed; 2-5% die from complications
Clinical Presentation (post-acute phase)
Guillain Barré Syndrome (GBS)
- complete recovery is common
- slowly resolves (spontaneous)
- may have residual paralysis
80% - full recovery between 1-12 months
Diagnostic Techniques
Guillain Barré Syndrome (GBS)
- Clinical Exam - loss of reflexes
- Differential Diagnosis (process of elimination) - nerve conductions, analysis of CSF, antibody tests, MRI
Non-Ox Interventions
Guillain Barré Syndrome (GBS)
- Plasma exchange - remove pathogen
- Intravenous Immunoglobulin
- PT/OT/ST - contractures and neurorehab
Ox Intervention
Guillain Barré Syndrome (GBS)
- Contracture prevention during acute phase
- Lightweight/dynamic options
- AFOs/KAFOs
Consider designs that can accommodate pt improvement rapidly
Similarities to GBS
Transverse Myelitis
- often caused by infection
- rapid onset (weakness)
- bilateral
- monophasic
- similar treatments
- short acute phase with long recovery phase
Differences from GBS
Transverse Myelitis
- idiopathic occurrences too
- associated with other autoimmune disorders
- very rare (1-8 per 1 million people per year)
- 1/3 become permanently disabled
- 1/3 recover with little deficit
- symptoms dependent on spinal cord level
Etiology
ALS
“Lou Gehrig’s Disease”
* progressive, neurodegenerative condition involving spine and brain
* Idiopathic but can have genetic link
* males more common
* 50-60 years old
* fatal - 50% die within 5 years of onset (failure of respiration)
Diagnosis
ALS
Difficult to diagnose (variability in presentation)
Escorial Criteria
* based on presentation of UMN & LMN
Clinical Presentation
ALS
- Progressive weakness/atrophy (degen. of UMNs and LMNs)
- Cognitive and behavioral changes
- All muscles will become paralyzed - can still think
History/Definition
PD
Progressive, neurodegenerative condition characterized by:
* tremor
* rigidity
* bradykinesia
Etiology
PD
- Idiopathic - caused by dopamine deficiency in basal ganglia
- Similar onset and demographic to ALS
Diagnosis
PD
No reliable test exists;
Based on clinical signs
* tremor
* bradykinesia
* rigidity
Clinical Presentation
PD
- Unilateral onset, bilateral when severe
- Freezing gait
- Use a walker with red laser line to help step length
- sight, speech, and swallow difficulty
Non-Ox Intervention
ALS/PD
- Palliative - comfort care
- Multidisciplinary
- Pharma - slow disease or treat symptoms
- Therapy - PT/OT/ST/RT/GC/psych/nutrition
