SILVER/BRONZE Neuromuscular Conditions

Question 1

What is Bell’s palsy?

Answer 1

Lesion of facial nerve, CN VII, resulting in unilateral facial paralysis secondary to unknown etiology that causes compression of the facial nerve within the temporal bone

Question 2

List 4 signs and symptoms associated with Bell’s Palsy.

Answer 2

1. Muscles of facial expression on one side are weakened or paralyzed
2. Loss of control of salivation or lacrimation
3. Acute onset with maximum severity in a few hours/days; commonly preceded by pain behind the ear
4. Sensation is normal

Question 3

List 3 examinations a PT should perform to assess for Bell’s palsy.

Answer 3

1. Drooping of corner of mouth, eyelids that don’t close
2. Function of muscles of facial expression: wrinkle forehead, raise eyebrows, smile, close eyes tightly, puff cheeks
3. Taste of the anterior 2/3 of the tongue

Question 4

List 4 treatment options to consider for treating Bell’s palsy.

Answer 4

1. Artificial tears or temporary patching to protect the cornea
2. Electrical stimulation to maintain tone and support function of facial muscles
3. Teach facial muscle exercises
4. Provide functional retraining (i.e. chewing on opposite side)

Question 5

What is post polio syndrome?

Answer 5

New, slowly progressive muscle weakness occurring in individuals with a confirmed history of acute polio; follows a stable period of functioning

Question 6

List 7 signs and symptoms associated with post polio syndrome.

Answer 6

1. New weakness and atrophy, asymmetrical in distribution
2. Abnormal fatigue (disproportionate to activity)
3. Pain (myalgia, cramping, joint pain)
4. Decreased function and reduced endurance for ADLs
5. Environmental cold intolerance
6. Difficulty in concentration, memory or attention
7. Sleep disturbances

Question 7

List 3 treatment options to consider for treating post polio syndrome.

Answer 7

1. Low intensity exercise, never to the point of fatigue
2. Use of orthotic devices PRN
3. Teach energy conservation techniques

Question 8

What is myasthenia gravis? Cause?

Answer 8

Neuromuscular junction disorder characterized by progressive muscular weakness and fatigability on exertion

Cause: autoimmune antibody mediated attack on acetylcholine receptor at the neuromuscular junction

Question 9

Describe muscle strength as it relates to myasthenia gravis.

Answer 9

Muscular strength worse with continuing contraction, improved with rest

Question 10

What is the difference between ocular, generalized and crisis myasthenia gravis?

Answer 10

Ocular: confined to the extraocular muscles
Generalized: involves bulbar (extraocular, facial, and muscles of mastication) and proximal limb girdle muscles
Myasthenic crisis: myasthenia gravis with respiratory failure. TREAT AS A MEDICAL EMERGENCY

Question 11

_______ drugs are used to treat myasthenia gravis.

Answer 11

Acetylcholinesterase inhibitors

Question 12

What is trigeminal neuralgia?

Answer 12

Abnormal pressure/lesion/irritation of the trigeminal nerve CN V

Question 13

What is the most common symptom of trigeminal neuralgia?

Answer 13

Stabbing or shooting pain along the mandible and maxilla

Question 14

List 5 stimuli that can trigger symptoms associated with trigeminal neuralgia.

Answer 14

1. Extreme heat or cold
2. Chewing
3. Talking
4. Brushing teeth
5. Movement of air across the face

Question 15

What is epilepsy?

Answer 15

A disorder characterized by repetitive seizures (repetitive abnormal electrical discharges within the brain)

Question 16

List 4 signs and symptoms associated with epilepsy. (motor, sensory, autonomic and cognitive).

Answer 16

1. Altered motor activity (convulsions): tonic activity (stiffening/rigidity of muscles); clonic (rhythmic jerking of extremities)
2. Sensory phenomena (auras)
3. Autonomic phenomena: sudden tachycardia, anxiety, sweating, piloerection, abnormal sensation rising from upper abdomen to chest
4. Cognitive phenomena: sudden failure of comprehension, inability to communicate, hallucinations, intrusion of thought

Question 17

What is a generalized seizure? Symptoms? How long does it last?

Answer 17

All areas of the brain are involved (grand mal)

Dramatic loss of consciousness, with stiffening, then rhythmic movements of the arms and legs; eyes are generally open; breathing is altered; loss of urine is common.

Typically lasts 2-5 minutes

Question 18

What occurs to a person after a grand mal seizure?

Answer 18

Consciousness is gradually regained
Person is typically drowsy, confused and amnesiac after the event
May last several hours

Question 19

Describe an absence or petit mal seizure. How long does it last?

Answer 19

Posture is maintained
Repetitive blinking or other small movements may be present
Typically brief, lasting few seconds; may occur many times a day.

Question 20

Describe how a person may present during a complex partial seizure.

Answer 20

Person appears dazed or confused, not fully alert or unconscious

Question 21

List 4 characteristics of a focal seizure affecting the temporal lobe.

Answer 21

1. Episodic change in behavior with complex hallucinations
2. Automatisms (lip smacking, chewing, pulling on clothing)
3. altered cognitive and emotional function (sexual arousal, depression, violent behaviors)
4. Preceded by an aura

Question 22

What is status epilepticus?

Answer 22

Prolonged seizure or series of seizures (lasting > 30 minutes) with very little recovery between attacks

TREAT AS MEDICAL EMERGENCY

Question 23

List 6 things a PT should do in the instance of a seizure.

Answer 23

1. Remain with the patient
2. Remove potentially harmful nearby objects
3. Loosen restrictive clothing
4. DO NOT restrain limbs
5. Establish airway, prevent aspiration by positioning patient in side lying, and wait for tonic clonic activity to subside.
6. Seek medical assistance ASAP