Unit 18 Neuromuscular Disorders Flashcards
An injury to where in the spinal cord would a PT be ventilator dependent?
C4 and above
Where does the ascending tract begin, what is it associated with and how many tracts are there?
Begins in the spinal cord and ends in the brain, carries sensory input to higher levels in CNS
The sensory pathway
perception of touch, pressure, vibration, proprioception, pain, temperature
Describe the Descending Tracts and what tract is Parkinson’s associated with?
Associated with the motor pathway
Two tracts
1. Pyramidal tract
voluntary movement
2.Extrapyramidal tract
automatic movement, posture
(Parkinson’s associated with problems of extrapyramidal tract)
Describe the two types of motor neurons.
Upper Motor Neurons (UMN)
- entirely within the CNS
- initiates voluntary movement
Lower Motor Neurons (LMN)
- directly innervates skeletal muscles
- essential for muscle contraction
- part of peripheral nervous system
Describe UMN Lesions vs LMN Lesions
UMN lesions will have weakness below level of injury and muscle tone will be spastic.
-injuries usually above sacral spinal cord
LMN lesions will be specific to nerve root and muscle will be flaccid
What are the common groups for spinal cord injuries and most common cause?
- elderly and young males
- some form of trauma
What is the difference between complete and incomplete spinal cord injury?
Complete- loss of all sensory, proprioception, & voluntary motor activity
Incomplete- part the the spinal cord is intact
Define Tetraplegia/Quadriplegia and Paraplegia.
Tetraplegia/Quadriplegia- loss of sensation and movement in all four limbs
Paraplegia- loss of movement & sensation in lower half of body
What are the types of spinal cord injuries?
Hyperextension
Hyperflexion (going forward, chin tuck)
Compression
Flexion-rotation (usually c-spine injury)
Penetrating
What is Rx given in high doses for spinal injury and what is the contraindication?
methylprednisolone (Solu-medrol)
*contraindication for penetrating spinal injury because PT is already at risk for infection and steroid Rx will increase the likeliness.
Describe Neurogenic shock and spinal shock.
Neurogenic shock: Loss of vasomotor tone and impairment of autonomic function
The higher the injury -T6 and above you’ll usually see neurogenic shock
S/S hypotension, bradycardia, warm dry skin
Spinal shock: Loss of spinal reflexes»flaccid paralysis
-Even with UMN injury you’ll see spinal shock initially before spasticity kicks in
What is myelin?
Covering or coating around nerve cells
Describe Multiple Sclerosis.
-Chronic disease of the CNS characterized by the degeneration and loss of myelin in the brain, spinal cord, and cerebrum. T-cells attacking myelin
- autoimmune
- cause not yet known
- 25-40 most common age group
- 60% in women
Early stages: Nerve damage minimal
Progressive stage: Nerve impulses are completely blocked
What are the motor and sensory clinical manifestations of MS?
Motor:
- weakness
- paralysis
- diplopia
- spasticity of muscles
- scanning speech (pauses in speech)
- fatigue
Sensory: Numbness and tingling Patchy blindness Vertigo Tinitus (ringing in ears)
What are cerebellar and other clinical manifestations of MS?
Cerebellar:
- Ataxia (loss of full control of body movements)
- Nystagmus (repetitive uncontrolled eye movements)
- Dysarthria (slowed speech)
- Dysphagia
Other:
- Bladder dysfunction
- Sexual dysfunction
- Emotional instability
What diagnosis can be done for MS?
Health and Physical
Cat-scan: if MS is advanced enough they will see diffused white lesions
What are the drug therapy classes and medication for MS?
> Biological Response Modifiers
- Interferons *beta-1a, *beta-1b
(decrease inflammation and immune system response) - Synthetic Immunomodulator: *glatiramer acetate
> Steroid therapy
- methylprednisolone
- prednisone
> Immunosuppressants (not first choice)
*cytosin
> Antipasmodics (for spasticity)
*baclofen
What is Parkinson’s Disease?
- Impairment of dopamine-producing cells in the brain.
- more common in men
- no known cause
What is dopamine?
A neurotransmitter that is essential for normal functioning of the extrapyramidal system which controls posture, support, and autonomic movement
What are the key features to Parkinson’s Disease and how is it diagnosed?
“TRAP”
Tremors -increases at rest
Rigidity- resistance to passive range of motion
Akinesia/Bradykinesia- Slowing of automatic movement
Postural disturbances
*Dx with 3 out of 4
Parkinson’s Disease has many drug therapies, which is the top choice class/Rx and describe it.
-Dopaminergics
*carbidopa/levadopa
PT is on it for life
:::Problems:::
Paradoxical intoxication- when the Rx should work, but is to concentrated in the body so a “Medication holiday” (stop and restart) is needed to fix.
-Unpredictability of when it will decrease or stop working
What are the other drug classes/Rx’s for Parkinson’s Disease?
Dopamine agonists
-bromcriptine (helps release own supply of dopamine; mild symptoms)
Catechol O-methyltransferase (COMT) inhibitors
-entacapone (“ase”-enzyme)
usually given with carbidopa/levadopa
not for monotherapy
MAO-B inhibitors
(same as COMT inhibitors but can be given alone)
-rasagiline
Anticholinergics (blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system)
-benzotropine
What is Deep Brain Stimulation (DBS)?
- a permanent stimulating lead placed in brain & connected to an impulse generator that’s implanted in PT’s chest
- controlled by radio frequency transmissions from a computer
- DBS helps interrupt “short circuits” in brain
- decreases some symptoms of Parkinson’s
