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Cranial and Peripheral Nerve Pathologies

Terms in this set (27)

Bell's Palsy
Facial paralysis. A LMN lesion involving CN VII (facial nerve), resulting in unilateral facial paralysis
Etiology: Acute inflammatory process of unkown etiology (immune or viral disease) resulting in compression of the nerve within the temporal bone
Characteristics of Bell's Palsy
Bell's Palsy
- Muscles of facial expression on one side are weakned or paralyzed
- Loss of control of salivation or lacrimation
- Onset is acute, with maximum severity in a few hours or days; commonly preceded by a day or two of pain behind the ear
- Most recover fully in several weeks or months
- Sensation is normal
- Drooping of corner of mouth, eyelids that don't close
Test CN VII
Cranial nerve VII
- Have patient wrinkle forehead, raise eye brows, frown, smile, close eyes tightly, puff cheeks
- Patient is having difficulty with speech articulation
- Taste of the anterior 2/3 of tongue
Bulbar Palsy
This conditions refers to weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, affecting the muscles of the face, tongue, larynx and pharynx
What condition is being examined/tested?
- Glossopharyngeal (CN IX), vagus nerve (X) paralysis: Phonation, articulation, palatal action, gag reflex, swallowing
- Changes in voice quality: Dysphonia (hoarseness or nasal quality)
- Bilateral involvement: Severe airway restriction with dyspnea, difficulty with coughing
Bulbar Palsy
Possible complications of Bulbar Palsy
Aspiration pneumonia
What condition is being facilitated/treated with this PT intervention?
- Suctioning, oral care
- Maintenance of respiratory function, open airway
- Elevate head of bed
- Dietary changes: soft foods, liquids
Bulbar Palsy
Acute ascending symmetrical polyneuropathy: Polyneuritis with PROGRESSIVE muscular weakness that develops rapidly
Etiology: Unknown; associated with an autoimmune attack, usually occurs after recovery from an infectious illness (respiratory or gastointestinal)
Guillain Barre Syndrome
Which Condition is associated with the following characteristics?
- Involves acute demyelination of both caranial and peripheral nerves (LMN disease)
- Sensory loss, parestheisas (tingling, burning), pain
- Sensory loss < motor loss
- Motor paresis or paralysis: relative symetrical distribution of weakness
- Progresses from LE to UE (ascending pattern) and from Distal to Proximal
- May produce full tetraplegia with respiratory failure
- Severe cases: dysarthria, dysphagia, diplopia and facial weakness
- Progression evolves over a few days or weeks.
- Recovery usually slow (6 months to 2 years)
- Usually complete recovery in 85% of cases, though some mild weakness may persist
Guillain Barre Syndrome
What are some complications associated with Guillain Barre Syndrome?
Respiratory impairment and failure, pain, pneumonia
What are some of Autonomic instability/complications associated with Guillain Barre Syndrome?
Tachycardia, arrhythmias, BP fluctuations
What cranial nerves should be examined with Guillain Barre Syndrome?
Cranial nerve 7,9,10,11,12
ALS
Amyotrophic Lateral Sclerosis
ALS
Amyotrophic Lateral Sclerosis or "Lou Gehrig's Disease
A = no; Myo = Muscle; trophic = nourishment; Lateral = site in the spinal cord that is affcted; Sclerosis = hardening or scaring
ALS = no muscle nourishment; in the spinal cord, the lateral side is scarring or hardening due to degeneration.
No muscle nourishment = muscle atrophy = person looks thinner
Describe ALS
A degenerative disease affecting both UMN and LMN (degeneration of anteior horn cells and descending corticobulbar and corticospinal tracts)
Progressive disease, often leading to death in 2 - 5 yrs
Highly variable symptoms
6 Stages on ALS
Characteristic of this condition include:
LMN Signs
- muscular weakness that spread over time: early onset involves limbs progressing to whole body.
- Atrophy, cramping, muscle fasciculations or twitching
UMN Signs
- Spasticity, hyperreflexia
ALS
Other Characteristics associated with ALS include:
- Dysarthria, dysphagia, dysphonia due to pseudobulbar palsy and progressive bulbar palsy
- Pain due to spasticity, cramping and postural stress syndrome
- Respiratory impairments: weaknes > paralysis, noctural difficulty, exertional dyspnea, accessory muscle use, paradoxical breathing, ventilator dependent, poor cough, clearance of secretions
Paradoxical breathing
The reverese of what happens during inhalation and exhalation. During inhalation, the chest wall moves in and during exhalation the chest wall moves out
Stages of ALS
Early disease, mild focal weakness, asymmetrical distribution, symptoms of hand cramping and fasciculations
Stage 1
Stages of ALS
Moderate weakness in groups of muscles, some wasting (atrophy) of muscles, modified independence with assitive devices.
Stage 2
Stages of ALS
Severe weakness of specific muscles, increasing fatigue
Mild to moderate functional limitations, ambulatory
Stage 3
Stages of ALS
Severe weakness and wasting of LEs, mild weakness of UEs
Moderae assistance and assitive devides
REQUIRED wheechair user
Stage 4
Progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk
spasticity hyperreflexia, loss of head control, Maximal assist.
Stage 5
Bedridden, dependent ADL, FMS progressive respiratory distress
Stage 6
What intensity and type of exercises should a patient with ALS perform to prevent further deconditioning and disuse atrophy while avoiding overwork damage in weakened, denervated muscles?
Mild resistive exercises
What precautions should be observed with a patient of ALS in terms of exercise management?
Monitor fatigue levels, avoid overwork injury, limited positions with decrease pulmonary function
What's the ACSM recomendation for exercise and activity level for a patient diagnosed with post polio syndrome?
Aerobic exercise, use ergometer that uses both UEs and LEs such as Schwin Airdyne, discontinuous protocol, submaximal test
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