64 terms

Rehab II: Neuromuscular Diseases (ALS, MD, etc)

ALS stands for
Amyotrophic Lateral Sclerosis
A rapidly progressive disorder associated with degeneration of motor nerve cells, replacing them with scar tissue
Typical lifespan post-ALS diagnosis
5 years
Neurons affected by ALS
both upper motor and lower motor neurons including brainstem, spinal cord and corticospinal tract
Median age of onset of ALS
ALS affects men more often than women in what ratio
The most common cause of death associated with ALS
respiratory failure
This percent of ALS cases are familial
One theory of the cause of ALS is
buildup of free radicals in the body
ALS is often diagnosed by
Exclusion, EMG can confirm fasiculations
Signs and symptoms of ALS (9)
weakness, atrophy, fatigue, spasticity, hyperreflexia, dysarthria, dysphagia, emotional lability, fasiculations
Sensory involvement with ALS?
Treatment of ALS is
symptomatic, and includes PT to make patient feel better and family education
PT for ALS patients might include
strengthening, stretching, ROM, transfer training, wheelchair fitting, gait training, assistive devices, AFOs
Spinal muscular atrophy affects
muscles throughout body but predominately proximal muscles. Weakness in legs often greater than in arms
Sensory affected with Spinal muscular atrophy?
Spinal muscular atrophy tends to impact these vital muscles
respiratory muscles
Intellectual activity affected with Spinal Muscular atrophy?
Autosomal recessive genetic disease caused by missing or mutated gene called survival motor neuron
Spinal muscular atrophy
4 types of spinal muscular atrophy
Type I (Werdnig Hoffman Disease), Type II, Type III (Kugelberg-Welander or Juvenile SMA), Type IV: Adult Onset
Type IV, adult Onset SMA typically
begins after age 35, loss of function occures rapidly when ill or gradually
Diagnosing SMA occurs via
a blood test looking for the absence of SMN1 gene (also suggestive history and physical exam)
PT for SMA patients
ROM, Seating systems, Chest PT, Aquatics, Standing frames/wheelchairs, Orthoses, Assistive devices
Scientific name for Guillain Barre
Acute Inflammatory Demyelinating Polyradiculoneuropathy
2/3 of Guillain Barre patients report
a fever with respiratory or GI tract disorder 1-3 weeks prior to onset
Test results for Guillain Barre patients
increased CSF production with normal cell count
Inflammation and demyelination in all nerves due to a cellular immunologic response...
Guillain Barre
Three stages of Guillain Barre
Acute, Plateau, Recovery
Signs and symptoms of Guillain Barre
ANS dysfunction, Sensory loss, Symmetrical muscle weakness distal to proximal (evolves in hours to up to 10 days), decreased DTRs
Acute phase of Guillain Barre ends when
no new signs and symptoms develop
Plateau phase of GB can last
several days to 2 weeks
This percent of Guillain Barre Patients return to normal
PT for Guillain Barre
ROM, strengthening, Splits, gait training
Biggest complain for GB patients
Medical management of Guillain Barre includes
repeated plasmopheresis, steroids, gamma globulin, other immunomodulators, psychological support, proper analgesics
Myesthenia gravis is
an aquired autoimmune disorder associated with deficiency of acetylcholine receptors at the NeuroMuscular junction
In Myesthenia gravis, __ take up space on the acetylcholine receptors
myesthenia gravis may also be due to increased
amount of acetylcholinesterase
Signs and symptoms of Myesthenia gravis
weakness and fatigue of muscles, Usually begins with eyelids (ptosis), symptoms fluctuate through day though improve with rest
Medical treatment of Myesthenia Gravis:
Drugs to deactivate acetylchoninesterase, High dose steroids, gamma globulin, other immunomoderlators, thymectomy, plasmapheresis
Physical therapy and Myesthenia Gravis
Rarely needed. Most pts live normal lives. If referred to PT activities should be light, short in duration and few reps
Common symptom to all muscular dystrophies
muscle weakness
The term muscular dystrophy refers to
a group of steady progressive, degenerative myopathies with genetic determination
Duchenne's Muscular Dystrophy is
the most common form of MD, affects boys only (asymptomatic mother to male child), boy usually dies by age 20
Gower's sign is __ and is associated with __
child who must "crawl" up his legs to rise to standing (due to hip weakness), in Duchenne's MD
Symptoms of Duchenne's usually appear before age
3. May be significant by age 7
Hypertrophy of calf muscles occurs in
Duchenne's MD
Intellectual/emotional disturbances with Duchenne's?
Children with Duchenne's often end up
Obese and in a wheelchair
Impairments with Duchenne's Muscular Dystrophy
weakness, decreased AROM and PROM, loss of ambulation, decreased pulmonary function, lumbar lordosis (b/c of imbalanced hip muscles), scoliosis
Myotonic muscular dystrophy is
an autosomal dominant disorder, first noticed in adolescence and characterized by myotonia and muscle weakness
a delay in muscle relaxation time
as weakness increases, myotonia
Characteristic appearance of Myotonic muscular dystrophy
long thin face with temporal and masseter muscle wasting, frontal balding, weakness and wasting of SCM
Myotonic muscular dystrophy patients present with weakness and wasting...
distally (foot drop,difficulty opening jars)
Fascioscapulohumoral MD is
autosomal dominant disorder involving face, shoulder girdle muscles (asymmetrical scapular winging) progressing into pelvic girdle. Patients wear corset-like back support and are active throughout adulthood.
Limb girdle MD affects
proximal shoulder girdle and proximal pelvic girdle and LE muscles.
Limb girdle MD can begin
any time, but more severe when starts in childhood
with all forms of Muscular Dystrophy, it is important to exercise but...
not to the point of fatigue
Limb girdle MD is not fatal but...
if the heart or respiratory muscles become involved, this could lead to death
Myesthenia Gravis affects what part of the body?
Begins with eyelids,proceeds to throat, then trunk then limb
Spinal muscular atrophy affects only children, true or false?
What is Gower's sign?
Crawling up legs in order to come ot standing
The common complaint of patients with neuromuscular diseases