What are peripheral neuropathies and what are they also known as?
Peripheral nerve damage causing motor, sensory and or autonomic dysfunction, also known as polyneuropathies
Name 3 inherited peripheral neuropathies
- MND
- Charcot-Marie Tooth
- SMA
Name 3 acquired peripheral neuropathies
- GBS
- Diabetic
- Associated with infection/disease
What is Guillain Barres Syndrome (GBS)?
Acute demyelination of peripheral nerves (autoimmune inflammatory condition)
Idiopathic
How can GBS result in paralysis?
Multiple adjacent nerve fibres become demyelinated (nerve block)
What are common symptoms of GBS?
Paralysis (rapid onset - hours)
Loss of strength
Altered sensation
What usually precedes onset of GBS?
Respiratory tract or GI infection
What is the prognosis for GBS?
Generally recoverable (80% of Pts have complete recovery in 12 months)
Some (5-15%) have relapses
- chronic inflammatory demyelinating polyneuropathy (CIPD)
Is there spasticity or dexterity loss in GBS?
No as it only affects lower motor neurons
What are the impairments of GBS? (Primary and secondary)
Primary Impairments:
- Strength loss
- Sensation loss
- Autonomic dysfunction
Secondary Impairments:
- Contracture
- Loss of function
What are the main physiotherapy principles for treating GBS? (3)
- Restore motor function
- Maintain cardiorespiratory and neuromuscular system while waiting for remyelination to occur
- Use principles of specificity, repetition and feedback
What are treatment options for GBS? (Rx = 4 categories; 3 notes)
Strength/ROM
- Positioning
- Tilt table
- Serial casting ? to prevent contracture due to extreme weakness
Respiratory physiotherapy
Sensory retraining
Task training
Note:
- Don?t use ES (sensation loss)
- Dexterity is not a problem so don’t do early modified task practice
- Focus on strength
What does the research say about strength training in GBS?
Mild strengthening, stretching and aerobic exercise over 6 weeks
= significant strength and QoL increase
Overwork weakness doesn’t seem to be the case
Research about general exercise in GBS
12 week cycling, 30mins 3x/week
= less fatigue, mobility, perceived physical/mental function
What is Motor Neurone Disease? (MND)
Terminal progressive degenerative disease affecting:
- Anterior horn cells
- Corticospinal tract
- Motor nuclei of brain stem
What are the results of MND?
Upper and lower motor lesions Bulbar palsy (dysarthria and dysphasia)
What is the difference between dysarthria and dysphasia?
Dysarthria - problems with articulation and pronunciation
Dysphasia = receptive or expressive
- receptive: difficulty with comprehension
- expressive: difficulty putting words together to make meaning
What are the 3 main forms of MND?
Amyotrophic lateral sclerosis ? 65% (UMN, LMN and bulbar)
Progressive bulbar palsy - 25% (speech and swallowing)
Progressive muscular atrophy ? 10% (only LMN, slower progress, 5-10 years)
Additional problems involved with MND (8)
Problems
- Pain
- SOB
- Eye soreness
- Insomnia
- Fatigue
- Pressure areas
- Constipation
- Urinary retention
Physiotherapy role in MND (6)
Educate and reassure
Pain management
Maintain (strength, ROM)
Promote mobility and independence (aids and adaptive)
Fatigue management
Manage respiratory dysfunction
Should people with MND exercise?
Yes (likely to help improve QoL)
- safe, low intensity (minimise fatigue)
- stretching, strengthening and aerobic
What assistive devices are common with MND?
Devices
- Seats (mm length, comfort, social interaction)
- Orthoses
- Neck collars (cervical weakness)
- Mobile arm supports/splints
- Communication systems
