PNS Pathology

Question 1

Acute inflammatory demyelinating polyneuropathy ; Autoimmune disease that attacks the myelin around the axon slowing or impeding nerve conduction; Lesions occur throughout PNS from spinal nerve roots to distal end of motor and sensory fibers; Characterized by motor, sensory, and autonomic dysfunction; May be related to bacterial or viral infection

Answer 1

Guillain-Barre Syndrome

- Acute inflammatory demyelinating polyneuropathy – AIDP, most common form

Question 2

What are the S and S of GBS?

Answer 2

1. Characterized by ascending symmetrical motor and sensory impairments and autonomic symptoms
2. Motor: Distal weakness more than proximal, LE’s usually before UE’s, Can affect cranial nerves, May affect respiratory muscles
3. Sensory: Absence of DTR’s, Paresthesias
4. Autonomic: BP, HR, arrhythmia, tachycardia, fatigue

Question 3

What are PT treatments for myasthenia gravis?

Answer 3

1. Energy conservation techniques
2. Isometric strength training
   * Avoid fatigue - frequent rest breaks

Question 4

What are medical treatments for myasthenia gravis?

Answer 4

1. AChE (acetylcholinesterase) inhibitor medication
2. Surgical removal of thymus - Stops production of antibodies to ACh
3. Immunosuppressives
4. Plasmapheresis

Question 5

What is the time course of Guillan-Barre?

Answer 5

• Time from onset to peak impairment is 4 weeks or less followed by gradual recovery over approx. 2 years
• 90% of cases the progression ends by 4 weeks
• 80% ambulatory within 6 months
• 20% have long term neurologic deficits
• 5% mortality rate; prognosis is poorer when it reaches respiratory symptoms

Question 6

What is the medical tx for GBS?

Answer 6

1. Intravenous immunoglobulin (IVIg)
2. Plasmapheresis
   - Steroids have NO benefit

Question 7

What is the PT tx for GBS?

Answer 7

1. # 1 focus is toward prevention of complications associated with immobilization
2. Maintain joint ROM
3. Monitor muscle strength - can change daily
4. Proper skin care
5. Coughing and deep breathing
6. Orthotics or splinting devices
7. Educate pt. and family
8. Take extreme care to not over fatigue patients***

Question 8

What are S and S for myasthenia gravis?

Answer 8

1. Cranial muscle weakness: Ptosis of eyelids, Double vision, Difficulty holding head upright, Difficulty chewing meat, lips do not close, Difficulty swallowing
2. Limb weakness: Proximal weakness more than distal

Question 9

Motor endplate disorder; Acetylcholine receptors are decreased - Decreased efficiency of neuromuscular transmission; Autoimmune disease; Skeletal muscle weakness and fatiguability (Repetition of activity causes more fatigue; 85% have generalized weakness)

Answer 9

Myasthenia Gravis

Question 10

Compensated muscle no longer have the metabolic ability to support all the fibers; New denervation results; Slowly progressive with stable periods; Those diagnosed with this will be older than 65 years old

Answer 10

Post-Polio Syndrome (PPS)

-20-50% polio survivors

Question 11

What is the medical tx for post polio syndrome?

Answer 11

1. Symptomatic treatment and modification of lifestyle

2. Surgery/tendon transfers

Question 12

What is the PT tx for post polio syndrome?

Answer 12

1. General conditioning
2. Never exercise to point of fatigue
3. Energy conservation techniques
4. Orthotics