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585-14
NM Disease
| Term | Definition |
|---|---|
| Duchenne muscular dystrophy (DMD) | Most common MD, 18-36 months X-linked recessive trait Less dystrophin makes muscles easy to break & tear during contraction Muscle replaced by fat & fibrous tissue In boys only |
| DMD progression | Starts in thigh, then lower leg, trunk, shoulder girdle, upper limb Pseudohypertrophy of calf muscles Gower's sign- climb up body w/ hands when standing up |
| DMD presentations that influence unsafe gait | Tight heel cord- walking on toes Belly sticking out Weak butt Poor balance and clumsy when walking Foot drop |
| Limb-girdle MD | Childhood- teens Affects upper arm and legs Proximal limb muscles |
| facio-scapulo-humeral MD | Young onset age Affects muscles in face, shoulder, upper arms Mild & asymptomatic Diff whistling, diff using shoulders above shoulder levels, abnormal scapula position |
| oculopharyngeal MD | Onset 40-70 years Affects eyelids, face, throat then pelvic & shoulder muscles Swallowing may be affected |
| myotonic dystrophy | 20-40 years, most common adult MD Organs & tissues affected Myotonia- unable to relax muscles Cataracts, cardiac arrythmia/ failure, gonadal atrophy& failure Risk of cardiomyopathy Facial problems |
| OT MD assessment | Physical- mobility, safety, balance Cognition, perception Psychosocial Self care, productivity, leisure Activities related to school/ work Developmental factors |
| person OT intervention for MD | Personal care Splinting/ orthoses Safety (number 1 priority), esp if lower limbs involved Mobility/ transition to wc Driving Household tasks |
| occupation/ environment OT intervention for MD | Community life Work modifications- muscular impairment, excessive sleepiness, apathy, access, tech use Recreation- find good level of rec activities to maintain body function. LE strength, fatigue, pain |
| peripheral neuropathy pathology | Due to distal axonal degeneration Segments of nerve fibers become demyelinated (seen on leg muscles often) |
| peripheral neuropathy | Can affect multiple nerves or only 1/ 1 nerve group Causes numbness, weakness, pain Depends on nerves affected (sensory, motor, autonomic) |
| upper limbs peripheral neuropathy signs | Sensory- glove distribution of tingling, pins & needles Motor- grip weakness, distal lower motor neuron signs, loss of distal reflexes |
| lower limbs peripheral neuropathy signs | Sensory- stocking distribution of tingling, pins & needles, numbness, unsteady stance & gait Motor- abnormal gait, distal lower motor neuron signs in foot, loss of distal reflexes |
| Guillain-Barre Syndrome | Acute, rapid progressive form of polyneuropathy Over several days w/ life threatening degree of weakness Affects nerve roots & peripheral nerve Likely due to viral infection 30-50 years |
| Guillain-Barre Syndrome stages 1. acute 2. plateau 3. recovery | 1. When symptoms appear & ends when no symptoms noted- 1-3 wks 2. No further changes, days- 2wks 3. Re-myelination & axonal regeneration occurs, up to 2-3 years |
| side effects of Guillain-Barre Syndrome | Involve autonomic nerves, erratic rise & fall in HR & BP Constipation Very serious paralysis in limbs, chest, trunk muscles |
| Guillain-Barre Syndrome medical management | Hospitalized until reach plateau Good prognosis, 90-95% complete recovery Near-complete recovery over weeks to months(6mo-2yrs) 10-20% die of resp paralysis |
| reason for good prognosis for Guillain-Barre Syndrome | In predominantly myelin Due to capability of Schwann cells to build sheath |
| OT ax for Guillain-Barre Syndrome | Psychological- realistic expectations Motor- ROM, MMT, endurance, motor control Sensory- awareness & processing, protective Cognitive- coping skills Relevant OP areas |
| OT tx considerations for Guillain-Barre Syndrome | Positioning at acute stage Maintain full ROM Active ROM AT (fatigue) Maintain muscle strength Adaptive equipment used in plateau & recovery stage |
| motor tx for Guillain-Barre Syndrome | Non resistive activities, muscles graded 3+ or better Consider splinting to prevent deformity from atrophy & disuse, maintain functional position in early recovery Increase hand manipulation, grasp, release |
| sensory vs. cognitive tx for Guillain-Barre Syndrome | Give sensory stimulation when sensory system function returns vs. Stress mgmt, task scheduling to cope w/ muscle fatigue, learn energy conservation, joint protection |
| psychosocial vs. ADL tx for Guillain-Barre Syndrome | Relax techniques, positive encouragement vs. Use shoulder slings, mobile arm supports, hand splints in functional position |
| work vs. leisure tx for Guillain-Barre Syndrome | Work simplification, temporary modifications of home & work environment vs. Strenuous leisure activities will not be possible until full recovery |
| precautions for Guillain-Barre Syndrome | Watch for redness over bony areas of body/ change body position Discontinue activities when shown signs of fatigue Never stress muscles past point of pain |
Created by:
craftycats_
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