Other Neuropathic Disorders
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| how many types of GBS are there? | 4
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| 4 types of GBS | AIDP
Miller Fischer syndrome
Acute motor axonal syndrome
Acute motor-sensory axonal syndrome
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| what is the best know acute neuropathy | Guillain Barre Syndrome
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| what is GBS commonly preceded by? | viral or bacterial infection (not always)
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| GBS causes elevated levels of ____ fluid protein | cerebrospinal
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| GBS is Due to an Autoimmune attack on the ____ nerves (demylination) | peripheral
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| ___ nerves may be affected by GBS | cranial (facial and occulomotor most common)
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| Usually follow ____ infections or occur w/o previous illness | respiratory
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| when was GBS first discovered? | 1976 followed vaccination against the swine flu, also other flu shots may trigger it.
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| mild vs severe GBS | Mild ->severe (ventilator) ->Death due to respiratory complications
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| May be life threatening, some improvement occurs in almost all, may be left with some disability. Maximum recovery is ___ years | 2
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| meds for GBS | plasmaphoresis, immunoglobulin therapy, corticosteroids
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| Permanent weakness has usually resulted from prolonged periods of ____ during the acute phase | hypoxia
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| what 6 things should evaluation for GBS include? | strength tests -proximal weakness most common
sensation-paresthesias
ROM, balance, coordination, endurance
pain -tenderness on pressure over affected muscles
mobility tests
reflex testing -may also be useful (deep reflexes are usually lost)
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| overwork weakness | overworking a pt with GBS in the early phases can lead to permanent damage to the axons, proceed with exercise carefully
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| GBS precautions | Vigorous strengthening exercises may aggravate the weakness or cause a relapse
***Avoid Overwork weakness!!!!
Exhaustive endurance exercises may also cause a relapse
Pressure ulcerations
Autonomic Dysfunction
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| behavioral issues with GBS | not usually a problem there may be depression secondary to the pts disability, however, they usually get better unlike MS
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| how long does weakness from GBS last? | usually reversible over a period of two months to Two years.
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| If GBS onset is ___, the recovery is quicker. | acute
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| ____ onset recovery is 1-2 yrs and may not fully recover | insidious
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| PT tx for GBS | Temporary Amb. aids- wrap ankle for dflex support. May need knee support
Ambulation- Parallel bars->cane/no assistive device
Neural Flossing/Nerve Gliding
May need UE aids (reacher and hand splints
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| Tightness is prevented/corrected by ___ and ____ | positioning and stretching
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| ____ ____ may be essential during early phases of GB syndrome | Family training
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| home program considerations for GBS | make sure you do not give the patient too much, emphasize pacing and frequent rests
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| why does nerve gliding help decrease pain with movement for GBS pts? | helps the nerve move more freely within the myelin sheath
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| most common and fatal motor neuron disease for adults | ALS
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| ALS involves ___ and ____ motor neurons | upper, lower
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| manifestations of ALS | Flaccidity (LMN) and spasticity (UMN). As the disease progresses UMN signs may decrease
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| bulbar palsy | common with ALS
Dysartheria, Dysphagia, drooling
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| onset of ALS | insidious
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| ALS is characterized by | degeneration and scarring of motor neurons
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| what SC cells are lost with ALS? | anterior horn
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| early sign of ALS | tongue and eye fasciculations
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| respiratory impairments from ALS | Fatigue, dyspnea with activity,
sighing, morning headache
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| what % of ALS pts have significant cognitive impairments | 40%
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| ____ impairments are rare with ALS | sensory
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| diagnostics for ALS | Genetic Testing
EMG
Nerve Conduction Velocity testing
Nerve and muscle biopsy
Presence of LMN and UMN clinical signs
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| prognosis for ALS | Depending onset date but typically 5 year survival rate once diagnosed.
Individuals with Bulbar lesions have worse prognosis
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| is there a cure for ALS? | no cure
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| ___ can extend life of ALS pts by three months but many side effects | Rilutek
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| PT evaluation components for ALS | Cognition
Psychosocial
Pain – Visual analog scale
ROM, joint integrity, muscle length
Motor performance (MMT, endurance of muscle, Coordination, dexterity)
Tone – Modified Ashworth
Cranial Nerve assessment – See PTA 105 notes
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| ___ weakness is common with ALS | cervical
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| respiratory assessment for ALS | Cough assessment
Forced Vital Capacity – spirometer
Aerobic capacity
Chest excursions
(will need ventilator eventually)
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| PT for ALS in early stages | improving impairment
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| PT for ALS in late stages | preventing contractures, edema, adhesive capsulitis
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| compensatory interventions for ALS | orthoses, w/c, assistive device, etc.
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| early preventative PT for ALS | preventing loss of ROM, slowing progression of decrease aerobic capacity, strength, etc.
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| later preventative PT for ALS | difficult – minimize complications
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| shoulder pain from ALS | adhesive capsulitis and muscle imbalances
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| PT for respiratory weakness from ALS | Caregiver training – quad cough, inspiratory muscle training
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| what can PT provide to help with LE weakness with ALS | AFO's, AD
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| how can PT help with decreased mobility with ALS | Functional training with AD
Equip - Easy Pivot, Uplift seat
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| treatment for spasticity and cramps from ALS | Cryotherapy, stretches, positioning
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| is exercise safe for ALS? | Overuse atrophy does not occur with a MMT of 3/5 or greater
Moderate exercise can increase grades of 3/5 or greater
No heavy eccentric exercise
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| benefits of exercise for ALS | Exercise may produce psych and functional benefits
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