Result of polio damage
flaccid paralysis
Sensation intact
Brachial Plexus injury severely affect
upper extremity as contains all nerves that serve the arm leading to paralysis and pain
Motor Unit made up of
Motor neuron
Muscle fibers it innervates
Elementary functional unit in the motor system
Motor unit
Neuromuscular Junction
point at which nerve fiber contacts a muscle cell
Motor Unit Diseases result in
Muscle weakness
Muscle atrophy
Complications associated with loss of muscle function
Two types of Motor unit diseases
Neurogenic
Myopathic
Neurogenic
motor unit disease originating in the nerves, causing the nerve to not work correctly
Myopathic
motor unit disease originating in the muscle, causing neuromuscular junction to malfunction or muscle fibers to malfunction
Type of motor unit disease
Poliomyelitis
Poliomyelitis cause
polio virus
Poliomyelitis damages
anterior horn cells of gray matter in spinal cord
Polio mostly affects
Lower Extremities
Accessory muscles of respiration
Swallowing muscles
Muscle atrophy
Contractures common
Post polio Syndrome
characterized increased weakness of muscles that were previously affected by the polio infection
Causes of neurogenic motor unit diseases
Nerve root compression
Trauma
Toxins
Infection
Neoplasms
Vascular disorders
Degenerative CNS diseases
Congenital malformations
Types of Trauma causing Neurogenic motor unit diseases
bone fractures and dislocations
Lacerations
Traction
Penetrating wounds
Friction
OT interventions generally occur
after acute phase of disease
Positioning intervention for Polio
reduce skin breakdown, pain, and joint deformities and to promote function
Positioning intervention of polio promotes function
Bed positioning
Wheelchair positioning -type and cushion
Splinting
ROM and Strengthening intervention for Polio
Progress from PROM to AAROM to AROM to resistance exercises
No resistance until full ROM against gravity
Focus on correct movement, avoid compensatory movements (use mirror, follow with stretching)
Rationale for ROM and strengthening intervention for Polio
Strengthen unaffected muscles to compensate for deficits
Maximize use of affected muscles
Fatigue management intervention for polio
assistive devices
Task simplification
Environmental modifications
Splints
Mobile arm supports
ADL training intervention for Polio
Teach compensatory strategies
Encourage exploration of leisure interests
Adaptive equipment training
Transfer training
Guillain-Barre Syndrome define
acute inflammatory condition involving the spinal nerve roots, peripheral nerves, and possibly cranial nerves
Guillain-Barre Syndrome follows
viral infection, vaccinations, or post-surgery
Guillain-Barre Syndrome onset
Rapid
Starts with pain and tenderness in muscles
Proceeds to weakness and paralysis
Sensory loss and muscle atrophy
In serious cases, respiratory failure
Recovery for Guillain-Barre Syndrome
within a few weeks to a few months
Guillain-Barre intervention rehab begins
after patient is medically stable
May still be totally paralyzed
Early phase Guillain-Barre interventions
Prevent contractures, deformities and protect weak muscles
Passive activities
Early phase prevention interventions for Guillain-Barre
PROM
Positioning
Splinting
Early phase passive activity interventions for Guillain-Barre
Watch TV
Visit friends
Encourage leisure pursuits to improve outlook and engage in environment
Active movement starts returning interventions Guillain-Barre
Gentle, non-resistive activities
Light ADL's (wipe with washcloth, assist in dress)
Avoid fatigue
Rationale of interventions as active movements begins to return with Guillain-Barre
alleviate stiffness and atrophy
Prevent contractures
Improve strength
Improve psychological outlook
Increase of activity tolerance interventions in Guillain-Barre
AROM and light exercise
Joint protection
Table-top activities/crafts
ADL's (using mobile arm supports and overhead suspension slings)
Guard against fatigue
Upgrade slowly until able to work on full body dressing, bathing, functional mobility
As activity tolerance increases, intervention for Guillain-Barre precaution
Inflamed nerves aggravated by too much work
Joint protection
Peripheral Nerve Injuries
Damage along nerves of the PNS anywhere from spinal nerves to the distal extremities
Area of body nerve goes to in peripheral nerve injuries will have
Weakness or flaccid paralysis
Muscle atrophy
Loss of deep tendon reflexes
Loss of sensation
Paresthesia,
Dry skin, hair loss, brittle nails
Slow healing wounds
Loss of sweating
Contractures, deformities, joint stiffness
Medical management of peripheral nerve injuries
Nerve grafts
Microsurgery
Injections
Peripheral nerve regeneration
begins 1 month after injury
Peripheral nerve regeneration rate
� inch to 1 inch per month
Factors in peripheral nerve regeneration
severity of injury
Surgical intervention
Proximal faster than distal
Age
Signs of Nerve regeneration
skin color and texture improve
Gross recognition of pain, temp, pressure and touch
Paresthesia distal to injury
Scattered points of sweating
Discriminative sensations-localized touch, proprioception, sterognosis
Flaccidity decrease, muscle tone increase
A
Brachial Plexus injury
affects entire upper limb
Long Thoracic Nerve Injury
affects shoulder girdle
Radial Nerve Injury
Affects all extensors of elbow and forearm
Median nerve injury
affects hand and finger flexors
Ulnar Nerve injury
affects hand and finger flexors
Axillary Nerve injury
affects shoulder joint
Tibial Nerve injury
affects plantar flexion of ankle
Sciatic Nerve injury
affects muscles of leg and foot
Peroneal Nerve injury
affects dorsiflexors
Femoral Nerve injury
affects hip flexion and knee ext.
Brachial Plexus injury often caused in children
birth trauma
Brachial Plexus injury in football
Stinger
Klumpke's paralysis
Brachial Plexus injury (c8-T1) characterized by paralysis to distal musculature of the wrist flexors and intrinsic muscles of hand
Erb's Palsy
Brachial plexus (C5 &C6 roots)
Characterized by a limp arm with hand rotating medially
Long Thoracic Nerve Injury define
Long Thoracic Nerve innervates in Serratus Anterior Muscle of shoulder girdle resulting in weakness or paralysis and "winging" of scapula.
Interventions for Long Thoracic Nerve injury
Surgery
OT focus on maximize functional independence with long handled devices.
OT also help with progressive strengthening.
Axillary Nerve Injury Definition
Innervates deltoid and teres minor
Weak abduction, external rotation and horizontal abduction
Atrophy of deltoid
Hyperesthesia of area
OT intervention of Axillary Nerve injury
Maintain ROM to prevent deformity and improve circulation
Dressing training
How to prevent deformity and improve circulation for Axillary Nerve Injury
Protect Deltoid and Teres minor from over stretch
Start with AROM, progress to AROM and eventually strengthening exercises
With surgical transplant of tissue, helpful for EMG feedback
Sciatica
condition characterized by pain and electricity traveling down the leg along the course of the sciatic nerve.
Foot Drop
inability to dorsiflex the ankle
Caused by peripheral nerve injuries or by central nervous system condition.
Use AFO splint to keep ankle in neutral position
Pain in Peripheral Nerve pain Syndromes
common complication of PN injuries
Two types of pain syndromes
Complex Regional Pain syndrome
Neuroma Pain
Complex Regional Pain syndrome
also known as Causalgia or Reflex Sympathetic Dystrophy
After injury, intense pain and sensitivity develops far greater than expected for the injury
Is cyclical
Symptoms of Complex Regional Pain Syndrome
Pain, burning, extreme sensitivity to temperature, wind and even noise
Often holds limb to guard it against any trigger of pain.
Area often shiny and puffy
Neuroma pain
nerve tissue tumor or growth
Often occurs with incompletely healed nerve endings after injury
Common in fingers and amputated limbs
Phantom limb pain often result of neuroma formation
Interventions for Peripheral Nerve pain
Graded sensory input
Purposeful activities to provide cognitive diversion from experience
Background music or headphones during activities affect pain intensity
Types of Graded sensory input
Tapping/vibration
TENS
Instruction on protecting tender areas during ADL's
CRP associated with
tension and stress
Intervention in CRPS
Relaxation techniques
Types of useful relaxation techniques for CRPS
Deep breathing
Progressive relaxation
Guided imagery
Reason Relaxation works for CRPS
muscles relax, heart rate and respiration rate slow, general sense of well being
Give patient control over emotional tension and depression
Intervention for CRPS
Scrubbing exercises
Carrying exercises
Myasthenia Gravis
autoimmune disease that affects receptors at neuromuscular junction so muscles can't receive signals from motor nerves
Myasthenia Gravis symptoms
Fatigue of voluntary muscles
Targets muscles of eyelids, eyes, oropharyngeal muscles, tongue, jaw and throat
Affects more proximal muscles
Respiratory paralysis in severe cases
Main OT goal for MG
regain muscle power and build endurance
Avoid in Myasthenia Gravis
fatigue and respiratory exertion
Interventions for Myasthenia Gravis
Gentle, non-resistive activities that are intellectually and psychologically stimulating
Energy conservation, work simplification
Adaptive devices to reduce effort during ADLs
Home modifications
Mobile arm supports and splints to assist weakened muscles a
Muscular Dystrophies
degeneration of muscle fibers. Nerves for motor actions and sensation remains
Types of Muscular Dystrophies
Duchenne's
Becker's
Facioscapulohumeral
Myotonic
Limb-Girdle
OT interventions for Muscular Dystrophy
Decline of muscle function unable to be stopped
Delay deformity and achieve maximum function within disease limits
Focus on maintain maximum function
Patient/Family Training
Patient and Family Training for Muscular Dystrophy
Gentle passive stretch
Body alignment and joint integrity
Bed and wheelchair positioning to prevent contractures (hip, trunk, extremities)
ADL intervention for Muscular Dystrophy
Practice dressing, toileting, bathing to maintain skills and independence
Feeding and leisure
Compensate for weakness
Ways to compensate for weakness in Muscular Dystrophy
Built-up utensils for weak grip
Suspension sling and mobile arm support
Wheelchair lap-board to support reading, writing, games, crafts