1 / 28

PT Management in Others Neurological conditions

PT Management in Others Neurological conditions. Nichapha Chandee School of Ailed Health Science and Puplic Health E-Mail: cnichaph@wu.ac.th, Tel: 084-2408849. Others Neurological. Myasthenia gravis ALS (Amyotrophic Lateral Sclerosis) MS (Multiple sclerosis) Guillain-Barre’s Syndrome

emilie
Télécharger la présentation

PT Management in Others Neurological conditions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PT Management in Others Neurological conditions Nichapha Chandee School of Ailed Health Science and Puplic Health E-Mail: cnichaph@wu.ac.th, Tel: 084-2408849

  2. Others Neurological • Myasthenia gravis • ALS (Amyotrophic Lateral Sclerosis) • MS (Multiple sclerosis) • Guillain-Barre’s Syndrome • Duchenne and Becker Muscular dystrophy • Parkinson’s disease • Cerebellar dysorders

  3. Myasthenia gravis • Neuromuscular junction defect • Autoimmune disease Thymoma (Active function of Thymus gl.) • Produce Antibody to nicotinic receptors (NMJ) - Receptor was blocked, damage - Complement of NMJ defect

  4. Myasthenia gravis Clinical Features • peaks of incidence : Woman 20-30 and 60-80, Men 50-60 • female : male = 3:2 • The cardinal features are “ Weakness” and “ Fatigability” of muscles • The weakness increases during repeated use and may improve following rest or sleep

  5. Myasthenia gravis • Remissions are rarely complete or permanent • Infections or systemic disorders : weakness will be worse and may precipitate “ myasthenic crisis”  respiratory failure • Muscle weakness : • lids and extraoccular muscles, diplopia and ptosis • facial weakness , a “snarling” expression when the patient attempt to smile or facial diplegia

  6. Myasthenia gravis • Weakness in chewing, speech, difficulty in swallowing • Proximal weakness of limb muscle • Deep tendon reflex : normal • “ CRISIS” weakness of respiration and require respiratory assistance

  7. Myasthenia gravis • DIAGNOSIS • History : diplopia, ptosis, weakness in characteristic distribution, fluctuation during the day, effects of previous treatments • Physical examination : ptosis, diplopia, motor power, FORWARD ARM ABDUCTION TIME (5min), vital capacity, absence of other neurologic signs • Laboratory : anti AChR radioimmunoassay : definite diagnosis if positive

  8. PT Management in MG • General exercise (early stage) • PT chest therapy (late stage) - BE (Breathing exercise) - Coughing - Huffing - Chest Trunk Mobilization • Respiratory failure

  9. ALS (Amyotrophic Lateral Sclerosis)

  10. ALS (Amyotrophic Lateral Sclerosis) • Loss of motor neurons in the cortex, brainstem and spinal cord • Mix of upper motor neuron and lower motor neuron findings • Weakness, atrophy, fasciculations • Slurred speech, difficulty swallowing, shortness of breath • Can start in any extremity or the bulbar musculature • Relentlessly progressive

  11. ALS (Amyotrophic Lateral Sclerosis) • 50 % dead in 3 years, 80% dead in 5 years, 5-10% live more than 10 years • Death usually from respiratory failure • Etiology still only theoretical • Excess glutamate • Oxidative stress • Free radicals • Mitochondrial dysfunction

  12. ALS (Amyotrophic Lateral Sclerosis)

  13. PT management in ALS (Amyotrophic Lateral Sclerosis) • General Exercise: mind/Moderate • Chest Therapy - BE (Breathing Exercise) - Coughing - Huffing - Chest Trunk Mobilization

  14. MS (Multiple sclerosis) • Idiopathic disease of suspected autoimmune • Attacks a person's central nervous system (brain and spinal cord), leading to demyelination • Attacks and damages the myelin • Refers to scars (scleroses—better known as plaques or lesions) in the white matter of the brain and spinal cord

  15. MS (Multiple sclerosis) • Cause remains unknown • Genetics or infections • Different environmental risk factors

  16. MS (Multiple sclerosis) There are three categories of MS; Definite, Probable, and Possible MS. • Definite MS • Probable MS • Possible MS

  17. MS (Multiple sclerosis) • Relapse-remitting MS (RRMS): Here you have an attack, go into complete or partial remission, then have the symptoms return. • Primary-progressive MS (PPMS): Here you continually decline and have no remissions. There may be a temporary relief in symptoms. • A few patients have malignant MS which is where they have a quick decline which leaves them severely disabled or even lead to death.

  18. MS (Multiple sclerosis) • Secondary-progressive MS (SPMS): This stage of MS starts with RRMS symptoms and continues on to show signs of PPMS. • Progressive-relapsing MS (PRMS): This is a rare form but here it takes a progressive route made worse by acute attacks. • 20% of the people with MS have a benign form. Here they show little progression after the first attack.

  19. MS (Multiple sclerosis) • Fatigue • Depression • Memory change • Pain • Spasticity • Vertigo • Tremor • Double Vision/Vision Loss • Weakness • Dizziness/Unsteadiness • Numbness/Tingling • Ataxia • Euphoria • Speech disturbance • Bladder/Bowel/Sexual dysfunction

  20. PT management in MS (Multiple Sclerosis) • General Exercise: depend on progression of lesion • Chest Therapy - BE (Breathing Exercise) - Coughing - Huffing - Chest Trunk Mobilization

  21. Guillain-Barre’s Syndrome • Most common cause of rapidly progressive weakness • Demyelinating neuropathy • Ascending weakness which may include cranial neuropathies • Exam reveals symmetric weakness with areflexia and large fiber sensory loss • Bowel and bladder usually preserved

  22. Guillain-Barre’s Syndrome • Respiratory failure can be precipitous • Other causes of morbidity and mortality • Autonomic instability • DVT • Infection • Immune mediated, may be post infectious • Treatment • Plasma exchange • Intravenous immunoglobulin

  23. PT Management in Guillain-Barre’s Syndrome • General Exercise • Pumping Exercise: Prevent DVT • PT Chest Therapy - BE (Breathing Exercise) - Coughing - Huffing - Chest Trunk Mobilization

  24. Duchenne and Becker Muscular dystrophy

  25. Duchenne’s Muscular Dystrophy Duchenne’s Muscular Dystrophy • X-linked recessive • Absence of dystrophin protein • Slow to reach motor milestones, sxs by age 5 • All walk, may never run • End up in wheelchair by age 10-12 • Steroids may delay time until wheelchair bound • Muscles replaced by fat may appear hypertrophic • Frequently mildly mentally retarded • Life expectancy < 20 years with death related to respiratory failure or cardiomyopathy

  26. Duchenne’s Muscular Dystrophy General Appearance • Shoulder arkwardly • Sway back • Scoliosis • Knee bend (locked-knee) • Pseudohypertrophy of calf • Tip-Toe walking • Muscle of LE Atrophy

  27. PT Management in Duchenne’s Muscular Dystrophy • Trunk Stabilization exercise • Management of Posture: Scoliosis • Stretching of calf muscle • Exercise for Strengthening of Muscle of LE • Chest PT in late stage

  28. Any Question?

More Related