Neuropathies + Developmental/birth injuries Flashcards Preview

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Flashcards in Neuropathies + Developmental/birth injuries Deck (40)
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1
Q

Peripheral neuropathy causes

A
o	diabetes (most common)
o	Lyme disease
o	HIV
o	Shingles
o	Guillain-Barre
2
Q

What is a peripheral neuropathy

A

injury to peripheral N due to injury or illness

3
Q

Are diabetic neuropathies focal, diffuse, or both

A

Can be either

4
Q

What nervous systems do diabetic neuropathies effect

A

Somatic or autonomic PNS

5
Q

Diabetic neuropathy Presentation

A

symmetrical distal pattern (diabetic polyneuropathy)

6
Q

Diabetic neuropathy Causes

A
  • hyperglycemia leading to abnormal microcirculation
  • change in insulin levels alter gene-regulation
  • loss of myelinated + non-myelinated fibers
  • vascular changes
  • nerve growth reduced
7
Q

Diabetic Neuropathy S&S

A
  • burning pain
  • symmetrical sensory changes (paresthesia, burning)
  • can be slow or rapid onset (people may not notice it)
  • paresthesia: impaired proprioception, touch, pressure
  • minimal motor weakness
8
Q

Diabetic neuropathy Rx

A
  • control hyperglycemia
  • symptoms management
  • skin care checks* (risk of wound and amputation)
  • exercises:
    • strength (ankle, hips: strategies for prevention of falling)
    • balance
    • prevention of damage to skin, joint, muscle, CT
9
Q

What is complex regional pain syndrome (CRPS)

A

chronic pain condition

10
Q

What may cause CRPS

A

Dysfunction in central or peripheral NS

11
Q

CRPS presentation

A

o change in color/temp of the skin over the affected limb or body part
o intense burning pain
o skin sensitivity
o sweating
o swelling
o stiffness
o usually occurs after trauma or immobilization (cast)

12
Q

CRPS Stages + corresponding presentation

A

Stage 1 (0-3 months) puffy swelling, redness, warmth, stiffness, allodynia, pos bone scan

Stage 2 (3-6 months) Increased P and stiffness, firm edema, cyanosis, atrophy, osteopenia on xray

Stage 3 (6 months +) tight, smooth, glossy, cool, pale skin
     - stiffness and contractures, nail and hair changes, severe osteopenia
13
Q

CRPS Rx

A

Prevention and early detection

- early ROM, P/edema management (desensitization, contrast baths, modalities), education

14
Q

What is cerebral palsy (CP)?

A

Non-progressive lesion of brain, occurs before 2yrs

15
Q

CP Comorbities

A
o hearing and speech problems
o hydrocephalus
o microcephaly
o scoliosis
o hip dislocation
o mental retardation
16
Q

CP Risk Factors

A

o prenatal (maternal infection, malnutrition, maternal seizures)
o perinatal (prematurity 27-30 weeks gestation, obstetric complications (breech)
o small for gestational age
o rupture of membranes
o intrauterine infection
o low APGAR
o multiple births
o post-natal: infection, environmental toxins, brain tumor, anoxia, CVA
o loss of autonomic regulation of CNS blood flow until full term
• (cycle of perfusion and reperfusion)

17
Q

What are the 5 CP classification

A
Spastic 
Ataxic 
Dystonic 
Hypotonia 
Athetoid
18
Q

What are the key features of spastic CP

A

stiffness, dec. ROM, movements limited to synergies primitive movement patterns- trouble start/stop movement

19
Q

What are the key features of ataxic CP

A
  • difficulty with rapid movements
  • coordinated gait
  • fine motor
  • balance
20
Q

What are the key features of dystonic CP

A
  • Inc. tone, can’t relax muscles easy
  • long sustained involuntary movements and postures
  • tend to lock joints at end range
  • usually have full ROM
  • mid control difficult
21
Q

What are the key features of hypotonia CP

A

Lack of tone

Weakness

22
Q

What are the key features of Athetoid CP

A

Writhing movement

Snake like

23
Q

What are 3 causes of CP

A
  • intraventricular hemorrhage - below - periventricular leukomalacia - common ischemic injury
  • small holes surrounding ventricles - death of small areas of brain tissue
24
Q

CP Rx

A

Medical:

  • baclofen pump
  • dorsal rhizotomy (cut dorsal roots of SC)
  • Botox to ADDs
  • serial casting
  • tendon release
  • osteotomy

PT Management

  • manage atypical mm - ROM, orthotics
  • habituation, not rehab
  • positioning, sitting modifications - put pummel between legs
25
Q

What is spinal bifida?

A

Neural tube defect leading to vertebral and/or spinal cord malformation

26
Q

What are 4 types of Spina bifida

A
  • Spina Bifida Occulta - no spinal cord involvement, may be indicated by hair tuft
  • Spina Bifida Cystica - visible or open lesion
  • Meningocele - cyst includes cerebrospinal fluid cord intact
  • Myelomeningocele - cyst includes CSF and herniated cord tissue
27
Q

What is Spina Bifida Occulta

A

no spinal cord involvement, may be indicated by hair tuft

28
Q

What is Spina Bifida Cystica

A

-visible or open lesion

29
Q

What is Meningocele

A

cyst includes cerebrospinal fluid cord intact

30
Q

What is Myelomeningocele

A

-cyst includes CSF and herniated cord tissue

31
Q

There is a link between spina bifida and what maternal factors

A

maternal decreased folic acid + infection + exposure to teratogens (alcohol)

32
Q

Spina Bifida S&S

A
  • flaccid or spastic muscles
  • muscle weakness
  • contractures
  • muscle wasting
  • decreased/absent DTR
  • rectal/bladder incontinence
  • hydrocephalus (Chiari malformation)
  • osteoporosis, lordosis, scoliosis, kyphosis
  • foot deformities  talipes equinovarus (club foot) especially with L4, L5 level
33
Q

Spina Bifida Rx

A
  • ROM, strengthen functional muscles
  • teach transfers
  • equipment (orthotics, early mob, standing and ambulation)
  • encourage awareness of sensory deficits (protection of feet, position of legs, check for sores)
34
Q

What is Erbs palsy?

What is the presentation for Erbs Palsy?

A

Most common brachial plexus injury (73%), paralysis of UE muscles + sensory loss, grasp intact
- C5, C6 injury in infants: usually coming out of birth canal

shoulder ext/IR/add + elbow ext + forearm pronation + wrist/fingers flexed) (waiters position)

35
Q

What muscles are effected in erbs palsy

A
  • Rhomboids, levator scapulae, serratus anterior, delts, supraspinatus, infraspinatus
  • biceps, brachioradialis, brachialis, supinator, long extensors of wrist, fingers, thumb
36
Q

Erbs palsy Rx

A
  • immobilization initially, positioning, splinting
  • gentle ROM
  • play exercises - functional training + facilitation of normal movement (age appropriate)
37
Q

What spinal levels are injured in Klympke’s palsy?

A

C7/8-T1

38
Q

What muscles are effected in Klumpkes palsy ?

What is another term for this injury?

A

Intrinsics hand mm, flex+ext of wrist/fingers

Clar hand

39
Q

What spinal levels are injurd in Median N Palsy

A

C6-C8, T1, Median nerve

40
Q

What muscles are effected in Median N palsy ?

What is another term for this injury?

A

Thenar mm - no thumb abduction or opposition

Ape hand