Neuromuscular Conditions

ALS

Radiculopathy = pinch nerve

Clinical signs/symptoms

Cervical - pinch in neck = neck pn

  • Symptoms: neck and arm pain. Weakness of UL

Lumbosacral = LBP/ sciatica → degen change in spine

  • Symptoms: LBP, glut, thigh, and calf pain

Peripheral Neuropathies

1. Diabetic neuropathy (polyneuropathy) - affects nerves to feet and hand

2. Carpal Tunnel (mononeuropathy) - Compression on the median nerve causing inflammation and pressure

Charcot Marie Tooth disease (CMT) & Guillian Barre Syndrome (GBS)

Muscular Dystrophy – Duchenne

Clinical signs/symptoms

Exercise considerations & recommendations

Myasthenia Gravis (MG)

Clinical signs/symptoms

Exercise considerations & recommendations

Genetic disorder that cause progressive deterioration of the body’s muscle = increasing weakness and disability

Autoimmune disease affecting the neuromuscular junction of muscles → where muscle n nerves meet

Dysfunction of UL and LL (upper and lower neurons)

  • Rapidly progressive neurodegenerative disorder of the brain and spinal cord

Clinical signs/symptoms

CMT - inherited nerve problem, abnormalities of nerves in hands, feet, legs and arms

GBS - Autoimmune destruction of nerves in the PNS;

  • Damaged peripheral nerves causing weakness/paralysis (motor nerves affected)
  • Abnormal sensations and pain (sensory nerves affected).
  • Loss of motor control in the hands and arms
  • Dropping things → impaired grip strength
  • Lasting severe tiredness (fatigue)
  • Uncontrollable periods of laughing or crying

pain (radiating),

sensory deficits (numbness/tingling),

motor deficits (weakness),

Rehab strategies

Cervical

  • Limit atrophy of muscles and surrounding tissues
  • Maintain R.O.M of arm and neck
  • Cold packs following rehab session
  • Correct/manage causative factors: Poor posture, workstation set up, scoliosis , education on lifting techniques.
  • Preventative rehabilitation for athletes: Tackling, strengthening, proprioception, muscle reaction time, education.

Lumbosacral

  • Stage 1: stretching, gentle movement, hydrotherapy
  • Stage 2: Progress ROM, stretching, aerobic exercise, start strengthening: limit guarding postures, gradually increase intensity.
  • Stage 3: strengthening and conditioning: high repetition exercises for global strengthening. Functional activities. At least 20-30 minutes of aerobic exercises 2-3 times per week and 30 minutes of strength and flexibility stretching 3 times per week.
  • Stage 4: return to activity: Full pain free ROM. Restoration of adequate muscular strength and endurance and control to prevent reinjury.
  • Stage 5: Maintenance

Symptoms

  • Hypoglycaemia unawareness (cause shakiness, sweating and incr HR)
  • Loss of toe, foot or leg: nerve damage results in loss of feeling, minor cuts can turn into sores or ulcers.
  • UTIs and urinary incontinence
  • Sharp drops in BP – dizziness when standing
  • Digestive problems
  • Increased or decreased sweating
  • Changes in vision.

Exercise Considerations

Hydration before and after ex

Monitor hypoglycemic events

Foot care

Symptoms

  • Numbness
  • Shock
  • Pain or tingling radiating into forearm
  • Weakness
  • Dropping objects

Management strategies

stretching and strengthening

  1. Wrist Extension stretch
  1. Wrist Flexion stretch
  1. Tendon Glides
  1. Median Nerve Glides

Symptoms

  • Weakness of foot and LL muscles
  • Foot deformities, including a high arch and bent toes (hammer toes)
  • Foot drop
  • Loss of muscle around hands and feet
  • Numbness, tingling, burning, sensation in hands and feet
  • Discomfort pain in hands/ feet
  • Scoliosis

Management

Exercise considerations

  • Physical therapy: strengthen and stretch muscles to delay disability caused by weakness and deformity.
  • Orthopaedic devices: ankle braces, thumb splints.
  • Pain medicines
  • Surgery: to manage severe deformities of the spine, feet or other joints

Symptoms

  • Weakness and tingling in hands and feet
  • Loss of all deep tendon reflexes.
  • Fatigue and pain.

Management

  • Plasmapheresis- procedure that removes the plasma and replace w/ other fluids.
  • Pain medications
  • Physical therapy to incr muscle flexibility and strength

Waddling gait, calf enlargement, positive Gowers sign (weakness of the proximal muscles of LLs), foot drop, falls ++

  • Cardiac manifestations: Persistent tachycardia is one of first symptoms
  • Respiratory manifestations: Vital capacity decreases.
  • Cognition: Higher incidence of attention deficit hyperactivity disorder and autism spectrum disorders.
  • Orthopaedic: scoliosis, poor bone health. Joint contractures are common at the hips, knees, ankle joints and iliotibial bands.
  • Other: Obesity, bladder dysfunction.
  • Moderate intensity exercise may maintain muscular strength
  • Avoid intensive eccentric muscle exercise, + high-resistance
  • Stretching to prevent contractures.
  • Referral to orthotist for AFOs and KAFOs.
  • Active, active-assisted, and/or passive stretching to prevent or minimise contractures
  • Ambulatory phase: regular stretching at the ankle, knee, and hip is necessary.
  • Non-ambulatory phase: regular stretching of the UL, including the long finger flexors and wrist, elbow, and shoulder joints

Skeletal muscle weakness

  • Eye Muscles: Drooping of one or both eyelids
  • Tongue weakness: slurred speech, trouble swallowing, weakness in chewing, and dysphagia.
  • Axial Muscles: neck muscle weakness, vocal cord paralysis, respiratory muscle weakness, pelvic floor muscle weakness.
  • Limb Muscles: Proximal involvement > than distal. Usually asymmetrical. Proximal UL weakness, proximal LL weakness, and some distal limb weakness may occur (finger extensor and foot drop).
  • General fatigue

Worsens with physical activity, and improves with rest or application of ice to muscle group → adjust Rx as appropriate