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PT Management in Others
Neurological conditions
Nichapha Chandee
School of Ailed Health Science and Puplic Health
E-Mail: [email protected], Tel: 084-2408849
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
Myasthenia gravis
• Neuromuscular junction defect
• Autoimmune disease
Thymoma (Active function of Thymus gl.)
• Produce Antibody to nicotinic receptors
- Receptor was blocked, damage
- Complement of NMJ defect
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
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
• facial weakness , a “snarling” expression when
the patient attempt to smile or facial diplegia
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
Myasthenia gravis
• History : diplopia, ptosis, weakness in
characteristic distribution, fluctuation during
the day, effects of previous treatments
• Physical examination : ptosis, diplopia, motor
(5min), vital capacity, absence of other
neurologic signs
• Laboratory : anti AChR radioimmunoassay :
definite diagnosis if positive
PT Management in MG
• General exercise (early stage)
• PT chest therapy (late stage)
- BE (Breathing exercise)
- Coughing
- Huffing
- Chest Trunk Mobilization
• Respiratory failure
ALS (Amyotrophic Lateral Sclerosis)
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
• Relentlessly progressive
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
ALS (Amyotrophic Lateral Sclerosis)
PT management in ALS
(Amyotrophic Lateral Sclerosis)
• General Exercise: mind/Moderate
• Chest Therapy
- BE (Breathing Exercise)
- Coughing
- Huffing
- Chest Trunk Mobilization
MS (Multiple sclerosis)
• Idiopathic disease of suspected
• Attacks a person's central nervous system
(brain and spinal cord), leading to
• 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
MS (Multiple sclerosis)
• Cause remains unknown
• Genetics or infections
• Different environmental risk factors
MS (Multiple sclerosis)
There are three categories of MS;
Definite, Probable, and Possible MS.
• Definite MS
• Probable MS
• Possible MS
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
• A few patients have malignant MS which is
where they have a quick decline which
leaves them severely disabled or even lead
to death.
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.
MS (Multiple sclerosis)
Memory change
Double Vision/Vision
• Weakness
• Dizziness/Unsteadin
• Numbness/Tingling
• Ataxia
• Euphoria
• Speech disturbance
• Bladder/Bowel/Sexu
al dysfunction
PT management in MS
(Multiple Sclerosis)
• General Exercise: depend on progression of
• Chest Therapy
- BE (Breathing Exercise)
- Coughing
- Huffing
- Chest Trunk Mobilization
Guillain-Barre’s Syndrome
• Most common cause of rapidly progressive
• 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
Guillain-Barre’s Syndrome
• Respiratory failure can be precipitous
• Other causes of morbidity and mortality
– Autonomic instability
– Infection
• Immune mediated, may be post infectious
• Treatment
– Plasma exchange
– Intravenous immunoglobulin
PT Management in
Guillain-Barre’s Syndrome
• General Exercise
• Pumping Exercise: Prevent DVT
• PT Chest Therapy
- BE (Breathing Exercise)
- Coughing
- Huffing
- Chest Trunk Mobilization
Duchenne and Becker Muscular
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
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
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