Peripheral Neuropathy RehabilitationWuMan 1PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions21.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve31.1AnatomyPeripheralnervescanbecategorizedintotwogroupsbasedonwheretheyconnecttothecentralnervoussystem:Cranialnervesinnervatepartsofthehead,andconnectdirectlytothebrain(especiallytothebrainstem).Spinalnervesinnervate(distributeto/stimulate)muchofthebody,andconnectthroughthespinalcolumntothespinalcordandthustothecentralnervoussystem.41.1AnatomyTherearethreetypesofnervefibersinamixednervethatinclude:Sensorynervefibers(afferentfibers),Motornervefibers(efferentfibers),Autonomicnervefibers(autonomicfibers).51.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve61.2CauseInfectionTraumaToxinsPhysicalcompressionIschemiaMetabolicdisorders71.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve81.3Pathology1.Walleriandegeneration2.Axonaldegeneration3.Segmentaldemyelination9101.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve111.4ClassificationPeripheralnerveinjurytraumaWalleriandegenerationNeuropathyInflammation,toxins,ischemia,MetabolicdisordersAxonaldegeneration121.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve131.5Peripheralnerveinjuryclassification1.NeurapraxiaNeurapraxiaisadisorderoftheperipheralnervoussysteminwhichthereisatemporarylossofmotorandsensoryfunctionduetoblockageofnerveconduction,usuallylastinganaverageofsixtoeightweeksbeforefullrecovery.Neurapraxiaresultsintemporarydamagetothemyelinsheathbutleavesthenerveintactandisanimpermanentcondition;thus,Walleriandegenerationdoesnotoccurinneurapraxia.141.5Peripheralnerveinjuryclassification2.AxonotmesisAxonotmesisisadisruptionofnervecellaxon,withWalleriandegenerationoccurringbelowandslightlyproximaltothesiteofinjury.Ifaxonsandtheirmyelinsheatharedamaged,butSchwanncells,theendoneurium,perineuriumandepineuriumremainintact,itiscalledaxonotmesis.Axonotmesisisusuallytheresultofamoreseverecrushorcontusionthanneuropraxia.Therateofoutgrowthofregeneratingnervefibersisabout1mmto2mmperday,sothattherecoveryofconductiontoatargetstructuredependsonnotonlyregrowthintotheappropriateendoneurialtube(endoneurium),butalsoonthedistanceinvolved.151.5Peripheralnerveinjuryclassification3.NeurotmesisNeurotmesisisthemostseriousnerveinjuryinthescheme.Inthistypeofinjury,boththenerveandthenervesheatharedisrupted.Whilepartialrecoverymayoccur,completerecoveryisimpossible.Inmostcasesitcannotbecompletelyrecoveredfromevenwithsurgicalrepair.161.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve171.6ClinicalmanifestationsMovementimpairmentSensoryimpairmentLossofthereflexesAutonomicnervedysfunction181.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve191.7RegenerationofperipheralnerveWhenanaxonisdamagedThedistalsegmentundergoesWalleriandegeneration,losingitsmyelinsheath.Axonalsproutsformattheproximalstumpandgrowuntiltheyenterthedistalstump.2122PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions232.Rehabilitationevaluation1.Musclestrengthtests:manualmuscletest(MMT)isometricmuscletest24Grading of manual muscle testGradeNumerical scaleMuscle activityzero0No contraction visible or palpableTrace1Contraction seen or palpated but no joint movementPoor2Contraction with gravity eliminatedFair3Contraction against gravityGood4Contraction against minimum to moderate resistanceNormal5Contraction against maximum resistance2.Rehabilitationevaluation2.Circumferencemeasuring3.Rangeofmotion(ROM)measuringDevicestomeasurerangeofmotioninthejointsofthebodyincludethegoniometerandinclinometerwhichuseastationaryarm,protractor,fulcrum,andmovementarmtomeasureanglefromaxisofthejoint.4.Sensoryexam262.Rehabilitationevaluation5.Testingofreflexes:BicepsreflexTricepsreflexRadialreflexPatellarreflexAnklereflex27Bicepsreflex28Tricepsreflex29Radialreflex30Patellarreflex31Anklereflex322.Rehabilitationevaluation6.Autonomicnervetestasweattest7.ElectrodiagnosisElectromyographytestEMGchanges(2to3weeksafterinjury)NerveconductionvelocitytestSomatosensoryevokedpotentialtest332.Rehabilitationevaluation8.Activitiesofdailyliving(ADL)evaluation34PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions353.Rehabilitationtreatment3.1Theearlyphase3.2Recoveryphase363.1Theearlyphase1.Keepalljointsoftheaffectedlimbonfunctionalpositione.g.Radialnerveinjurypatientsoftenmanifestatedropwrist.Treatmentsincludesupportingwristwithasplint.Theangleofthewristextensionsplintis20-30degrees.373.1Theearlyphase2.Activemovementorpassivemovementonalljointsoftheaffectedlimbpassivemovement1-2timeperdayactivemovement3.Themeasuresofswellingontheaffectedlimb383.1Theearlyphase4.Theapplicationofphysicalfactorsultrashortwavetherapy,microwavetherapy,infraredtherapyCirculationinthelimbisstimulatedwiththeuseofheat.5.Protecttheaffectedareas393.Rehabilitationtreatment3.1Theearlyphase3.2Recoveryphase403.2Recoveryphase1.NeuromuscularelectricalstimulationtherapyMaintainingmusclestrength413.2Recoveryphase2.Strengthtrainingmusclestrengthis0-1,takepassivemovement,electromyographicbiofeedbacktherapymusclestrengthis2-3,takeassistedmovement,activemovement,equipmentmovementmusclestrengthis3+-4,takeresistedmovement423.2Recoveryphase3.ADLtraining4.Occupationaltherapy5.Sensorytraining433.2Recoveryphase6.PromotethenerveregenerationNervegrowthfactor,VitB1,VitB12ultrashortwavetherapy,microwavetherapy,infraredtherapy7.Surgicaltreatment44PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6. Reviewquestions454.RehabilitationofcommonperipheralneuropathyPeripheralfacialparalysis(Bellspalsy)Cause:Reactivationofanexisting(dormant)viralinfectionSignsandsymptoms:distortionofcommissure;cannotfrownonthepareticsideandclosethepareticeyecompletely;thepareticnasolabialfoldshallow,andmouthtwisttothenon-paretic;cannotdrumgills.Centralfacialpalsy:controltheupperpartoftheirfaces46peripheralfacialparalysis47peripheralfacialparalysisRehabilitationtreatmentTheearlyphaseMedication:Corticosteroidsuchasprednisone,Bvitamins,AntiviralssuchasaciclovirPhysiotherapy:ultrashortwavetherapyRecoveryphaseNeuromuscularelectricalstimulationtherapy,activemovement,acupuncture48PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions495.SummaryMasterTherehabilitationtreatmentoftheperipheralneuropathyFamiliarTherehabilitationevaluationoftheperipheralneuropathyUnderstandTheperipheralneuropathycause,pathology,classification,clinicalmanifestations50PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions516.ReviewquestionsWhataretheclinicalmanifestationsofperipheralneuropathy?Thecontentofrehabilitationevaluation.Thetechniquesofrehabilitationtreatment.5253