Conditions Of The Spinal Cord, Peripheral Nervous System, & Neuromuscular System

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Causes of spinal cord injuries can include:

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-accidents
-compression of the spinal cord
-infectious conditions
-degenerative disorders
-congenital disorders

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The extent of functional consequences or losses as a result of spinal cord injuries depends

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-on which part of the spinal cord is injured
-whether cord is bruised, compressed, or severed
-the higher the injury, the more severe the injury

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An incomplete spinal cord injury

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-is when spinal cord severence is not complete

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Paraperesis

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-partial paralysis
-indicates that some function remains below the level of injury

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Neurogenic bladder or bowel

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-paralysis of the bladder or the lower rectal/anal muscles such that the ind. is unable to control bladder or bowel evacuation
-common after SCIs

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Employment rates for individuals with SCI are

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from 16%-69%

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Individuals with SCI will or will not typically have cognitive deficits.

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Will not unless they also have an associated brain injury

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Complications associated with spinal cord injuries include:

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-altered symptoms of illness due to lack of or limited sensations due to the SCI
-pressure sores (decubitus ulcers)
-urinary tract and bowel complications (kidney stones, UTIs)
-contractures (loss of range of motion or fixed deformity of a joint)
-spasticity (exaggerated involuntary movement of paralyzed muscles)
-osteoporosis
-cardiovascular complications (thrombophlebitis-blood clots in legs)
-autonomic dysreflexia
-pneumonia and upper respiratory problems
-other neurological complications (diaphoresis, paresthesia)
-sexual dysfunction

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Examples of conditions resulting from neural tube defects include:

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-spina bifida
-anencephaly (infants born with incomplete brain/skull development)
-encephalocele (infants born with hole in skull where brain protrudes)

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Spina Bifida

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-is a neural tube defect/condition in which one or more vertebrae are left open so that the spinal cord is exposed

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Types of spina bifida include:

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-spina bifida occulta
-meningocele
-myelomeningocele

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Spina bifida occulta:

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-is the most mild form
-does not involve damage to the spinal cord
-refers to an opening between one or more of the vertebra of the spinal column but nothing protrudes between the openings

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Meningocele

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-refers to a more severe form of spina bifida where the meninges (covering that protects the spinal cord) protrude through an opening in the spinal column
-does not include the actual spinal cord
-can be corrected with surgery although the ind. may have some residual effects

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Myelomeningocele

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-the most common and most severe form of spina bifida
-nerves and meninges protrude through the opening of the vertebra to the outer part of the body
-most individuals with this type of spina bifida have paraplegia and poor bowel and bladder functioning
-many may also suffer from hydrocephalus and/or scoliosis

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Is spina bifida a congenital and/or progressive condition?

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-it is congenital
-the condition itself is not progressive but the other associated conditions, ex. scoliosis, may become progressive

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Intellectual abilities in individuals with spina bifida should or should not be altered?

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Should not unless other issues, eg. hydrocephalus, other brain damage, also occur

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Poliomyelitis (polio)

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-is an acute infectious viral disease that was prevalent in the US in the first half of the 20th century but is now more prevalent in developing countries
-virus enters the body when contaminated food or water is ingested
-it targets the nerve cells that control muscles, causing muscle cells to become unable to contract
-causes paralysis to one or more extremeties and it can be temporary or permanent
-is non-progressive

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The vaccine developed ni the 1950s that is responsible for the decline in polio cases in the US is called:

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-the inactivated poliovirus vaccine (IPV)

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Manifestations of polio include:

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-early symptoms: gastrointestinal or upper respiratory symptoms, fever, headache, stiff neck, and muscle pains
-muscle weakness and paralysis
-extremities affected are smaller in size due to delayed growth
-paralysis most often affects the legs but can affect all four extremeties, one leg and one arm, or just one extremety

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Two types of polio are:

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-paralytic polio=causes paralysis
-bulbar polio=affects the brain stem and muscles that control breathing and swallowing

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Post-polio syndrome

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-symptoms appearing 30-40 years after a person recovers from acute polio
-include: abnormal muscle fatigue & generalized fatigue, new muscle weakness in muscles not previously affected, muscle pain (myalgia) and/or joint pain, respiratory difficulties
-is progressive

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Vocational issues in people with post-polio syndrome:

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-onset of it may make it necessary for a number of alterations in the work setting and/or job duties
-ability to lift, reach, walk, or climb may be altered and cause a need for restructuring of the job
-may necessitate the use of additional assitive devices (from crutches to wheelchair)
-adaption in workplace accommodations may be needed
-transportation to/from work, increased time for ind. to get ready, and/or adjustment in work schedule may be necessary

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Parkinson's Disease

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-refers to a slowly progressive d/o of the central nervous system that leads to progressive loss of motor function
-symptoms include: tremor at rest, slowness of movement (bradykinesia), rigidity, and postural instability
-involves extensive degeneration in the basal ganglia (gray matter of the brain) and decreases in dopamine, both involved in controlling movement
-commonly occurs after the age of 50

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Secondary parkinsonism

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-refers to a syndrome with symptoms similar to Parkinson's Disease but caused by ingestion of drugs or chemicals vs. genetic causes

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Typical manifestations of Parkinson's Disease include:

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-shuffling gait
-gait hesitation
-urinary and/or bowel problems
-blinking less frequently and mask-like expression
-difficulty swallowing, more prone to coughing and choking
-speech changes
-changes in handwriting
-tremors, especially resting tremors
-increased fatigue
-some emotional and/or behavioral changes
-depression, apathy, passivity, and loss of initiative

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This medication can decrease the symptoms Parkinson's disease:

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-levadopa (L-dopa)

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Two neurosurgical interventions for treatment of Parkinson's include:

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-deep brain stimulation (DBS)
-pallidotomy (surgical removal of part of the basal ganglia)

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Vocational issues with Parkinson's Disease include:

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-work that is more sedentary and does not require much verbal communication is best
-jobs that are highly stressful or that require considerable walking, stooping, or bending should be avoided
-transportation to and from work may be the largest obstacle to employment

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Huntington's Disease (Chorea):

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-is a progressive genetic conditions of the central nervous system in which neurons in the basal ganglia degenerate
-characterized by disorders of movement, cognition, and/or behavior
-symptoms appear between 30-50 years of age and the condition advances slowly and progressively
-it leads to severe functional consequences and death after 15-20 years.

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The 3 types of symptoms associated with Huntington's Disease are:

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-cognitive deficits: absent-mindedness, diff. concentrating, dementia
-motor consequences: finger movements (like fidgeting), slowness of movement (bradykinesia), rigidity, jerky involuntary movements (chorea), diff. speaking and swallowing
-behavioral changes: delusions, impulse-control problems

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Diagnosis of Huntington's Disease is done by

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-neurologists

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Vocational issues with Huntington's Disease include:

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-short-term training is appropriately early after onset
-increasing diff. with communication, memory, and physical abilities may lead to sheltered employment being the best option later in the progression of the disease

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Amyotrophic Lateral Sclerosis (ALS)

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-also known as Lou Gehrig's Disease
-is a progressive, degenerative condition in which there is destruction of motor neurons in the brain, spinal cord, and peripheral nervous system
-damaged portions of the nerve tracts are replaced by scar tissue and plaques
-cause is unknown

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The 2 primary forms of ALS are:

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-spinal form: characterized by muscular weakness, muscle atrophy, spasticity, and hyperactive reflexes
-bulbar form: difficulty breathing, slurring of speech, lowered speaking volume, difficulty swallowing
-regardless of which one a person initially presents with, the person will eventually have all symptoms

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Manifestations of ALS (regardless of spinal or bulbar form at onset) include:

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-progressive weakness and immobility
-progressive paralysis leading to complete dependence on others for self-care
-muscle pain
-drooling
-respiratory muscle weakness

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What is NOT usually affected by ALS?

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-cognitive functions
-sensation
-vision
-hearing
-bowel and bladder function

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Management of ALS

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-focused on management of symptoms, as there is no cure
-includes focus on maintaining muscle function, relieving discomfort, and forestalling complications
-medications are used to reduce spasticity

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ALS generally progresses:

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-rapidly, within 3-5 years, 10 at most

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Vocational issues in ALS

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-physical demands of work should be light and sedentary
-wheelchair-accessibility is an important consideration
-occupations requiring considerable speaking/verbal communication should be avoided

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Guillain-Barre Syndrome:

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-is an acute and progressive inflammatory condition where the body's immune system attacks the peripheral nerves
-is an immune-mediated condition that appears to follow infection
-is characterized by muscular weakness and ascending paralysis

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Symptoms of Guillain-Barre Syndrome:

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-develop rapidly, within a few hours to a few weeks
-typically peak in intensity within 3-8 weeks
-are reversible once symptom progression stops

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Manifestations of Guillain-Barre Syndrome include:

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-muscle weakness
-paralysis (usually ascending)
-breathing difficulties
-abnormal blood pressure or hearbeat
-numbness, tingling, sensation of skin-crawling
-muscle aches and/or back pain

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Vocational issues in Guillain-Barre Syndrome include:

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-lengthy time off of work for rehabilitation
-individual's may need reemployment training to return to work
-individual's may initially need to return to work on a part-time basis and may need periodic rest breaks

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Myasthenia Gravis

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-is a neuromuscular condition characterized by weakness and fatigability of the muscles
-is an autoimmune condition in which symptoms are caused by a decrease in a neurotransmitter called acetylcholine
-is characterized by weakness and fatigue in the eyelids, muscles of the throat, and muscles of the extremeties, as well as ptosis (drooping) of the eyelid

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Muscular Dystrophy

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-refers to a group of hereditary conditions that are characterized by progressive muscle weakness, muscle wasting, contractures of the joints, and deformity
-some forms are rapidly progressive

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Manifestations of muscular dystrophy include:

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-difficulties with ambulation, mobility, and arm function
-if facial muscles or muscles of the gastrointestinal system are affected, feeding and speech difficulties may also be present
-mental retardation may also be present

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Multiple Sclerosis

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-is a progressive condition of the CNS with a myriad of physical, psychological, social, vocational, and economic consequences
-is one of the most common disabling conditions among young adults
-is an autoimmune condition in which the body's immune system attacks segments of myelin that protect axons in the brain and spinal cord
-scar tissue (sclerosis) replaces segments of myelin, which carry messages throughout the brain and spinal cord, causing interference with the messages being sent/received

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Categories of Multiple Sclerosis include:

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-relapsing-remitting: fluctuating course of relapses associated with neurologic deficits followed by periods of quiet
-secondary progressive: cessation of fluctuations with slow deterioration
-secondary progressive with relapses: fluctuation with relapses and deterioration between relapses
-primary progressive: deterioration from the beginning
-progressive relapsing: progressive with relapses

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Manifestations of Multiple Sclerosis can include:

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-dizziness
-muscle spasticity
-numbness
-weakness and fatigue
-visual problems: vertigo, diplopia (double vision)
-unsteadiness (like a person who's intoxicated)
-poor bowel and bladder control
-difficulty with concentration and balance (ataxia)
-partial or complete paralysis
-intention tremor (in the hands)
-speech slurring
-swallowing difficulties
-incontinence and/or urinary retention
-cognitive changes (performing tasks that require conceptualization, memory, or new learning, diff. with tasks req. rapid or precise motor responses, diff. with abstract reasoning)

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Vocational issues with Multiple Sclerosis include:

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-accommodations and needs must be evaluated individually for each person due to how MS is experienced diff. by the people who have it
-low emotional and physical stress work environments are important
-hot and humid environments and environments where infectious diseases are common should be avoided

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Lyme Disease

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-is a multisystem inflammatory condition that affects the nervous system, joints, and muscles
-is the result of an infection caused by an organism called a spirochete
-is transmitted by the bite of an infected tick
-is characterized by a reddened area around the site of the tick bite
-is not fatal or contagious

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Symptoms of Lyme Disease include:

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-gait spasticity
-facial palsy
-memory loss or mild confusion
-joint pain
-meningitis

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Bell's Palsy

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-a form of paralysis (partial or complete) of one side of the face
-characterized by a sagging eyebrow, inability to close the eye, and drooping of one side of the mouth
-occurs when a nerve running from the brain to the face becomes inflamed
-may involve a causal link between reactivation of herpes in some individuals