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1、Peripheral Neuropathy RehabilitationWuMan 1PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions21.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassifica
2、tion1.6Clinicalmanifestations1.7Regenerationofperipheralnerve31.1AnatomyPeripheralnervescanbecategorizedintotwogroupsbasedonwheretheyconnecttothecentralnervoussystem:Cranialnervesinnervatepartsofthehead,andconnectdirectlytothebrain(especiallytothebrainstem).Spinalnervesinnervate(distributeto/stimula
3、te)muchofthebody,andconnectthroughthespinalcolumntothespinalcordandthustothecentralnervoussystem.41.1AnatomyTherearethreetypesofnervefibersinamixednervethatinclude:Sensorynervefibers(afferentfibers),Motornervefibers(efferentfibers),Autonomicnervefibers(autonomicfibers).51.Overview1.1Anatomy1.2Cause1
4、.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve61.2CauseInfectionTraumaToxinsPhysicalcompressionIschemiaMetabolicdisorders71.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Cli
5、nicalmanifestations1.7Regenerationofperipheralnerve81.3Pathology1.Walleriandegeneration2.Axonaldegeneration3.Segmentaldemyelination9101.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve111.4Classific
6、ationPeripheralnerveinjurytraumaWalleriandegenerationNeuropathyInflammation,toxins,ischemia,MetabolicdisordersAxonaldegeneration121.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve131.5Peripheralner
7、veinjuryclassification1.NeurapraxiaNeurapraxiaisadisorderoftheperipheralnervoussysteminwhichthereisatemporarylossofmotorandsensoryfunctionduetoblockageofnerveconduction,usuallylastinganaverageofsixtoeightweeksbeforefullrecovery.Neurapraxiaresultsintemporarydamagetothemyelinsheathbutleavesthenerveint
8、actandisanimpermanentcondition;thus,Walleriandegenerationdoesnotoccurinneurapraxia.141.5Peripheralnerveinjuryclassification2.AxonotmesisAxonotmesisisadisruptionofnervecellaxon,withWalleriandegenerationoccurringbelowandslightlyproximaltothesiteofinjury.Ifaxonsandtheirmyelinsheatharedamaged,butSchwann
9、cells,theendoneurium,perineuriumandepineuriumremainintact,itiscalledaxonotmesis.Axonotmesisisusuallytheresultofamoreseverecrushorcontusionthanneuropraxia.Therateofoutgrowthofregeneratingnervefibersisabout1mmto2mmperday,sothattherecoveryofconductiontoatargetstructuredependsonnotonlyregrowthintotheapp
10、ropriateendoneurialtube(endoneurium),butalsoonthedistanceinvolved.151.5Peripheralnerveinjuryclassification3.NeurotmesisNeurotmesisisthemostseriousnerveinjuryinthescheme.Inthistypeofinjury,boththenerveandthenervesheatharedisrupted.Whilepartialrecoverymayoccur,completerecoveryisimpossible.Inmostcasesi
11、tcannotbecompletelyrecoveredfromevenwithsurgicalrepair.161.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve171.6ClinicalmanifestationsMovementimpairmentSensoryimpairmentLossofthereflexesAutonomicner
12、vedysfunction181.Overview1.1Anatomy1.2Cause1.3Pathology1.4Classification1.5Peripheralnerveinjuryclassification1.6Clinicalmanifestations1.7Regenerationofperipheralnerve191.7RegenerationofperipheralnerveWhenanaxonisdamagedThedistalsegmentundergoesWalleriandegeneration,losingitsmyelinsheath.Axonalsprou
13、tsformattheproximalstumpandgrowuntiltheyenterthedistalstump.2122PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions232.Rehabilitationevaluation1.Musclestrengthtests:manualmuscletest(MMT)
14、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 res
15、istanceNormal5Contraction against maximum resistance2.Rehabilitationevaluation2.Circumferencemeasuring3.Rangeofmotion(ROM)measuringDevicestomeasurerangeofmotioninthejointsofthebodyincludethegoniometerandinclinometerwhichuseastationaryarm,protractor,fulcrum,andmovementarmtomeasureanglefromaxisofthejo
16、int.4.Sensoryexam262.Rehabilitationevaluation5.Testingofreflexes:BicepsreflexTricepsreflexRadialreflexPatellarreflexAnklereflex27Bicepsreflex28Tricepsreflex29Radialreflex30Patellarreflex31Anklereflex322.Rehabilitationevaluation6.Autonomicnervetestasweattest7.ElectrodiagnosisElectromyographytestEMGch
17、anges(2to3weeksafterinjury)NerveconductionvelocitytestSomatosensoryevokedpotentialtest332.Rehabilitationevaluation8.Activitiesofdailyliving(ADL)evaluation34PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Sum
18、mary6.Reviewquestions353.Rehabilitationtreatment3.1Theearlyphase3.2Recoveryphase363.1Theearlyphase1.Keepalljointsoftheaffectedlimbonfunctionalpositione.g.Radialnerveinjurypatientsoftenmanifestatedropwrist.Treatmentsincludesupportingwristwithasplint.Theangleofthewristextensionsplintis20-30degrees.373
19、.1Theearlyphase2.Activemovementorpassivemovementonalljointsoftheaffectedlimbpassivemovement1-2timeperdayactivemovement3.Themeasuresofswellingontheaffectedlimb383.1Theearlyphase4.Theapplicationofphysicalfactorsultrashortwavetherapy,microwavetherapy,infraredtherapyCirculationinthelimbisstimulatedwitht
20、heuseofheat.5.Protecttheaffectedareas393.Rehabilitationtreatment3.1Theearlyphase3.2Recoveryphase403.2Recoveryphase1.NeuromuscularelectricalstimulationtherapyMaintainingmusclestrength413.2Recoveryphase2.Strengthtrainingmusclestrengthis0-1,takepassivemovement,electromyographicbiofeedbacktherapymuscles
21、trengthis2-3,takeassistedmovement,activemovement,equipmentmovementmusclestrengthis3+-4,takeresistedmovement423.2Recoveryphase3.ADLtraining4.Occupationaltherapy5.Sensorytraining433.2Recoveryphase6.PromotethenerveregenerationNervegrowthfactor,VitB1,VitB12ultrashortwavetherapy,microwavetherapy,infrared
22、therapy7.Surgicaltreatment44PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6. Reviewquestions454.RehabilitationofcommonperipheralneuropathyPeripheralfacialparalysis(Bellspalsy)Cause:Reactivationofane
23、xisting(dormant)viralinfectionSignsandsymptoms:distortionofcommissure;cannotfrownonthepareticsideandclosethepareticeyecompletely;thepareticnasolabialfoldshallow,andmouthtwisttothenon-paretic;cannotdrumgills.Centralfacialpalsy:controltheupperpartoftheirfaces46peripheralfacialparalysis47peripheralfaci
24、alparalysisRehabilitationtreatmentTheearlyphaseMedication:Corticosteroidsuchasprednisone,Bvitamins,AntiviralssuchasaciclovirPhysiotherapy:ultrashortwavetherapyRecoveryphaseNeuromuscularelectricalstimulationtherapy,activemovement,acupuncture48PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitati
25、onevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions495.SummaryMasterTherehabilitationtreatmentoftheperipheralneuropathyFamiliarTherehabilitationevaluationoftheperipheralneuropathyUnderstandTheperipheralneuropathycause,pathology,classification,c
26、linicalmanifestations50PeripheralNeuropathyRehabilitation1.Overview2.Rehabilitationevaluation3.Rehabilitationtreatment4.Rehabilitationofcommonperipheralneuropathy5.Summary6.Reviewquestions516.ReviewquestionsWhataretheclinicalmanifestationsofperipheralneuropathy?Thecontentofrehabilitationevaluation.Thetechniquesofrehabilitationtreatment.5253
