Neuromuscular conditions Flashcards
(45 cards)
What is a neuromuscular condition?
condition that impacts the motor unit - ant horn cells, peripheral nerve, neuromuscular junction, muscle
- strong genetic component
- many are progressive in nature
-
Neuromuscular conditions impact…
a) any portion of the motor unit
b) only the muscles
c) the synapses at the neuromuscular junction
d) the myelin sheath of the sensory nerves
A)
What do neuromuscular conditions present as generally?
muscle weakness
what is a Spinal Muscular Atrophy (SMA)?
- autosomal recessive disorder
- mutation or lack of survival motor neuron gene (SM1)
-deficiency in SMN
what part of the motor unit is affected in SMA?
a) white matter of the spinal cord
b) anterior horn cells of the spinal cord
c) neuromuscular junction
d) the muscle tissue
B) anterior horn cells of the spinal cord
what might having 2 copies of SMN 2 indicate about ones physical presentation?
Having more copies of SMN2 is associated with LESS severe symptoms of SMA
what does SMN1 do?
produces all the SMN protein we need to function
When is the typical onset of Type 1 SMA? What are the typical milestones?
onset: before 6 months
milestones: no sitting
When is the typical onset of Type 2 SMA? What are the typical milestones?
onset: 6-18 months
milestones: sitting, not walking
When is the typical onset of Type 3 SMA? What are the typical milestones?
Onset: childhood after 12 months
Milestones: walking
When is the typical onset of Type 4 SMA? What are the typical milestones?
onset: after 30 YO
milestones: normal
What is spinraza?
- injection in spine. Every 4-6 months
- SMN enhancing therapy - targets SM2 gene, creating a more complete protein
What does Zolgensma do?
- gene therapy
- targets SMN 1 gene - 1x injection (given when <2 YO)
What is risdiplam?
- daily oral medication
- modifies SMN2 (same as spinraza)
What are possible assessments for non-sitters?
- postural control
- sitting tolerance
- chest deformities
- muscle weakness
- contractures
- hip dislocation
What are some PT interventions for non-sitters?
- positioning & bracing
- static thoracic bracing (scoliosis)
- stretching & orthoses(contractures)
- seating & mobility systems
What are some assessments for sitters?
- Postural control
- foot and chest deformities
- scoliosis & pelvic obliquity
- hip dislocation
- contractures (ROM, goniometry)
- functional scales (HFMSE, RULM, MFM)
- muscle weakness
What are some interventions for sitters?
- positioning & bracing
- thoracic & cervical bracing
- stretching & orthoses
- KAFOS, AFOs
- gait training devices, mobility devices
which segments of the body are known to be at risk for contractures in SMA?
hip, knee, elbows, fingers
What is a secondary complication that is very common for neuromuscular conditions?
Scoliosis
- muscle weakness + affects of gravity = scoliosis
- many people with SMA will require spinal fusion (brace will allow for spinal fusion when they are teens, it DOESNT prevent scoliosis)
- must consider alginment & positioning 24hrs/day
What are some common symptoms in SMA?
- Weakness
- Motor milestone delays
- Difficulty with walking (weakness) and keeping up with peers
- Frequent falls
- Wheezing sounds after eating
- Weak cry
What is Duchenne Muscular Dystrophy?
- genetric disorder caused by a defect in the gene coding for Dystrophin (acts as a shock absorber for muscle cells)
- progressive muscle weakness & degeneration –> loss in function
- unable to regenerate damaged muscle
- impacts all muscles of the body including heart & respiratory muscles
What part of the motor unit does DMD impact?
a) the muscle
b) neuromuscular junction
c) motor neuron
d) neurotransmitters
a) the muscle
What are some early signs of DMD?
- difficulties coming up from floor
- waddling gait
- difficulties running, climbing, crawling
- pseudohytrophy of the calves (muscle become replaced by fat and fibrotic tissue)
- delayed speech