Peripheral Neuropathy

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Peripheral Neuropathy:

Peripheral Neuropathy Alcohol & Diabetes Related Laura Siviter , SPT (6).

Etiology of Peripheral Neuropathy:

Etiology of Peripheral Neuropathy Damage or disease involving the nerves, specifically lower motor neurons. Clinical manifestations will differ greatly depending on what type of nerve is involved. Leading cause of peripheral neuropathy is DM most commonly sensory neuropathy rather than motor most common cause of neuropathic joints. (1) High blood glucose levels leads to blood vessel constriction leads to a lack of oxygen reaching the tissues. leads to symptoms ranging from mild tingling, burning, numbness, pain, to a compete loss of sensation usually see in the feet or hands (1). Alcohol related peripheral neuropathy related peripheral neuropathy can either be caused from a B1 malabsorption which can cause Thiamine deficiency (4) or through the direct damage alcohol has on the nerves

Slide 3:

Different Types of Neuropathy Mononeuropathy – affecting only 1 specific nerve (3). Mononeuropathy Multiplex- affects 1 or more nerves in at least 2 different areas of the body Plexopathy- affecting a network of nerves (plexus) Polyneuropathy – affecting several nerves (6).

Prognosis of Peripheral Neuropathy:

Prognosis of Peripheral Neuropathy Peripheral nerves have the ability to regenerate as long as the cell body has not been destroyed. Effects of peripheral neuropathy can be slowed and further damage can be prevented as well as regeneration of the nerves. (6).

Clinical Manifestations:

Clinical Manifestations Sensory, motor, or autonomic dysfunction which can be acute to chronic (1). These deficits will begin to manifest as a tingling or prickling sensation in the distal extremities and progress to complete loss of sensation (4). Impairments seen in distal extremities first followed by upper extremity impairments. Ulcers due to excessive plantar pressure in the presence of peripheral neuropathy and foot deformity (1). Affects the distal portion of the extremities with the lower extremity typically more affected than the upper extremity (1).

Diabetes Mellitus:

Diabetes Mellitus (6). Hyperglycemia seen in diabetes can injure nerve fibers (3) . High BMI leads to diabetes, which later manifests to diabetic neuropathy. Strict regulation of blood sugar can slow the progression or even prevent diabetic neuropathy (3). LMN Foot ulcers Pain & Prickling Sensory Loss LE > UE ( 3). (6).

Alcohol Neuropathy:

Alcohol Neuropathy (6). High ETOH with Low food intake for greater than 1 year is the group that tends to develop neuropathy (6) . If the patient is getting adequate nourishment, then neuropathy should not happen. Thin and Tender leg muscles (6) . Dysethisia over the feet and shins (6) . Reduced reflexes of the ankle (6) .

Medical Treatment:

Medical Treatment DM related peripheral neuropath can be treated through proper regulation of blood glucose levels. ETOH related peripheral neuropathy can be treated through the cessation of consumption of alcohol as well as through consuming a healthy balanced diet. Medications such a pain relievers, lidocaine patch, or Capsaicin cream can be used to reduce symptoms (3).

Clinical (PT) Treatment:

Clinical (PT) Treatment Physical therapist can provide mechanical aids to help lessen the pain and impact of disability. There are many examples of these aids available in the clinic: Shoe braces or pads can be applied to aid in weight distribution while walking. Hand or foot braces can help compensate for muscle weakness and aid in reducing nerve compression and encourage nerve regeneration (2). Gait and strength training are important in the management of large fiber neuropathies when impaired vibration, decreased tendon reflexes, and shorting of the Achilles tendon occur (foot drop) (1). Advised not to soak feet due to danger of removing protective coating on skin leading to an increased risk of burns and fungal infections. Pt advised to shower rather than bath (1). Client education to monitory and detect potential problems. Educate pt on proper foot wear, foot care, and cleaning of feet (1). TENS may help relieve symptoms through introducing a gentle electrical current at varying frequencies (3).

Websites:

Websites http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131 http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm http://www.neuropathy.org/site/PageServer?pagename=About_Facts http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Physical_Fitness/Members_Only/PocketGuide_Diabetes.pdf#search=%22peripheral%20neuropathy% 22

References:

References 1. Goodman, C. C., & Fuller, K. S. (2009). Pathology: Implications for the Physical Therapist (3rd Edition ed.). St. Louis, MO, USA: Saunders Elsevier . 2. National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy Fact Sheet. Retrieved on November 21, 2013, from http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm 3. Mayo Clinic. Peripheral Neuropathy. Retrieved on November 21, 2013, from http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131 4. The Neuropathy Association. About Peripheral Neuropathy. Retrieved on November 21, 2013, from http://www.neuropathy.org/site/PageServer?pagename=About_Facts 5. Blumenfeld , H. (2010). Neuroanatomy through Clinical Cases (2nd Edition ed. ) Sunderland , MA, USA: Sinauer Associates, Inc . 6. Carrick Institute for Graduate Studies. (2012, January 12). Module 803: Peripheral Nervous System. Cape Canaveral, FL, USA.

Bulletin Board Question:

Bulletin Board Question Do you think electrical stimulation would be beneficial for a patient with Peripheral Neuropathy considering they may have a decreased sensation and atrophy in the area being treated and MMT is 2/5? If advised, what parameters would you use?

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