PREVENTION PRACTICE FOR

NEUROMUSCULAR CONDITIONS
Arham Shamsi
 Intro
Normal neural physiological function depend
upon nervous system being anatomically intact
isolated from external milieu by blood brain
barrier and meninges, stable ionic concentration
and PH. And a constant supply of O2 and
Glucose.
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1. If damage, Nervous system has limited ability
for repair it self.
2. Trauma and toxins can disrupt neuroanatomy,
cardio vascular accidents breach blood brain
barriers, infections can damage the meninges.
3. Gastro intestinal dysfunction can alter ion
concentration, cardiac arrest cuts off O2 and
Diabetes Alter glucose availability.
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Most Adult Neuro muscular disorders fall into several broad Etiology category.
1. Cardio vascular Impairments
2. Metabolic Dysfunction
3. Traumas
4. Primary Secondary Neoplasm
5. Toxins
6. Drug Exposure
7. Nutritional deficiencies
8. Genetic anomalies
9. Some are Idiopathic Multifactorial (Multiple Sclerosis)
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1. Primary Prevention Directed towards
identifying and reducing risk factors
2. Thorough screening Education and
promoting healthy life styles
3. Secondary and tertiary prevention attempt to
reduce sequels and optimize person’s quality
of life.
 STROKE
1. Most common and most preventable Neuro Muscular
Dysfunction.
2. Loss of Blood flow to the CNS usually occur in cerebral
hamerroghe
3. Thrombosis arise from Arthrosclerosis (Slow onset)
4. Ischaemic stroke (88% of stroke cases) occurs when a
supplying artery is occlude by embolus arising from
heart. (Rapid Onset)
5. Hamerrohge occur when artery ruptures
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1. Stroke risk increases with age
Gender(male) and Ethnicity (Black Male
And Female)
2. Silent Ischaemic Attacks 11%
3. TIA residue with in 24 hour without
apparent functional Loss, there is 10 % risk
of Stroke in 3 months following TIA.
 Modifiable Risk Factors for Stroke
1. Include Diabetes Mellitus Hypertension (Systolic 160 or Higher
or Diastolic 95 or Higher)
2. Smoking more than 40 Cigarettes /Day quadruple Risk.
3. Blood disorder that increase Clot Formation
4. CAD
5. High LDL and Low HDL,
6. Obesity
7. Alcohol
8. Illegal Drugs
9. Oral Contraception
 Sign Of Stroke
1. Sudden Weakness or Numbness of Face
arm Leg (One Side)
2. Sudden Confusion, Trouble Speaking and
Understanding
3. Sudden trouble seeing in One or Both Eyes
4. Sudden trouble Balance Coordination
Walking or having Dizziness
5. Sudden severe Head aches
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1. 25% of Stroke Survivors dies with in 1 year post stroke

2. 14% who have first stroke will have another stroke with in 1
year

3. Secondary Prevention should Address Recurrence and Death

4. Physical Activity in DOSE DEPENDENT MANNER > Greater

Activity greater reduction in Risk
 COMMON PROBLEMS POST STROKE

Pneumonia, Incontinence, UTI,

Depression, Altered Emotional issues.
 POST STROKE NEEDS OF YOUR CLIENT
(SECONDARY PREVENTION)
1. Determine need of your client require knowledge of
Stroke‘s Vascular etiology Function of Affected Region of
Brain and Individuals Capability.
2. When Developing Primary Prevention for Stroke Survivor
Pt Must Keep in Mind that Those Individual Usually
physically deconditioned Pre stroke and are
3. Increased risk of Sustaining another stroke or Cardio
vascular Disease and are often taking Anti Hypertensive
Cardiovascular or Anticonvulsant medicine.
 RECOMMENDATIONS FOR STROKE
SURVIVORS
MODE OF EXERCISE MAJOR GOAL INTENSITY ,FREQUENCY ,DURATION

AEROBIC> WALKING, TREAD INCREASE INDEPENDENCE 40% TO 70% OF HRR

MILL,STATIONARY BIKE OR INCREASE WALKING SPEED 3 TO 7 DAYS
STEPPER IMPROVE ENDURANCE 20 TO 60 MINUTES A WEEK
DECREASE CARDIO
VASCULAR RISK

STRENGTHENING> CIRCUIT INCREASE INDPENDENCE IN 1 TO 3 SETS OF 10 TO 15

TRAINING FREE WEIGHTS ADL REPS. 2 TO 3 DAYS A WEEK

FLEXIIBILITY>STRETCHING INCREASE ROM , PREVENT 2 TO 3 DAYS A WEEK HOLD

CONTRACTURES STRETCH 10 TO 30 SEC.

NEUROMUSCULAR IMPROVE LEVEL OF SAFETY 2 TO 3 DAYS A WEEK

COORDINATION DURING ADL
 Spinal Cord Injury
1. Each SCI client has unique Presentation , There is
No Typical Case.
2. Can be Damaged by Direct Violence > Knife or
Bullet RTA’s
3. Non Traumatic > Disruption blood, tumor, spinal
stenosis
4. can be damage at any level, injury occur at one
level often extend across multiple segments
Presentation May Be ,paraplegia or tetraplegia
 SCI
1. Most vehicle crashing account for over half of SCI,
followed by falls , violence (gun shot injury) than
sporting activities.
2. falls are leading cause in over 65 years. In sports
2/3rd of injuries are due to diving accidents. over
90% sports injuries are tetraplegia
3. in all cases presence of alcohol in blood worsen
the damage possibly due to presence of ethanol
directly contracting the neural tissues due to injury.
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1. Incomplete Injury > if sensory motor
function present below the level of injury.

2. “ASIA “Stands for (American spinal Injury

Association)
PROGNOSIS RELATED TO SECONDARY COMPLICATIONS

1. Post injury employed picture is better with any person with

paraplegia.
2. In mid 1900 SCI victim were expected to live only few years
after injury death occurring due to decubitis ulcer UTI’s or
RTI’s
3. Today individual with SCI living approximately 85 % to 90%
of adult life.
4. In recent year leading cause of death of tetra is respiratory
complications while in Paraplegia it is heart disease and
cancer.
1. Long term changes lower limb osteoporosis and
fractures substance abuse autonomic dysereflexia
neurogenic bladder bowl changes MSK and
cardiopulmonary system , endocrine integumentary
genitourinary and Ailementary system as well as
psychological issues., major depressive order is
common among all clients 23 to 30%. Pain
contractures spasticity are common occurrence .
2. Fertility problems in males.
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1. Following protocols may Help reduce Secondary complications
2. DIET > Protein, Fresh Fruits Vegetables for Healthy Skin Bowl
Function and Urinary Track.
3. MOBILITY > immobilization can lead to DVT due to Venous
Stasis Blood Pooling and Edema as there is No venous Pump.
Have the Individual change position frequently in bed and
wheel chair to avoid pressure sores.
4. Regular Exercise can Improve Cardio Vascular and Pulmonary
Function. Increase Bone Strength and Reduce Spasticity
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1. SMOKING > Constrict blood vessels and negatively affect
Cardiopulmonary System.
2. RESPIRATORY HYGIENE >
3. Altered Autonomic System in SCI Can Limit ability to
exercise as Autonomic Reflexes normally Augment Blood
Flow to Metabolically Active Muscle to provide more O2 and
Fuel Substances while Removing Waste Products.
4. Lesion Above T6 can affect sympathetic nerve innervating
Heart that Ensure Adequate Blood Supply during exercise
and swear gland activity as well
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1. BP should always done during and after exercise.
2. FES for Tetraplegics.
3. Some Individuals have Bowl elimination problems as
rectal fullness sensation and ability to contract Anal
Sphincter is Absent.
4. BLADDER AND BOWL PROGRAMS
5. Predictable Elimination, High Fiber Diet, Increase
Water Intake , Digital Stimulation, Rectal Suppository,
Manual removal and Valsalva Manuver
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Chronic UTI leads to Multiple Hospitalization
and Increased cost, Secondary Complications
are Calculi Formation Abscess and septicemia
and Renal Failure.
 Traumatic Brain Injury
1. Results from Intentional or Un intentional trauma to brain.
2. Major Impairments and Functional Limitation results from
Vascular Hemorrhage & DAI (diffuse Axonal Injury) i.e.
tearing of nerves located throughout brain. Functional
deficits positively Correlated with the amount of DAI.
3. Injury may be a Single Event o repeated Micro
Traumas(Boxing) or Heading the Ball as in Foot ball
4. Males are Twice Affected with two age groups 15-24 and
over 75 years.
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1. Bike & RTA Alcohol and Drug Use Contributes.
2. Older Group With H/O Falls.
3. Risk Increases with each subsequent Injury
4. TBI can be Mild Concussion or Severe Leading to Death
or Persistent Vegetative State.
5. GCS used in Acute Medical Care while in Physical therapy
Revised Ranchos Los Amigos Level of Cognitive Function
is More Common.
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1. Most Devastating Problem in TBI is Cognitive Deficit which
is further complicated by Sensory Motor Deficits (Hemi
paresis/plegia) and Abnormal Tone and Apraxia (inability to
Plan Voluntary Movement)

2. Risk need to be addressed by Suggesting Protective Gear

when engage in Sports and Avoid high risk activities.
3. A unique Complication of SCI and TBI is Heterotrophic
Ossification , occurring with in One Year of Injury and most
frequently Noted at Hip Flexors.
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1. Other Movement Disorders Seizures Head Aches
Visual Deficits and Sleep Disorders.
2. Non Neurological > Pulmonary , Metabolic Nutritional
Gastrointestinal, Musculo Skeletal , Skin.

3. Exhibit Aggressive Verbal And Physical Behavior

4. Mood Disorders, Increased risk of Suicide, Divorce
and Depression.
 PARKINSONS
1. Most Common Movement Disorder
2. Impairment Arise due to Damage to Substantia Nigra’s
Dopanergic Neurons , occur due to Various Etilogies
Including
3. Genetic Abnormalities , Metabolic Dysfunction,
Stroke , Environmental Toxins , infections And
Oxidative Stress.
4. Resting or Postural Tremors, Bradykinesia , Rigidity,
5. Micrographia , Simian Gate and Hypophonic Speech.
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1. Non Motor Signs appear early May Include Autonomic
Dysfunction, Slow Gastric and Intestinal Motility
Urinary and Sexual Dysfunction, Pain Cognitive
Changes Speech and Swallowing Problems.
2. Dementia in One Third Clients , Depression un 50%
3. Aspiration Pneumonia is Major Cause of Morbidity and
Mortality.
4. PT must address Complications.
 MULTIPLE SCLEROSIS
1. Demylination and Sclerosis of Myelin Sheath.
2. A pathology that Damages the Myelin Sheath that
surround Axon of CNS resulting Sclerosis and
Scaring.(Plaques)
3. Location of Plaques will determine Clinical Features
4. Cause is Unknown but Environmental and Genetic
(Auto Immune)Factors are Blamed.
5. Young Adult 20 to 40 years. Women are affected
Twice.
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1. Early Signs Fatigue , Thermal Sensitive ,
Uncomfortable Sensation in Face And Arms , May
Have Judgment, Memory Issues and Lassitude.
2. MS people are Strongest in Morning.
3. Exercise may Cause Fatigue and increase Body
temperature
4. Erratic Movements, Muscles can Become Spastic
5. Lack of Muscular Coordination is Evident in Speech
Pattern and in Hand Dexterity.
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1. Over The Time MS clients Experience the
same problems that Many with Neurological
Impairments Face> Decreased Mobility,
Contracture , Skin Break Down , UTI’s,
Pneumonia Progressive Weakness and
Depression.
2. Exercises> Stationary Bike, Swimming and
Strengthening (MERK MANUAL)
 POLY NEUROPATHY
1. Carpal tunnel syndrome (Single Nerve)
2. G.B Syndrome or Diabetic Neuropathy (Multiple
Nerves).
3. Causes > Entrapments, Genetic , Trauma and
Metabolic Dysfunction.
4. Neuropathy may Disrupt a Peripheral Nerve’s
Sensory, Motor or Autonomic Component.
5. Secondary Complication > Articular Instability and
Deformity. due to weakened muscles.
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1. If Phrenic Is Involved Respiratory support is
required.
2. In Legg Perthes Neuropathy there is
weakness of Distal Lower extremity
(Sensory Gate)
 TENSION HEAD ACHES
1. A tension headache is generally a diffuse, mild to moderate
pain in your head that's often described as feeling like a
tight band around your head. A tension headache (tension-
type headache) is the most common type of headache,
and yet its causes aren't well-understood.
2. The cause of tension headaches is not known. Experts
used to think tension headaches stemmed from muscle
contractions in the face, neck and scalp, perhaps as a
result of heightened emotions, tension or stress. But
research suggests muscle contraction isn't the cause.
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Episodic tension headaches
1. Episodic tension headaches can last from 30 minutes to a
week. Frequent episodic tension headaches occur less
than 15 days a month for at least three months. Frequent
episodic tension headaches may become chronic.
Chronic tension headaches
2. This type of tension headache lasts hours and may be
continuous. If your headaches occur 15 or more days a
month for at least three months, they're considered chronic.
(MAYO CLINIC)
 PREVENTION
1. STROKE > DECREASE BP,WEIGHT,LIPIDS,INCREASE PHYSICAL
ACTIVITY,TREAT DIABETES , QUIT SMOKING
2. MULTIPLE SCLEROSIS > INCREASE VITAMIN D GREEN TEA.
3. PARKINSON> GREEN TEA CAFFINE BUT AS CAUSE IS UNKNOWN NO REAL
PREVENTION
4. TBI > SEAT BELTS, HELMETS,NEVER DRIVE WHEN DRUNK, FALL
PREVENTIONS, NO RUGS ON WALKING AREA & GUN SAFETY
5. POLYNEUROPATHY > CONTROL DIABETES, DECREASE STRESS
6. TENSION HEADACHES > MANAGE STRESS POSTURAL CORRECTION
RELAXATION TECHNIQUES COGNITIVE BEHAVIURAL THERAPY BIO FEED
BACK.
REFRENCES

1.Prevention Practice A Physical Therapist’s Guide to Health,

Fitness and Wellness.by Catherine Rush Thompson
2.Web MD
3.Mayo Clinic
4.www.cdc.gov