Hum Occ II CH 27

Diseases of the muscular system may be

- neurogenic: originating in the nerves.

- myopathic: originating in the muscles.

Motor unit includes

the motor neurons and the muscle fibers that it innervates

Lesions can be caused by

- Infections

- Nerve root compression

- Toxins

- Neoplasms

- Vascular disorders

- Degenerative diseases of the CNS-amyotrophic lateral sclerosis (ALS)

- Congenital malformations

Poliomyelitis Medical treatment

- Bed rest, positioning and applications of warm packs to reduce pain and promote relaxation.

- Reconstructive surgery may occur as well (tendon transfer, arthrodesis and surgical release of fascia/muscles and tendons)

postpolio syndrome

Characterized by increased weakness of muscles that were previously affected by the polio infection

Postpolio syndrome: Develop an occupational profile by asking these questions.

- What activities are causing you pain and fatigue?

- When are your symptoms likely to occur?

- What kind of aids, compensatory strategies, energy conservation?

- Who is helping you?

Guillain-Barre Syndrome (GBS)

In many cases, the client completely recovers within a few weeks to a few months with relatively few residual side effects

Guillain-Barre Syndrome (GBS) , OT intervention process:

- Initial phase focuses on PROM, positioning and splinting, then progresses to gentle/nonresistive activities like ADLs

- Program should stress joint protection and avoid bringing muscles to the point of fatigue and irritating inflamed nerves

Guillain-Barre Syndrome (GBS)

In many cases, the client completely recovers within a few weeks to a few months with relatively few residual side effects

Peripheral Nerve Injuries

- Peripheral nerve injury results in muscle weakness or flaccid paralysis

- Results in atrophy (loss of muscle innervation)

- Nerve regeneration begins about 1 month after the injury, but depends on the nature of the nerve lesion.

- Proximal lesions regenerate faster than distal.

Peripheral Nerve Injuries OT intervention

- Treatment is directed to the stage of recovery and focuses on remediation and compensation for sensory, motor and performance deficits

- May also include splints, positioning, manual therapy, and compression

Muscular dystrophy (MD):

Progressive degeneration of muscle fibers with intact neuronal innervation and sensations

Facioscapulohumeral MD:

- Onset in adolescence and affects muscles of face and shoulder girdle

- Does not shorten life expectancy

Myotonic MD:

- Causes weakness and myotonia that makes relaxation of muscle contraction difficult

- Involves cranial muscles and shows a pattern of limb weakness that is distal rather than proximal

- GI, vision, heart, or respiration symptoms can also occur

Duchenne and Becker MD

- Inherited as an X-linked recessive trait that affects only males and is usually diagnosed between 18 and 36 months

- Muscle weakness begins in the pelvic girdle and legs and then spreads to the shoulder girdle

- Most boys use a w/c by age of 12 for mobility and progresses to death, usually by the age of 30

- Becker MD presents with a later onset, slower course and far less predictability, and can affect girls

Myasthenia gravis

-Disease of chemical transmission at the nerve-muscle synapse or neuromuscular junction

- Results in abnormal fatigue of voluntary muscle