Peripheral Neuropathy and Physiotherapy

Peripheral neuropathy is a disorder of the peripheral nervous system due to damage to the peripheral nerves resulting from a variety of causes like trauma,
infections, autoimmune disorders, systemic infections,inherited disorders, metabolic or endocrine disorders, toxic causes and vitamin deficiency especially vitamin B12.

Peripheral Neuropathy is of four types mainly-

1.Sensory neuropathy, in which part of the sensory system is damaged causing pain, tingling, numbness, or loss of sensation. It usually progress from distal to proximal i.e. it first starts in fingers or toes.

2.Motor neuropathy is characterized by damage to the motor nerves resulting in motor weakness and atrophy. Also symptoms of tiredness, heaviness,cramps, tremor, muscle twitch (fasciculations) and gait abnormalities are present.

3.Autonomic neuropathy is characterized by damage to the autonomic nervous system which affects blood pressure, heart rate, sweating, digestion, and bowel and bladder function.Symptoms may include urinary incontinence, constipation, diarrhea, dizziness and fainting.

4.Mixed neuropathy, in which two or more of the above mentioned types are present.

The objectives of Physiotherapy management for peripheral neuropathy includes-

(a)Pain Relief-TENS, Transcutaneous Electrical Nerve Stimulation therapy has shown to be effective and safe in the treatment of diabetic peripheral neuropathy

(b)Flexiblity or stretching exercises-They are important for improving muscle mobility, function and blood circulation in the affected area.It also helps in
maintaining range of motion.

(c)Strengthening of muscles-It improves muscle strength and reduces the feeling of numbness and tingling.It can be done by using weights or strengthening bands to target the necessary muscle.

(d)Braces or splints- To improve balance and posture.It can be used for compression neuropathies like carpal tunnel syndrome.

(e)Practicing functional activities are also important.

(f)Treatment through vibrations or ultrasound.

(g)Balance training to improve gait and posture.

Safety is an important consideration for patients with peripheral neuropathy.Muscle weakness and loss of sensation increase the risk of falls.It can be prevented by following measures

* Testing water temperature before bathing
* Avoiding open toes or high heels and not to walk barefoot.
* Take care while cooking by using heat resistant ladles and pot holders
* Inspect your feet regularly for any cut,bruise or blister
* Wear socks and gloves when needed
* keep the skin moisturised.
* Make environment safe by removing obstacles in home, use adequate light at night, use handrails while ascending or descending stairs,Use non slip bath mats in bathroom.

Physical Therapy and Parkinson's disease

Parkinson's disease is a chronic progressive neurological disorder resulting from deficiency of dopamine in the brain.It manifest with the triad of-
1. Rigidity or stiffness in the body
2. Bradykinesia or slowness of the movements
3. Resting tremors and postural instability.

Other manifestations include- Intellectual impairment in form of dementia, communication problems due to dysarthria and hypophonia, dysphagia and silorrhea, muscuoskeletal problems due to disuse and inactivity and festinating gait pattern.

Physical therapy management of Parkinson's disease include-

1.Increasing activity levels-Increase overall mobility, do some stretching exercises to elongate muscles and involve patient in a regular walking program.

2.Decreasing rigidity and bradykinesia-Incorporate PNF patterns(specially D2F for upper extremity and D1E for lower extremity) with emphasis on trunk rotation patterns and rhythmic initiation technique.Relaxation exercises in form of gentle rocking can be used to reduce muscle tension.Deep breathing exercises can also be used.Daily stretching and ROM exercises are important.

3.Improving gait pattern-Emphasize high stepping, broad based gait with arm swing and contralateral trunk rotation.Toe wedge can be used to counteract festination.

4.Improving balance-Weight shifts in standing,stepping movements forward and backward, walking and marching in place can be helpful.

5.Improve strength-Focus on lower extremity strengthening in order to improve gait and posture.Trunk extension exercises are also important.

6.Walking aids in form of canes can be used to improve gait and balance