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DISORDERS OF THE MOTOR UNIT
motor unit - basic functional unit of the peripheral nervous system
elements:
> cell body of the motor neuron - located in the anterior horn of the spinal cord
> axon of the motor neuron - travels via spinal nerves and peripheral nerves to muscle
> neuromuscular junction
> muscle fibers - innervated by the neuron
Disorder can be:
> neurogenic
- lower motor neuron disorders
- affecting the cell bodies and peripheral nerves of the motor unit
> neuromuscular - affect the neuromuscular junction or the muscle itself
> myopathic - origin and generally cause muscle weakness and atrophy of skeletal muscle
NEUROGENIC DISORDERS
 Peripheral Neuropathies
- motor neurons in the anterior horn of the spinal cord - mediate voluntary movement and reflexes that produce motor behavior
- characteristics of movement - determined by the pattern and firing frequency of specific motor units
- Muscle contraction - output of the motor system
- lower motor neuron system
> cell bodies in the anterior horn of the spinal cord and their axons
> nuclei of cranial nerves III through X (located in the brain stem) and their axons
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- This phase can last up to 2 years, depending on the extent of paralysis
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- frequent rest breaks
- Pshych
> acute progressive phase
= severe anxiety
= fear
= panic
> plateau phase
= anger
= depression
> recovery phase
= severe depression - occurred as clients contemplated the long, slow convalescence and the possibility
of permanent neurologic deficits
>>OT
= facilitates:
- feelings of self-worth
- positive attitude
- encouragement through the engagement in valued occupations
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> Pathphysio:
- The virus moves from the throat into the digestive tract and is shed through fecal material for several weeks
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FYI
** 95% of individuals who contract the disease are asymptomatic but can still spread the disease
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** If weakness or paralysis lasts more than 12 months, it is usually permanent
> Types of paralytic Polio:
= spinal polio
- most commonly diagnosed type
- 79% of the reported cases
- produced asymmetric flaccid paralysis predominantly in the legs
= bulbar polio
- 2% of cases
- infected the cranial nerves, leading to muscle weakness in oral and facial musculature
= bulbospinal polio
- a combination of the two types
- 19% of cases
- Marked atrophy could be seen in the involved extremities
- deep tendon reflexes were often absent
- Sensation and cognition remained intact
- asymmetry of muscles pulling on various joints sometimes produced deformities, such as:
> subluxation
> scoliosis
> contractures
postpolio syndrome (PPS)
- After an interval of 30 to 40 years, 25% to 40% of these adults are currently dealing with new muscle pain and increasing
weakness or are developing new weakness or paralysis
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> generally does not produce pain, the strain it puts on joints and muscles through abnormal biomechanics can
produce degenerative disk disease
> pain in the shoulders, knees, and other joints and muscles
- Decreased vital capacity and difficulty breathing with deventilation during sleep - observed frequently in these clients
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> assess:
- client’s functional status in:
= ADLs and IADLs
= ROM exercises
= muscle strength
= fit and proper use of adaptive equipment
= engagement in leisure activities
= emotional status
- Active exercise - maintaining strength, but overexertion and fatigue must be prevented (cardiac complications)
- Incorporating exercise into meaningful, age-related activities - promote engagement in participation
= Parachute games
= obstacle courses
= swimming
- powered wheelchair, a wheelchair lap board, suspension slings, or mobile arms supports
> facilitate greater independence in self-feeding, writing, reading, use of a computer, and tabletop
leisure activities
- Built-up utensils - helpful when grip strength declines
- wheelchair - minimize the development of scoliosis, hip and knee flexion contractures, and ankle plantar flexion
deformity
= powered wheelchair – conserve energy, decrease strain on shoulders and trunk
- pain - more prevalent in female
- spiritual activities – engage clients and families = a sense of hope and well-being
- encouraging families to use humor and to play and laugh together can promote bonding
> reduce fear and anxiety
> produce positive physical and emotional feelings
- Encouraging parents not to be overprotective and to continue to promote their child’s independence



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