Neurological Conditions: Stroke

• The provided text describes factors, location of lesion, level of lesion, sensation/motor function, tone, reflexes, strength, muscle bulk, involuntary movements, postural control, other features specific to the condition, and type of exercises for Stroke, Spinal Cord Injury (SCI), Parkinson's Disease (PD), Guillain-Barré Syndrome (GBS), Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), and Myasthenia Gravis (MG).

Stroke

• Brain lesion location.
• Upper Motor Neuron (UMN) lesion level.
• Sensory and motor function impaired or absent depending on lesion; Contralateral sensory loss.
• Hypertonia/spasticity tone, with initial flaccidity during cerebral shock.
• Hyperreflexia.
• Contralateral weakness or paralysis strength.
• Normal muscle bulk during acute stage, disuse atrophy if chronic.
• Spasm involuntary movements.
• Impaired or absent postural control.
• Synergy patterns and Brunnstrom's stages of recovery are other condition specific features.
• Strengthening, PNF, and out of synergy patterns are the recommended exercises.

Spinal Cord Injury (SCI)

• Spinal cord lesion location.
• Upper Motor Neuron (UMN) lesion level.
• Sensory and motor function impaired or absent below the level of the lesion, depending on the extent of the injury.
• Spasticity tone below the level of the lesion, with initial flaccidity during spinal shock.
• Hyperreflexia.
• Impaired or absent strength below the level of lesion; paraplegia/paresis or tetraplegia/paresis.
• Disuse atrophy muscle bulk.
• Spasm involuntary movements.
• Impaired postural control below the level of lesion.
• Clinical syndromes with neurological levels are other condition specific features. Spinal shock is the state of initial flaccidity. Bulbocavernosus reflex is the first reflex to return after shock.
• Wheelchair, bowel/bladder training, and spasticity management are the recommended exercises.

Parkinson's Disease (PD)

• Basal ganglia lesion location.
• Intact Upper Motor Neuron (UMN).
• Sensation not affected.
• Rigidity tone; leadpipe-uniform resistance or cogwheel-ratchet like.
• Reflexes are normal or decreased.
• Disuse weakness in chronic stage.
• Normal or disuse atrophy muscle bulk.
• Resting tremors involuntary movements.
• Impaired postural control, stooped and impaired balance.
• Other condition specific features manifest as festinating gait, freezing of gait (FOG), on-off phenomenon of drugs, pill rolling tremors and rigidity. Rapid onset of weakness (distal to proximal), bilateral symptoms peaking at approximately 2-3 weeks. Symptoms will not progress greater than 4 weeks.
• Distributed practice and blocked practice are the recommended exercises.

Guillain-Barré Syndrome (GBS)

• Autoimmune disease affecting the PNS (peripheral nervous system).
• Lower Motor Neuron (LMN) lesion level.
• Motor and sensory function more affected in distal extremities; symmetrical.
• Flaccidity tone.
• Hyporeflexia.
• Distal to proximal muscle weakness.
• Muscle atrophy and weakness muscle bulk.
• No involuntary movements.
• Impaired postural control in the initial stages.
• Has both pseudo-bulbar & bulbar palsy.
• Distributed practice with a lot of breaks.

Amyotrophic Lateral Sclerosis (ALS)

• Motor neuron disease, both UMN and LMN lesion level.
• Pure motor condition; asymmetrical.
• Spasticity or hypotonicity tone.
• Hyperreflexia or hyporeflexia reflexes.
• Muscle weakness.
• Weakness & atrophy muscle bulk.
• Fasciculations involuntary movements.
• Normal initially but deteriorates gradually; wheelchair bound impaired balance.
• Distributed practice with a lot of breaks.

Multiple Sclerosis (MS)

• Demyelination of axons and white matter lesion location and UMN lesion level.
• Motor and sensory dysfunction lesion level.
• Spasticity tone.
• Hyperreflexia reflexes.
• Muscle weakness can vary.
• Muscle atrophy secondary to inactivity/disuse muscle bulk.
• Intention & postural tremors, spasm involuntary movements.
• Might be impaired due to cerebellar involvement.
• Uhthoff's phenomenon, Lhermitte's sign, pseudobulbar effect, Marcus gunn pupil and optic neuritis are other condition specific features.
• Distributed practice with a lot of breaks.

Myasthenia Gravis (MG)

• Disorder of NMJ (neuromuscular junction); autoimmune condition.
• Pure motor
• Proximal muscles more affected than distal muscle strength.
• Weakness that worsens with activity.
• Good to fair depending on the muscle weakness
• Fatigable & rapidly fluctuating asymmetric ptosis is a hallmark of the problem. Symptoms show a fluctuation in intensity & are more severe late in the day or after prolonged activity.
• Distributed practice with a lot of breaks.