By Karolina Kozlova, PT, DPT, Neurologic Clinical Specialist
What causes polyneuropathies? (poly = many; neuropathy = damaged nerves)
Neuropathy is a term used to describe damage to nerves and nerve endings that can cause weakness, pain, and altered sensation, specifically in peripheral regions (areas away from the center of the body or a body part).
This condition does not affect your brain or spinal cord, however when the nerves are damaged, they can’t send “normal” signals back to your brain. There can be multiple causes of neuropathy and a range of diagnoses that can cause these symptoms which include Guillain-Barré syndrome (GBS), diabetes mellitus (DM), and peripheral nerve injuries. Common symptoms can include: paresthesia (abnormal sensations), numbness, sharp pain, burning/tingling in the hands and feet, muscle weakness, difficulty swallowing and/or difficulty with walking/balance.
Diagnosis/functional limitations summary
Guillain- Barré Syndrome: is an inflammatory disorder of the peripheral nerves characterized by rapid numbness, weakness and/or paralysis that ascends symmetrically from the ends of the arms/legs towards the chest. This is caused by destruction of a fatty tissue called myelin that surrounds and protects your nerve cells.
Diagnosis includes clinical, cerebrospinal fluid (CSF), and electrophysiological evidence.
Treatment: Plasma Exchange (PE) or Intravenous Immunoglobulin (IVIG) are proven effective treatments.
Limitations in function are common for individuals with GBS. Careful analyses of basic tasks occur throughout the course of the disease to recovery. Depending on the severity of the disease, individuals with GBS may have difficulty with bed mobility, transfers, balance, gait, stairs, and activities of daily living.
Diabetes: is a disease that prevents your body from efficiently using energy from the food you eat; there are two kinds – Type 1 & Type 2. Diabetic neuropathy is a serious complication that results from uncontrolled high-level blood sugar levels. This condition, known as peripheral neuropathy, develops slowly, and presents in your hands and feet as: numbness, tingling/burning, sensitivity to touch, inability to sense hot/cold, muscle weakness, sharp pain and/or loss of balance and coordination.
Peripheral neuropathy is diagnosed with a full medical history review and neurological examination by a physician. Nerve function tests such as electromyography (EMG) can help detect nerve damage.
Peripheral Nerve Injuries: usually result from trauma or damage to a peripheral nerve in the body which inhibits the flow of signals from the muscle to the brain. Symptoms usually present as muscle weakness, cramps, uncontrollable twitching, pain/change in sensation and numbness in hands or feet that affect gait, balance and coordination. Nerve injuries are diagnosed with EMG nerve conduction studies.
Recommended activity levels/precautions
With GBS it is recommended to engage in balance training:
- Subacute (rather recent onset or somewhat rapid change) – Incorporation of seated or standing balance activities including static and dynamic training on firm or compliant surfaces with variable base of support
- Chronic (indefinite duration or virtually no change) – Incorporation of dynamic standing balance activities including challenging balance tasks, narrowed base of support or single-leg stance, and varied surface compliance
With peripheral neuropathies and nerve injuries, we recommend you engage in aerobic activities and physical therapy to address muscle stiffness and strength, maintain range of motion, gait/balance, and restore function and feeling. With loss of sensation, it is also important to check for pressure point development as well as visually checking areas for injury.
Most recent evidence to support exercise
GBS – Strength often recovers in a descending pattern with distal muscles (away from the center of body) recovering slowest. Depending on recovery, strengthening may range from active assisted active range of motion to progressive resistive exercise. Eccentric exercises should be avoided (ask your PT what these are for clarification) throughout all stages. Patients should be monitored for prolonged post exercise weakness, delayed onset muscle soreness, and increased paresthesia (burning or prickling sensation). If the individual complains of unusual weakness 1–5 days post exercise, exercise intensity may need to be reduced.
Patients with chronic neuropathic pain – Transcutaneous electrical nerve stimulation as well as lower-level laser therapy has been shown to be effective and beneficial in pain relief as well as acceleration of healing in treatment of neuropathic pain.
For peripheral injury or neuropathy, studies have shown that exercise can enhance axonal growth (area injured with disease/damage) and aerobic activity should aim for 30 minutes 4 times each week.
Types of exercises that will be addressed with therapy
Based on impairment findings of evaluation:
GBS: Bed mobility, transferring among various surfaces, sitting and standing tolerance, wheelchair mobility, gait training on various surfaces and in different environments, stair training, community mobility, recreational activities, aerobic conditioning.
With peripheral nerve injuries and neuropathy, physical therapy will include strengthening of muscles, maintaining range of motion, moderate intensity exercises to help improve strength and function, nerve gliding activities to help manage symptoms, balance and coordination to decrease risk of falling, sensory stimulation to help with recovery, potential bracing to help protect injury and education throughout your entire therapy journey.
Summary of progression/therapy expectations/outcomes
Pain is a very common symptom with any polyneuropathy.
GBS – Available literature indicates that most individuals (80%) regain the ability to ambulate within 6 months and 84% at 1 year. Twenty percent of individuals with GBS continue to require external aid to walk at 6 months, and up to 3% of individuals may remain unable to ambulate long term. At 1 year, individuals report residual deficits that often include reduced strength, sensory changes, fatigue, and pain.
With peripheral neuropathies and injuries, physical therapy can help prevent further development of the condition by including daily exercise, lifestyle modifications, and routine checkups.
On evaluation, an individualized plan of care is developed based on findings. Goals are established and re-evaluated throughout therapy.