Okay__ your notes here for the powerpoint presentation in Adobe format.
Disease that will be on your test: ones I expect you will see on your massage table:
1. CENTRAL NERVOUS SYSTEM DISORDERS – HEADING
a. Cerebral palsy
b. Spina bifida
c. Seizure disorders
d. Spinal cord injuries
e. ADHD: attention deficit (hyperactive) disorder
f. Autism Spectrum Disorders
g. Depression
2. Neuro-degenerative disorders
a. Alzheimer disease
b. Parkinson disease
c. Multiple Sclerosis
d. Complex Regional Pain Syndrome
3. Neurovascular Disorders
a. CVA: cerebral vascular accident
b. Migraine
4. Peripheral Nerve Disorders
a. Guillain-Barre syndrome
b. Peripheral Neuropathy
c. Degenerative Disc Disease
i. Herniated
ii. Bulging
iii. Radiculopathy
d. Carpal tunnel syndrome
e. Thoracic Outlet Syndrome
5. Anxiety Disorders
Extra Credit Topics:
Hans Selye: General Adaptation Syndrome
Neurobiology of stress
Neurological Function: anatomy and function of the sensory nervous system
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1. Title Slide
2. Nervous System Functions: Along with the endocrine system, the nervous system
helps maintain homeostasis. The nervous system responds to changes in the
body rapidly, using nerve impulses to cause changes in the body.
●
The nervous system is responsible for mental processes such as
perceptions, cognition, and memory; for behaviors; and for emotional responses
such as joy, excitement, anger, and anxiety.
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6. ●
●
The fundamental unit of the nervous system is the neuron.
What functions do the various parts of the neuron perform?
The dendrites receive nerve impulses from neighboring neurons or detect
stimuli and create action potentials. The cell body of the neuron keeps the cell
alive. The axon transfers nerve impulses along the length of the neuron to the
synaptic vesicles. The synaptic vesicles contain neurotransmitters that are
released across the synaptic cleft to a muscle, gland, or another neuron.
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8. SYNAPSE: THE AQUA COLORED NEURON IN THIS CASE IS A PRESYNAPTIC
NEURON. IT IS SYNAPSING WITH ANOTHER NEURON, LIGHT PURPLE. THAT NEURON
IS THE POST SYNAPTIC NEURON. ELECTRIC/CHEMICAL/ELECTRIC. ENERGY COMES
FROM Ca+ and K+ transversing the membrane and changing the potential.
●
The junction of a neuron and an adjacent neuron, muscle, or gland is
called a synapse. The neuron releases chemicals called neurotransmitters into
the synaptic cleft to carry the nerve impulses across.
●
After the neurotransmitter is released, where does it go?
The neurotransmitter travels across the synaptic cleft binds to receptor
sites on the adjacent neuron, muscle, or gland where the nerve impulse will
either be acted upon or passed on.
9. ●
Neural Functions: What kinds of stimuli do sensory receptors detect?
Sensory receptors detect changes in conditions (such as blood glucose
levels) within the body and changes in conditions (such as temperature) outside
the body.
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●
There are three different kinds of neurons: motor neurons (efferent
neurons), sensory neurons (afferent neurons), and interneurons. Which of the
three types of neurons is the most common?
Most of the neurons in the body are interneurons (located between
sensory and motor neurons).
10. ●
Central Nervous System: The brain and the spinal cord have bony
protections, but they are also protected by the meninges and the cerebrospinal
fluid. What are the meninges and the cerebrospinal fluid?
Meninges are connective tissue coverings. The innermost layer of the
meninges, the pia mater, is a delicate transparent layer that is attached to the
surface of the brain and the spinal cord. The middle layer, the arachnoid mater,
is an arrangement of collagen and elastic fibers. The outermost layer, the dura
mater, is dense connective tissue layer. The cerebrospinal fluid is a clear fluid that
and supplies the tissues of the CNS with oxygen and nutrients and carries away
wastes. It also acts as a shock absorber. After it circulates through cavities in the
brain and spinal cord, it is reabsorbed into the bloodstream.
11. Spinal Cord Function:
In addition to being an integrating center, the spinal
cord acts as an information highway. It conveys sensory information from
peripheral nerves up to the brain, and it conveys motor information from the
brain out to peripheral nerves. There are 31 pairs of spinal nerves.
12. ●
The brainstem connects with the spinal cord and is responsible for
regulating vital bodily functions. What are the three main divisions of the brain
stem?
● The three main divisions of the brain stem are the medulla oblongata, the pons,
and the midbrain.
The cerebellum helps coordinate complex movements, and regulates posture
and balance.
●
What are the functions of the diencephalon?
It relays sensory information to the cerebrum, regulates and integrates the
autonomic nervous system and the pituitary gland, and controls behavioral
patterns and the circadian rhythm.
●
The cerebrum is the largest part of the brain. It is where language centers
are located as well as the limbic system, which governs emotional aspects of our
behavior.
13. Peripheral Nervous System:
●
All nervous tissue outside the CNS is considered part of the peripheral
nervous system (PNS).
●
The sensory neurons of the somatic nervous system carry information from
the bones, muscles, joints, and skin to the CNS. They also carry information from
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sensory receptors for vision, hearing, taste, and smell to the CNS. The motor
neurons carry impulses from the CNS to the skeletal muscles.
●
The sensory neurons of the autonomic nervous system carry information
from the visceral organs (e.g., the heart) to the CNS. The motor neurons carry
impulses from the CNS to smooth muscle tissue, cardiac muscle tissue, and
glands.
14. ● What is the function of parasympathetic nervous system?
The parasympathetic nervous system is in control when the body is at rest; it
supports body functions, such as digestion, that conserve and restore body energy.
●
What is the function of the sympathetic nervous system?
The sympathetic nervous system responds to physical exertion or emotional stress
by overriding the parasympathetic nervous system so that the body can respond
quickly if needed.
●
Massage often activates the parasympathetic nervous system, unless the
massage is perceived by the client as uncomfortable.
15. Identify central nervous system disorders and list appropriate massage
considerations.
Some skills to be acquired:
List first aid measures to be implemented when a person is experiencing a seizure.
Describe appropriate measures used when working with wheelchair-bound clients.
Define infectious diseases of the nervous system and list appropriate massage
considerations.
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19. CENTRAL NERVOUS SYSTEM DISORDERS:
● Many clients diagnosed with cerebral palsy, spina bifida, and spinal cord
injuries will be wheelchair bound.
● Brain tumors will be discussed in Chapter 14, and anxiety disorders and types
of depression will be discussed in Chapter 15.
● See Box 6-1 on page 164 for general manifestations of neurologic disease.
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21. CEREBRAL PALSY:
Etiology
Damage to motor areas at basal ganglia, cerebrum
Prenatal causes
Most cases develop during pregnancy: maternal infection,
diabetes, hyperthyroidism, Rh sensitization, abdominal
trauma, PIH
Birth trauma
Anoxia, asphyxia, head trauma during birth (relatively rare)
Acquired CP
Develops in infancy: jaundice, head trauma, infection, brain
hemorrhage, neoplasms in brain
Adults with Cerebral Palsy:
Essentially a new population group: longer lifespan than ever before
Age faster, more vision problems
Fatigue, exhaustion, overuse syndromes
Complications:
Many patients have changes in sensation (hearing, vision loss); digestive
difficulties; possibility of cognitive problems, seizures, contractures, pain
from disorder and treatment interventions
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24. SPINA BIFIDA:
Definition
- Cleft spine: neural tube defect in which the vertebral arch fails to close
completely over the spinal cord
Ranges from subtle to severe
- Demographics
1:1,000 live births
1,500–2,000/year in the United States
Hispanics and European whites have highest rates
- Neural tube defects occur day 14–28 of gestation: fetus is the size of grain of
rice
- Main risk factor is folate deficiency
- Shows its presence in fetal life by causing a positive alphafetoprotein test, done
routinely in early pregnancy is the U.S.
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29. SPINAL CORD INJURY:
Demographics
10,000–11,000/year
250,000 living with SCI
Male > female 4:1
MVA → 50%
Gunshot wound (GSW), violence → 11%
Falls → 24%
Sports → 9%
Other: nontraumatic
Arthritis, bone spurs, tumors
Etiology
Usually starts with crushing blow (Fig. 4.13)
Could also be slow compression
New injury → spinal cord shock
Blood pressure is low, bradycardia, peripheral vasodilation
Muscles may be flaccid
30. ● Common causes of spinal cord injuries are from the trauma of motorcycle
or automobile accidents, slips and falls, diving in shallow water, and horseback
riding accidents.
●
Elderly adults are at an increased risk of falling, which can result in a spinal
cord injury. See Box 6-3 for information of risk factors for slips and falls.
Knowledge of the risk factors for slips and falls is important to developing a safer
practice.
The area of insult is usually between C1-C7 or between T12-L2. These are
the most mobile regions of the spine. If the injury occurs in the cervical area, it
results in quadriplegia, which is shown on the right. If the injury occurs in the
lower thoracic or lumbar area, it results in paraplegia, which is shown on the left.
50% of SCIs produce paraplegia and 50% produce quadriplegia.
●
Teddy Pendergrass (musician) and Christopher Reeve (actor) were both
afflicted with spinal cord injuries due to accidents.
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35. SEIZURE DISORDERS:
●
Two types of generalized seizures are absence and tonic-clonic. Absence
seizures, once called petit mal, involve a brief loss of awareness and some transient
facial movements that last for up to 10 seconds. The young girl above is having an
absence seizure. Tonic-clonic seizures produce an intermittent contract-relax pattern in
muscles and is associated with a loss of consciousness. The gentleman on the right is
having a tonic-clonic seizure.
●
Famous people who were diagnosed with seizure disorders include
Vincent Van Gogh, Napoleon Bonaparte, Charles Dickens, and Danny Glover.
36. Treatment
Anticonvulsant medication
High-fat low-fiber ketogenic diet
Surgery if specific mass is determined to be cause
Vagus nerve stimulation
37. If the client’s condition is not being medically supervised, it is best to postpone
massage until medical clearance is given as this situation increases the likelihood of
status epilepticus. Status epilepticus occurs when seizures recur without a full return to
consciousness from the preceding seizure, or if a single seizure lasts more than 30
minutes. This represents a medical emergency as brain damage, even death, may
result so contact emergency medical services if a seizure last more than 5 minutes or
immediately repeats.
38. ADHD: No commentary
39. ATTENTION DEFICIT (HYPERACTIVE) DISORDER:
Etiology
Still being explored
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Problems with dopamine production, transportation, reabsorption
Noradrenaline disruption in frontal cortex and basal ganglia (judgment,
movement)
Signs and Symptoms
Three behavior patterns:
Inattentiveness
Hyperactivity
Impulsivity
Behaviors are consistent in various settings
Treatment
Counseling, training for coping skills
Medications
Psychostimulants
Medication side effects
Appetite suppression
Increased blood pressure, heart rate
Sleep problems
Facial, vocal tics
Nondrug approaches
Nutritional supplements
Avoid caffeine, sugar, stimulants
40. AUTISM SPECTRUM DISORDERS:
Etiology
Abnormalities in neural systems that link brainstem, limbic system, basal ganglia,
cerebellum, corpus callosum, cerebral cortex
Some causes identified:
Fragile X syndrome
Tuberous sclerosis
Genetic predisposition
Theories
Mitochondrial dysfunction in neurons?
Autoimmune response?
Exposure to heavy metals
Allergies
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42. ● Asperger syndrome is the most common type and is a mild form of autism.
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●
Symptoms of autism include an aversion to touching, avoidance of eye
contact, preference to play alone, delayed or absent verbal communication,
an inability to initiate or sustain conversation, repetitive motions, and a
compulsion for sameness. These behaviors become apparent in the second or
third year of life.
●
FOR MASSAGE: Reduce treatment time to 10 to 15 minutes. Discontinue
massage if client is showing signs of intolerance.
43. Rett syndrome is a disorder of the nervous system that leads to developmental
reversals, especially in the areas of expressive language and hand use.
Causes, incidence, and risk factors
- Rett syndrome occurs almost exclusively in girls and may be
misdiagnosed as autism or cerebral palsy.
- Studies have linked many Rett syndrome cases to a defect in the methlCpG-binding protein 2 (MeCP2) gene. This gene is on the X chromosome.
- Females have two X chromosomes, so even when one has this significant
defect, the other X chromosome is normal enough for the child to survive.
- Males born with this defective gene do not have a second X
chromosome to make up for the problem. Therefore, the defect usually
results in miscarriage, stillbirth, or very early death.
- The condition affects about 1 out of 10,000 children. Groups of the
disease have appeared within families and certain geographic regions,
including Norway, Sweden, and northern Italy.
Childhood disintegrative disorder
Disintegrative psychosis; Heller syndrome
- Last reviewed: May 13, 2010.
- Childhood disintegrative disorder is a condition in which children
develop normally through age 3 or 4. Then, over a few months, children
lose language, motor, social, and other skills that they already learned.
Causes, incidence, and risk factors
- The cause of childhood disintegrative disorder is unknown, but it has
been linked to brain and nervous system problems. A child who is
affected loses:
- Communication skills
- Nonverbal behaviors
- Skills they had already learned
- The condition is similar to autistic disorder (autism).
Symptoms
- Delay or lack of spoken language
- Impairment in nonverbal behaviors
- Inability to start or maintain a conversation
- Lack of play
- Loss of bowel and bladder control
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- Loss of language or communication skills
- Loss of motor skills
- Loss of social skills
- Problems forming relationships with other children and family members
44. Etiology
- Some distinguishing features
- Neurotransmitter imbalance: serotonin, norepinephrine, dopamine
- Hormonal imbalance: progesterone, estrogen, endorphins, cortisol
HPA axis: high amounts of corticotropin-releasing hormone (CRH), adrenal
stimulation
- Atrophy in the hippocampus: may be related to cortisol levels
Causes
- Genetics
- Environmental triggers
- Personality traits
- Chronic illness
- Other issues (hypothyroidism, smoking, drug use, side effects of
medications, B12 and folate deficiency)
45. TREATMENT
Antidepressant drugs
Four main categories
SSRIs
Selective serotonin reuptake inhibitors: Prozac, Zoloft
SNRIs
Serotonin norepinephrine reuptake inhibitors: Effexor,
Cymbalta
MAOIs
Monoamine oxidase inhibitors: Nardil, Parate
TCAs
Tricyclic antidepressants: Elavil
Two major disadvantages:
Take several weeks to establish changes
Produce side effects before benefits appear
Lithium: for bipolar
Psychotherapy
Cognitive-behavioral therapy: life skills
Interpersonal therapy: relationships
Psychodynamic: unresolved inner conflict
Other therapies
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Light therapy for SAD
Electroconvulsive therapy (ECT) (unclear why it works, but it does for
some)
St. John’s Wort may be effective for dysthymia
Others: transcranial magnet stimulation; vagus nerve stimulation; SAM-e,
omega-3 fish oil; 5-HTP, others
46. SPINAL CORD INJURY: CONT’D
● What is another difference between quadriplegia and paraplegia?
If the injury occurs in the cervical area, it results in quadriplegia. If the injury
occurs in the lower thoracic or lumbar area, it results in paraplegia.
● Massage is postponed until client is past the spinal shock stage and has
medical clearance. This stage may last 7-20 days, but may persist for as long
as 3 months. Indications that the spinal shock stage is subsiding is the
reappearance of reflex activity.
47. SPINAL CORD INJURY: CONT’D
● The area of insult is usually between C1-C7 or between T12-L2. These are the
most mobile regions of the spine. If the injury occurs in the cervical area, it
results in quadriplegia, which is shown on the right. If the injury occurs in the
lower thoracic or lumbar area, it results in paraplegia, which is shown on the
left. 50% of SCIs produce paraplegia and 50% produce quadriplegia.
● Teddy Pendergrass (musician) and Christopher Reeve (actor) were both
afflicted with spinal cord injuries due to accidents. Reeve’s damage was
high enough that it affected his respiratory system. He was dependent on a
respirator.
48. ● Common causes of spinal cord injuries are from the trauma of motorcycle
or automobile accidents, slips and falls, diving in shallow water, and
horseback riding accidents.
● Elderly adults are at an increased risk of falling, which can result in a spinal
cord injury. See Box 6-3 for information of risk factors for slips and falls.
Knowledge of the risk factors for slips and falls is important to developing a
safer practice.
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50. WHEEL-CHAIR PROTOCOLS:
● People use wheelchairs for many reasons such as amputations, inability to
walk long distances, obesity or inactivity, paralysis, recovery from surgery, or
short-term injury.
● Never push a wheelchair without permission from the person in the chair.
Never assume a wheelchair-bound client is helpless; let them direct you if
they need any assistance.
● It is not uncommon for a wheelchair bound client to be fatigued after
expending energy while moving. Because of this, he or she may need to rest
for a few moments after arrival to your office.
51. Some clients may elect to be massaged in the wheelchair. Be sure the
wheelchair brakes are locked before beginning massage.
52. POST-POLIO SYNDROME:
Postpolio syndrome is included for discussion because it is a fairly common
occurrence in persons with a history of poliomyelitis. (this would be
babyboomers and war generation in the US). Lyme disease and shingles are
covered elsewhere.
53. ENCEPHALITIS
● What are the possible causes of encephalitis?
In most cases, encephalitis develops as a complication of a systemic viral
disease.
● A coinfection of meningitis is always present with encephalitis.
● Meningitis may occur as a secondary infection to prior upper respiratory, ear,
or dental infections.
● Prompt diagnosis and treatment is needed as 25% of persons with meningitis
either have permanent brain damage or die.
two types: bacterial and viral
● The Salk and Sabin vaccines, developed in the 1950s and 1960s, have
virtually eliminated polio in the Western world.
● The therapist is unlikely to encounter persons who have polio.
● Famous people who had polio were Donald Sutherland (actor) and Franklin
D. Roosevelt (former U.S. president).
~ With the resistance to vaccination for children exhibited recently in the US,
polio is an increasing risk. It is still endemic in other countries.
54. ● Be sure to position the client for comfort.
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55. NEURO-DEGENERATIVE DISEASE:
- Diseases that involve degeneration of the central nervous system.
What are neurodegenerative diseases and appropriate massage
considerations.
- Alzheimer disease.
- vascular disorders and list appropriate massage considerations.
- warning signs of stroke.
- conditions of the peripheral nervous system and list appropriate massage
considerations.
56. ● What is the most common cause of DEMENTIA?
Advancing age is the most common cause of dementia. Other possible
causes include the following: cerebrovascular disease, CNS infections, brain
trauma, brain tumors, vitamin deficiencies, some metabolic and endocrine
conditions, immune disorders, multiple sclerosis, Huntington and Parkinson
diseases, and immune disorders such as AIDS.
● Famous people who suffered with dementia were Ronald Reagan (former
U.S. president), Charlton Heston (actor), and Charles Bronson (actor).
57. ● What are the typical early symptoms of ALZHEIMER DISEASE?
The disease usually begins with slight defects in memory and behavior.
● As the brain degenerates and begins to atrophy, ventricles dilate, grooves
(sulci) widen and elevations (gyri) narrow in the cerebral cortex.
58. Etiology
First observations were plaques and tangles: still leading issues
Plaques
Beta amyloid deposits on neurons in brain
Stimulates inflammatory response: kills affected and nearby
unaffected cells
Neurofibrillary tangles
Tau in cytoskeletons collapses; cells fall out of relationship, become
twisted and tangled
Can’t transmit messages, shrink and die
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60. ● Table 6-1 on p. 178 of the text book provides details of the seven stages of
Alzheimer disease.
61. ALZHEIMER DISEASE is a common neurologic disorder with over 4 million
persons affected in the US. This number is expected to triple by the year 2050 as
the population ages.
62. HUNTINGTONS DISEASE:
● The affected person experiences involuntary, purposeless, rapid or jerky
motions of the arms and face. Initial signs of the disease may not be
evident until the afflicted person is in their 40s. Because of the time of
diagnoses, the trait may be passed to the victim’s children.
● The massage therapist must rely heavily on the client to indicate comfort
of position, pressure, and technique.
● Because of the chronic and seemingly senseless repetitive behavior, this
disease used to be called Huntington’s Chorea.
63. PARKINSON DISEASE:
● The typical symptoms of Parkinson disease are shown in the diagram. The
classic triad of symptoms includes tremors, rigidity, and a slowness of
voluntary movements.
● The goal of massage therapy for clients with Parkinson disease should be
to reduce rigidity. Massage is best performed is a position which the client
can easily maneuver, which may be a recumbent or seated position.
Gentle gliding strokes and kneading during the massage followed by
passive movements of joints after the massage can be helpful, but force
should not be used. Symptoms may be reduced, although only
temporarily.
● Use the items in the checklist in Box 6-5 to help avoid slips and falls and
make the massage practice safer.
● Famous people with Parkinson disease include Michael J. Fox (actor) and
Muhammad Ali (boxer).
● Treatment
Medication
L-dopa, carbidopa (temporary, side effects)
Other dopamine-affecting drugs
Anticholinergic agents
Antivirals
Nondrug treatments
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Deep brain stimulation
Surgery to thalamus, midbrain
PT, OT, speech therapy
64. PARKINSON: Signs and Symptoms
Primary symptoms (related to disease process):
Nonspecific achiness, weakness, and fatigue
Resting tremor
Bradykinesia
Rigidity (not the same as spasticity)
Poor postural reflexes
Secondary symptoms (indirect effects or related to medications)
Shuffling, festinating gait
Changes in speech
Changes in handwriting
Sleep disorders
Depression
Mental degeneration
65. MULTIPLE SCLEROSIS:
● Common signs and symptoms of MS are paresthesias, fatigue, dizziness,
tremors, speech and hearing impairments. The person experiences
progressive muscle weakness that leads to loss of coordination and
postural instability and eventual paralysis.
● Speech and hearing impairments often develop. Box 6-6 on page 183
list many suggestions for working with clients who are visually or hearing
impaired.
Myelin sheath in CNS is attacked, destroyed
Oligodendrocytes multiply to repair damage; ultimately fail
Myelin is replaced with scar tissue
Electrical impulses are slowed or obstructed
Motor, sensory paralysis
Runs in flare/remission
With persistent flares the neuron is damaged: this is
permanent
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66.
- Progressive degeneration of motor neurons in CNS and PNS
- Large motor neurons on lateral aspect of spinal cord are replaced with
fibrous astrocytes
● ALS progresses rapidly, leading to respiratory failure and death, usually
within 2-5 years.
● What massage techniques can be useful for clients with ALS?
Gentle, gliding strokes can help the client to relax. The massage
therapist should also be aware that the client might not be able to get
on the massage table, which means that the therapist should be
prepared to perform massage while the client is in the wheelchair.
- There seem to be some people who have ALS who do not deteriorate
and die quite so rapidly. Stephen Hawking, the theoretical physicist
and cosmologist case in point. He has lived with ALS since his early 20s.
His diagnosis I believe was made at the age of 21.
Dr. Hawking I was 70 years old recently.
67. Abstract: FOR YOUR CURIOSITY AND/OR INFORMATION ONLY. WILL NOT
SHOW UP ON ANY TESTS.
The objective of this study is to undertake a population based study on the
incidence, prevalence, natural history, and response to treatment of complex
regional pain syndrome (CRPS). All Mayo Clinic and Olmsted Medical Group
medical records with codes for reflex sympathetic dystrophy (RSD), CRPS, and
compatible diagnoses in the period 1989–1999 were reviewed as part of the
Rochester Epidemiology Project. We used IASP criteria for CRPS. The study
population was in the Olmsted County, Minnesota (1990 population, 106,470).
The main outcome measures were CRPS I incidence, prevalence, and outcome.
Seventy-four cases of CRPS I were identified, resulting in an incidence rate of
5.46 per 100,000 person years at risk, and a period prevalence of 20.57 per
100,000. Female:male ratio was 4:1, with a median age of 46 years at onset.
Upper limb was affected twice as commonly as lower limb. All cases reported
an antecedent event and fracture was the most common trigger (46%).
Excellent concordance was found between symptoms and signs and
vasomotor symptoms were the most commonly present. Three phase bone scan
and autonomic testing diagnosed the condition in >80% of cases. Seventy-four
percent of patients underwent resolution, often spontaneously. CRPS I is of low
prevalence, more commonly affects women than men, the upper more than
the lower extremity, and three out of four cases undergo resolution. These results
suggest that invasive treatment of CRPS may not be warranted in the majority of
cases
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68. Illustration: physiologic reflection, complex regional pain syndrome.
69. Overview: for your information – will not be on any tests.
Intrathecal drug delivery, or “pain pump,” is a method of giving
medication directly to your spinal cord. The system uses a small pump that
is surgically placed under the skin of your abdomen and delivers
medication through a catheter to the area around your spinal cord –
similar to an epidural that women may have during childbirth. A pain
pump may be a treatment option if all other traditional methods have
failed to relieve your long-term symptoms. Because the medication is
delivered directly to the spinal cord, your symptoms can be controlled
with a much smaller dose than is needed with oral medication. The goal
of a drug pump is to better control your symptoms and to reduce oral
medications; thus reducing their associated side effects.
Sympathectomy: surgery that removes the sympathetic ganglia of
affected nerves to prevent the experience of chronic pain. No longer a
common piece of surgery.
70. ● VASCULAR DISORDERS OF THE NERVOUS SYSTEM, or cerebrovascular
disease, is the most frequently occurring neurologic disorder with more than
50% of affected individuals admitted to the hospital. The most common
manifestation of cerebrovascular disease is stroke.
● Cerebral aneurysm is discussed as one cause of cerebrovascular accidents
and is also included under the entry called aneurysm in Chapter 8 in
cardiovascular disease.
71. TIA: TRANSIENT ISCHEMIC ATTACKS: This is a neuro-vascular event. It will
be looked at again in the cardiovascular system.
●
Common causes of transient ischemic attacks are (1) thrombus
(clot) formation within the arterial system of the brain or; (2) an embolus
(floating clot) originating elsewhere travels to the brain and becomes
lodged there.
●
Since there are no modifications needed, consult with the client
before massage to devise a treatment plan as you would any other client.
● Signs and Symptoms
- Sudden onset of unilateral weakness, numbness or paralysis on the
face, arm, leg or any combination of the three
- Suddenly blurred or decreased vision in one or both eyes;
asymmetrical dilation of pupils
- Difficulty in speaking or understanding simple sentences; confusion
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- Sudden onset of dizziness, clumsiness, vertigo
- Sudden very extreme headache
- Possible loss of consciousness
72. CEREBRAL VASCULAR ACCIDENT (STROKE):
● Definition
Also called brain attack, cerebrovascular accident (CVA)
Damage to brain cells due to oxygen deprivation
● The disruption of cerebral blood vessels results irreversible brain
damage, coma, or death. The areas of infarction, or death, can be
noted in the dark areas of the photograph.
● If clearance has been obtained from the client’s health care provider,
what massage techniques can be helpful for a client who has had a
stroke?
Massage strokes should be slow, superficial, soothing, and rhythmic.
Deep pressure may increase spasticity and is therefore,
contraindicated.
73. CVA Cont’d:
●
Complications of CVA’s are common and range from mild, which
go almost unnoticed, to severe and include hemiplegia. Hemiplegia is
paralysis of one side of the body and is illustrated on this slide. Left-sided
brain damage results in right-sided paralysis and vise versa.
74. CVA Cont’d:
● Etiology what happens?
Oxygen deprivation from bleeding or ischemia
● Ischemic strokes (about 80%):
Cerebral thrombosis: blood clot forms in cerebral arteries, obstructs
blood flow
Embolism: Clot or other debris travels from elsewhere (heart, carotid
artery)
TIA is warning sign
PFO: patent foramen ovale allows blood to cross the atrial septum:
a factor in strokes in people < 55 years old.
(Fig. 4.14, animation 3)
● Hemorrhagic strokes (about 20%), Fig. 4.15
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Intracerebral hemorrhage: rupture of blood vessel inside the brain
Subarachnoid hemorrhage: rupture of blood vessel on surface of
the brain
Secondary damage from inflammation, free radicals causes a lot of
damage; limiting these can improve prognosis
75. CVA Cont’d:
● Immediate medical treatment may prevent permanent brain damage.
The acute care principle is “time is brain.” Immediate care includes the
use of clot-busting agents (administered within 3 hours of the event to be
effective) and to restore circulation to the damaged area.
76. MIGRAINE HEADACHES:
● Although the exact mechanism is not fully understood, migraine
headaches appear to be related to imbalances in brain chemicals,
including serotonin and neuropeptides. Chemical imbalances cause
intracranial blood vessels to become dilated and inflamed resulting in a
migraine headache.
● What are some trigger factors for migraine headaches?
Triggers include hunger as well as foods (carbohydrates, iodine-rich foods,
cheese, chocolate), alcohol (namely red wine), bright lights, loud noises,
hormonal changes, atmospheric changes, or the period of relaxation
after physical or emotional stress.
● Massage is contraindicated while the client is experiencing the
headache. Massage therapy between attacks can lessen the frequency
and intensity of migraines. At this time, a full-body relaxation massage is
indicated.
77. no commentary
78. TRIGEMINAL NEURALGIA: (TIC DOULOUREUX)
● The diagram on this slide shows the three trigeminal nerve branches. Pain
is unilateral, transient, and follows any or all parts of the nerve path.
Severity ranges from mild twinges to severe, sharp, electric shock-like
sensations lasting from a few seconds to several hours.
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● If the client is prone to TN, avoid any pressure on the face and scalp as
this may trigger an attack. Position the client carefully, perhaps opting for
a seated position to address the back.
79. ● What can the clients who have Bell’s palsy do on their own to alleviate
symptoms?
Clients can massage their own faces two or three times a day to maintain
muscle tone.
80. Complications Bell Palsy
85% have full, nearly full recovery within a few months
Can damage eye (inadequate lubrication, blinking)
As nerve heals, it makes new connections
Unpredictable muscle activity of face (synkinesis)
Excessive tears with salivation
81. ● Myasthenia Gravis: Facial weakness and loss of expression are often the
first indicators that something is wrong. Muscles of the eyes, mouth, throat
and neck are affected, and the face may falsely express sadness.
● Be sure to omit or only cautiously apply passive stretching and joint
mobilizations as clients with mobility impairments often have compromised
bone integrity.
82. ● Guillain-Barre Syndrome: The condition typically begins as weakness in
the legs and ascends to the trunk and arms. Symptoms usually subside by the
fourth week (90% of cases) and diminish in reverse order.
Etiology
Usually preceded by infection of respiratory or GI tract
May stimulate an immune system attack directed at Schwann cells
Linked to infection with
Campylobacter jejuni, Haemophilus influenzae, Mycoplasma
pneumoniae, Borrelia burgdorferi, cytomegalovirus, EpsteinBarr virus, HIV
Also seen with pregnancy, surgery, some vaccines (swine flu, 1976)
Myelin on peripheral nerves is attacked and destroyed by
macrophages and lymphocytes
Damage progresses proximally
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May affect cranial nerves
Many patients need ventilator before resolution
Signs and Symptoms
Unpredictable
Fast, severe onset (hours to days)
Symmetrical
Progresses proximally from extremities to trunk
Weakness, tingling in limbs
Reflexes diminish
If GBS is at cranial nerves: facial weakness, pain, speech,
swallowing difficulty
Respiratory control is lost
Symptoms peak 2–3 weeks after onset, linger, then subside
Massage
Contraindicated for circulatory work while acute
Later massage in conjunction with PT etc. can be helpful
Work with health care team
Massage is contraindicated until the client has fully recovered
83. Peripheral Neuropathy
● Peripheral Neuropathy: What are some of the known causes of
neuropathy?
Complications of diseases such as diabetes, chronic alcohol use, inherited
disorders, dietary deficiencies, kidney failure, multiple sclerosis, and
exposure to harmful substances, such as lead, can all lead to neuropathy.
● Clients with peripheral neuropathy of the lower extremity are prone to
additional nerve injury at pressure points. This is why bolster use is
discouraged in these cases.
● Any clients suffering from undiagnosed numbness or tingling should be
referred to their health care providers for diagnosis and treatment.
84. No commentary
85. ● Degenerative Disc Disease: Position the client for comfort. Be willing and
able to assist the client when getting up from the table or chair if he or she is
feeling weak or unstable.
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86. ● Herniated disc can result from cumulative trauma (poor posture) improper
lifting, degenerative disc disease, direct trauma, or a combination of these.
● Bulging Disc: Pre-Herniation the pulposus bulges out, stretching the annulus
fibrosis.
● Herniated disc is one of the most frequent causes of low back pain and
affects men more than women.
● If radicular symptoms originate in the cervical area, is it referred to a cervical
radiculopathy. If radicular symptoms originate in the lumbosacral area it is
called lumbar radiculopathy.
Radicular Pain and Radiculopathy Definition
Radicular pain is a type of pain that radiates into the lower extremity
directly along the course of a spinal nerve root. Radicular pain is caused
by compression, inflammation and/or injury to a spinal nerve root arising
from common conditions including herniated disc, foraminal stenosis and
peridural fibrosis. Leg pain can be accompanied by numbness and
tingling, muscle weakness and loss of reflexes. The most common
symptom of radicular pain is usually called sciatica or sometimes
radiculopathy, which is pain that radiates along the sciatic nerve down
the back of the thigh and sometimes into the calf and foot. Radicular
pain can be effectively treated conservatively (non-surgically) with
physical therapy, medications and epidural injections. If conservative
treatments fail, decompressive surgery, such as a laminectomy or
discectomy, may alleviate radicular pain
Hermiated discs the pulposa has ruptured through the annulus fibrosis.
Bulging disc no rupture, only bubble.
87. ● Paresthesias are sensations such as burning, numbness or tingling.
● Pay close attention to the client’s level of discomfort. If you client is in pain
while performing tasks related to getting a massage (removing a jacket,
sitting in a chair, climbing on a massage table), he or she is not a good
candidate for massage that day.
88. No commentary
89. Meniere Disease:
Possible causes
Rupture of the membranous labyrinth
Autoimmune activity
Viral infection
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Pressure from a tiny blood vessel wrapping around the
vestibulocochlear nerve
Signs and Symptoms
Four major symptoms
Starts in one ear, can progress to the other
Usually fast onset
Ménière attack can last 20 minutes to 24 hours
Hearing loss
Tinnitus
A sense of fullness in the middle ear
Rotational vertigo
90. ● What are some possible causes of sciatica?
Sciatica can be caused by herniated disc (most common cause), indirect
trauma (poor posture, tumors), spinal stenosis, spondylolisthesis, direct
trauma, or a combination of these. Piriformis syndrome is another possible
cause.
● Massage needs to be modified according to the cause. For example, if the
sciatica is due to a herniated disc, massage may need to be postponed.
However, if the cause is piriformis syndrome, work deeply, but briefly, to
release tight muscles in the low back and hip.
● Because the therapist cannot completely rely on the client’s feedback
regarding pressure in areas of paresthesia, the client may be injured because
of aggressively applied techniques so caution is merited.
91. ● When does carpal tunnel syndrome occur?
Carpal tunnel syndrome occurs when the size of the carpal tunnel (where the
transverse carpal ligament connects across the carpal bones) decreases or
the inflamed tendons increase in size.
● If inflammation is not present, massage the forearm muscles and muscles in
the palm, within the client’s tolerance. Gentle stretching of the anterior and
posterior forearm muscles is also helpful.
92. ● Carpal tunnel syndrome is an occupational hazard for massage
therapists. These preventive measures should be applied to help avoid this
condition.
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● Lowering table height will decrease the risk of wrist hyperextension and thus
decrease the risk of carpal tunnel injury.
93. ● What are some common symptoms of thoracic outlet syndrome?
Pain and weakness down the arm are common symptoms, but some people
also experience pain in the chest and neck.
● Compression or entrapment of the neurovascular bundle can be caused by
any of the following: a cervical rib, tight scalene muscles, a depressed
clavicle, a tight pectoralis minor muscle, poor posture, trauma or
accumulative stress.
● Although not shown on the slide, the subclavian artery and vein located
between the base of the neck and axilla may also be compressed.
● If edema is present, elevate the affected limb if swollen and use gliding
strokes applied centripetally.
94. no commentary
95. Anxiety Disorders: Neurotransmitters
Norepinephrine
GABA
Serotonin
CRF
Tightly interdependent: disruption in one → disruptions in all
Types of anxiety disorders
General anxiety disorder (GAD)
6.8 million in the United States
Women > men 2:1
Chronic, exaggerated, consuming worry; constant anticipation of
disaster
Restlessness/edginess
Fatigue
Poor concentration
Irritability
Muscle tension
Sleeping problems
Panic disorder
6 million in the United States
Sudden onset of extreme sympathetic reactions
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Pounding heart, chest pain, sweatiness, dizziness,
faintness
Feeling of impending doom, nearness of death
10 minutes to many hours
Can have panic attack without panic disorder
Complication: agoraphobia/claustrophobia
Shrinking safety zone
Acute and posttraumatic stress disorder
Acute (ATSD) = symptoms within 1 month of triggering event
Post (chronic) (PTSD) = symptoms persist 3 or more months
7.7 million in the United States
Persistent visceral memories of ordeal
Combat, abuse, rape, assault, torture, natural disaster,
terrorist attack
Patient may be a witness or participant
Memories relieved in nightmares, flashbacks
Exaggerated startle reflex, dissociation, hypervigilance
PTSD may have delayed onset
Obsessive-compulsive disorder (OCD)
2.2 million in the United States
Men = women
Can come and go, is not always progressive
Unwelcome thoughts (obsessions)
Efforts to control them (compulsions)
Common obsessions
Fear of contamination (dirt, germs, sexual acts)
Fear of violence, catastrophic events
Fear of committing violent, sexual acts
Fear of disorder, asymmetry
Common rituals
Repeated handwashing
Refusing to touch people, surfaces
Repeated checking locks, stove, irons, etc.
Counting telephone poles
Symmetrically arranging items
Repetition of chants, prayers
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Many hours/day devoted to rituals
Phobias: social and specific
Social phobia
Also called social anxiety disorder
15 million in the United States
Intense, irrational fear of being judged negatively by others,
public embarrassment
Can limit ability to work, school, relationships
Treatment
Medication and psychotherapy
Most are treatable if patients can find it
Medications
Antidepressants
Antianxieties
Beta-blockers
Psychotherapy
Supported resistance to compulsive behaviors
Controlled exposure to stimuli for phobics
Behavioral-cognitive therapies
96. no commentary
97. the end
A neuromuscular adaptation: General Adaptation Syndrome.
See attached notes GAS doc
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