9.12 Other Nervous System Disorders
Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a neurological disorder that affects motor neurons and the control of voluntary muscle movement and breathing. As motor neurons degenerate and die, they stop sending messages to the muscles, causing them to weaken, twitch, and shrink. Eventually, the brain loses its ability to control voluntary movements, such as walking, talking, chewing, and breathing. However, cognitive abilities are not affected. Medications are available that may prolong survival, reduce the rate of decline, or help manage symptoms, but there is no known treatment to cure ALS.[1]
Autonomic Dysreflexia
Autonomic dysreflexia is a medical emergency that occurs in clients who have sustained a spinal cord injury above T6. It is manifested by an exaggerated autonomic reflex response that is most often triggered by bowel or bladder distension such as constipation, impaction or urinary retention, or tight or restrictive clothing.
See Figure 9.31[2] for an illustration of neuronal pathways disrupted/rerouted by complete spinal cord injury above the sixth thoracic (T6) spinal level associated with the development of autonomic dysreflexia evoked by pelvic visceral distension.
Signs and symptoms of autonomic dysreflexia include the following:
- Severe headache
- Increased in blood pressure (hypertension)
- Bradycardia
- Flushing
- Profuse sweating
Management of autonomic dysreflexia focuses on removing the trigger, such as loosening restrictive clothing, emptying bowel or bladder, and elevating the head of the bed (while keeping correct body alignment).
Ongoing management includes frequent assessing of GI/GU systems, utilizing a kinetic bed to promote blood flow, providing range-of-motion exercise, applying sequential compression devices, protecting skin integrity, and promoting bowel and bladder training. Encourage the client to keep their bladder empty and their urine dilute and acidic to prevent urinary tract infection, a common cause of life-threatening sepsis.
View a supplementary YouTube[3] video on autonomic dysreflexia: Autonomic Dysreflexia.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common neurological and musculoskeletal disorder that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve passes through the carpal tunnel, a narrow, rigid passageway of ligament and bones at the base of the hand. The median nerve provides feeling to the thumb, index, middle finger, and part of the ring finger. Compression of this nerve causes the symptoms of numbness, tingling, weakness, and pain in these fingers.[4]
See Figure 9.32[5] for an illustration of carpal tunnel syndrome.
Carpal tunnel syndrome may be diagnosed with a nerve conduction study that measures how quickly impulses are transmitted along a nerve. An electromyography test may also be used, wh