ADVERTISEMENT

• JOBS
• CE
• Cardiopulmonary
• Geriatrics &
  Home Health
• Neurology
• Pediatrics
• Sports & Orthopedics
• PT Toolbox
• HOME

Search Over 1026 PT Jobs

State All States Alaska Alabama Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Specialty All Specialties Physical Therapy Physical Therapy Assistant Physical Therapy Manager

Keywords

• Print This
• Select Text Size:
• 

For those who must deal with chronic pain, the idea of losing sensation might seem highly desirable. But for people with peripheral neuropathy — particularly those with diabetes — numbness in the hands and feet can spell big trouble. Diabetic neuropathy is the most common form, but chemotherapy, radiation, alcohol abuse, and many other factors also can cause the condition.

There are four main categories of neuropathy:
Sensory neuropathy, in which part of the sensory system is damaged, causing tingling, numbness, or loss of sensation or position sense.
Motor neuropathy, marked by damage that affects the muscles under conscious control, also may result in muscle cramping or fasciculations.
Autonomic neuropathy, which affects the autonomic nervous system, may affect blood pressure, heart rate, sweating, digestion, and bowel and bladder function.
Mixed cases, in which two or more types may be involved.

Symptoms of neuropathy vary depending on what type the patient is experiencing and how far it has progressed, says Tricia Trinque, MHA, PT, owner of Seabreeze Physical Therapy in St. Petersburg, Fla. “In the beginning, some patients complain of a numbness or tingling in their feet. Other patients have pain they often describe as a burning or a bee sting sensation,” she says.

James Nussbaum, PhD, MSPT, CSCS, EMT, clinical director of ProHealth & Fitness in New York City, notes that patients with pain easily establish the therapist’s primary task. “When someone has pain, it’s a big deal,” he says. “We want to do everything in our power to ease that pain, but it’s important to know exactly what’s causing it. If you’re not assessing, you’re guessing.”

Neural Network Failure

Each of the various kinds of senses — vibration, kinesthetic, proprioceptive, and thermal — travels through a different nerve vector and can be lost independently, Nussbaum observes. “Sometimes symptoms point to a cause,” he says, “and sometimes they’re a bit more vague and you have to dig a little.”

Sensory neuropathy that causes numbness is especially worrisome in patients with diabetes, where the lack of lower extremity sensation can lead to an increased fall risk. Because of their compromised circulation, even a small problem such as a cut or blister on the foot can get infected if not noticed for a period of time, which can lead to gangrene and amputation.

With motor neuropathy, the most common symptoms are muscle weakness and atrophy. But muscles may begin to cramp or twitch uncontrollably, and patients may experience difficulty swallowing, breathing, or talking. Lower extremity weakness may lead to falls.

Autonomic neuropathy can cause significant problems because it affects systems in the body over which we have no control. “The autonomic nervous system controls blood pressure, for one thing,” Nussbaum says. “In someone with autonomic neuropathy, blood pressure can be extremely labile — it can get really high or low from one moment to the next, which can cause lightheadedness and fainting. Your [gastrointestinal] and urinary tracts are also controlled by the autonomic system, so people can have incontinence problems as well.”

Restorative Regimens

Before any treatment begins, it’s important to establish a baseline and compare it with objective measures at each step along the way, Nussbaum advises. Typically, he starts with the Berg functional balance test and the Biodex balance system to establish the patient’s initial status, followed by the SF-36 quality of life measure.

Depending on the patient’s level of capability, Nussbaum may use either a direct or indirect approach. “If someone’s weak, I want to strengthen the muscle and get rid of the weakness,” he explains. “But if a certain muscle isn’t responding, let’s find another muscle that can help circumvent that weakness.”

Because neuropathy is marked by a compromise in blood circulation that starves nerves of oxygen, Trinque focuses on getting more oxygen to the affected tissues. One modality she uses is infrared light therapy, which theoretically helps to stimulate release of oxygen into the damaged tissues. Massage and electrical stimulation also have shown good results, she says.

Nussbaum uses a full spectrum of therapies as well, including manual techniques such as joint compression and distraction, ultrasound, thermal modalities, and a vibration platform. “Healthcare is ultimately about two things: longevity and quality of life,” he says. “In my opinion, the most important thing we do is improve the quality of people’s lives.”

---

Mark Cantrell is a medical writer for the Gannett Healthcare Group. To comment, e-mail pteditor@gannetthg.com.

© Copyright 2009 Gannett Healthcare Group