Physical Rehabilitation of Peripheral Neuropathies

Peripheral Neuropathies
The term Peripheral Neuropathies describes a group of neurological disorders which affects the nerves lying away from brain and spinal-cord. Most commonly peripheral neuropathies lead to symptoms of muscle weakness and sensory impairment. The pattern of symptoms is determined by the cause of the neuropathy but typically symptoms is going to be symmetrical affecting either legs or arms. They may be isolated towards the distal extremities i.e. the feet and hands but can also affect muscles more proximally within the limbs. Most neuropathies progress in a slow pace having a gradual deterioration in function.
What causes peripheral neuropathy are numerous. Typical presentations we'd see are:
Hereditary neuropathies e.g. Charcot-Marie-Tooth syndrome
Metabolic disorders e.g. Diabetes neuropathy
Inflammatory conditions e.g. Guillain-barré syndrome
Chronic inflammatory demyelinating neuropathy (CIDP)
Drug induced neuropathy
Vitamin deficiency e.g. vitamin B12
Essentially most of the symptoms of these disorders include:
Muscle weakness. This maybe proximal e.g. shoulder girdle/pelvic girdle or distal in the possession of and feet
Sensory impairment which could produce tingling, numbness or pain
Disruption of body perception
Muscle stiffness and cramping
Fatigue
Balance impairment
Difficulty walking and performing important everyday tasks
Weakness or sensory impairment within the arms will affect grip strength and dexterity. Tasks for example writing, doing buttons, opening envelopes or lifting the kettle may become a major challenge.

Peripheral neuropathies will frequently affect the ankles and feet. Our feet play an important role providing information regarding balance, postural alignment and the body awareness. Any interference with sensation, flexibility or power in this area can affect balance control and walking. Often the individual will complain to be unable to stand still, have a problem stepping or report “catching” the foot when walking.
Physiotherapy control over peripheral neuropathies is centred round maintaining muscle power and joint flexibility, preserving function and mobility. Provision of appropriate orthotics, splints or aids can help this process. An important facet of our management technique is referral to other appropriate health care professionals including Occupational Therapists, Orthotists and Podiatrists. In many cases following assessment and provision of the appropriate treatment plan, periodic reviews is going to be recommended to monitor and manage symptoms assisting to maintain a satisfactory lifestyle. Again this can very much depend on the kind of neuropathy, extent of impairment and private goals.

Exercise
Research has revealed that strengthening exercise moderately improves muscle strength in individuals with peripheral neuropathy. In addition, physical exercise may reduce neuropathy pain and may help control glucose levels.
An extensive physical activity routine includes four types of activities:
Weight training Exercise
Balance Exercise

Aerobic fitness exercise:

Increases your heartbeat, works your muscles, and raises your breathing rate. For most of us, it's best to aim for an overall total of about 30 minutes a day, between 3-5 days per week. If you haven't been very active recently, you can begin out with 5 or 10 minutes each day and work up to additional time each week. Or separate your activity during the day -- try a 10-minute walk after every meal. Here are some examples of aerobic fitness exercise:
Take a brisk walk (outside or inside on the treadmill)
Take a low-impact aerobics class
Swim or do water cardio
Stationary bicycle indoors 

CALF STRETCH

Place one leg far behind you using the toe pointed slightly inward. Take a sizable step forward with the opposite foot. With the leading knee slightly bent lean forward keeping your high heel on the floor. You should feel a muscle stretch within the calf of your back leg.
SEATED HAMSTRING STRETCH
Looking at the front half of a strong chair, place one leg out straight using the foot pointing up. Bend the alternative knee so that your feet are flat on the floor. Center your chest within the straight leg, and slowly straighten your back before you feel a muscle stretch at the back of your leg.
\PLANTARFASCIA STRETCH
While facing a door frame, place your heel as near to the door frame as you possibly can. Slowly lean forward, allowing your heel to slip back as your toes extend upward. To improve the stretch, bend the leading knee toward the doorway frame. You should feel a muscle stretch towards the bottom of your foot and along your heel cord.
Strength Training
Strength training, done many times a week, helps build strong bones and muscles and makes everyday chores like carrying groceries simpler for you. With more muscle, you use-up more calories, even at rest. Here are a few ways to do it:
Enroll in a class to do weight training with weights, elastic bands, or plastic tubes
Lift light weights in your own home
Below are strengthening exercises that you can do at home.
SEATED DORSIFLEXION
While seating around the front half of a chair place both your feet flat on the floor. Gradually pull the toes and ankle as high as you can. Slowly fail them.
To make this exercise more challenging position the feet closer to your body.
CHAIR SQUAT
Utilizing a firm chair with armrests, position the feet in a split stance with one foot in the base of the chair and also the other foot placed comfortably in-front and slightly to the side. Slowly transfer unwanted weight forward until your legs support your body weight. Slowly press track of your legs to standing. To lower yourself, slowly take the chair together with your hips. Touch the chair together with your hips and press support for your next repetition. Do not "plop" in chair or rest among repetitions.
CALF RAISES
While standing around the kitchen counter, place two fingers on the counter. Get up on one foot lifting another heel off the floor, standing on your toes (while you strengthen your muscles, attempt to alternate your heels as shown within the picture above). Slowly decrease your heel to the floor and repeat. Once you are well on your toes take control of your lowering. Do not just decrease to the floor.
STANDING BALANCE
While standing around the kitchen counter, place two fingers on the counter. Stand on a single foot lifting another off the floor. Slowly lift your hands from the counter and maintain balance as long as you can. Minor balance checks are acceptable so long as you continue to maintain your balance with minimal the aid of your hands.
HIP FLEXION
Hold table or chair with one hand, the other fingertip, then no hands; then do exercise with eyes closed, if steady. Stand straight: possessing table or chair for balance. Slowly bend one knee toward chest, without bending waist or hips. Hold position for 5-10 seconds. Slowly calf all the way down. Repeat along with other leg.
HIP EXTENSIONS
Hold chair or table with one hand, the other fingertip, then no hands; then do exercise with eyes closed, if steady. Stand 12 to 18 inches from chair or table. Bend at hips; keep chair or table. Slowly lift one leg straight backwards. Hold position for 5-10 sections. Slowly calf and repeat along with other leg
SIDE LEG RAISE
Hold chair or table with one hand, the other fingertip, then no hands; then do exercise with eyes closed, if steady. Stand straight, directly behind chair or table, feet slightly apart. Hold chair or table for balance. Slowly lift one leg to side, 6-12 inches. Slowly calf and repeat along with other leg. Your back and knees are straight throughout exercise.
Physical rehabilitation
Physical therapy may be useful when you are maintaining strength, mobility, and performance regardless of the underlying reason for Peripheral Neuropathy (PN). Patients with diabetic neuropathy could also benefit from physical therapy, however, diabetic neuropathy patients should also tightly control their glucose levels to prevent major fluctuations.
The objectives of physical rehabilitation include:
Maintaining and improve functions using a range of motion - passive flexibility exercises consist of progressive stretching and self stretches
Strengthening muscles - including exercising against increasing resistance, utilization of weights, and isometric exercise
Balance training provides stability and prevents falls
Physiotherapists can also recommend braces and/or splints to boost balance and posture
Splinting is usually used in the treatment of compression mononeuropathies, for example carpal tunnel syndrome
Transcutaneous Electronic Nerve Stimulation (TENS)
Alternative therapies
Ergonomics and Splints