Chronic Neurological Disorders and Neurorehabilitation
Multiple sclerosis
Relapsing-remitting is the most common course. Symptoms track plaques: optic neuritis, internuclear ophthalmoplegia, sensory loss, ataxia, bladder dysfunction. Uhthoff phenomenon is transient worsening with heat. Acute relapses are treated with high-dose corticosteroids; nursing focuses on fatigue, bowel and bladder programs, spasticity, and fall risk. Disease-modifying therapy requires adherence support and infection screening.
Parkinson disease
Cardinal features are bradykinesia, resting tremor, rigidity, and postural instability. Dose timing is the central nursing issue: carbidopa/levodopa must be given on schedule, and abrupt withdrawal can precipitate a parkinsonism-hyperpyrexia syndrome. Avoid dopamine antagonists such as haloperidol and metoclopramide.
Epilepsy
Teach trigger reduction, adherence, seizure first aid, and the rescue benzodiazepine plan. Status epilepticus is an emergency. Women of childbearing age need preconception planning because of teratogenicity.
Neuromuscular disease
Myasthenia gravis causes fatigable ptosis, diplopia, and bulbar weakness; distinguish myasthenic crisis from cholinergic crisis (SLUDGE: salivation, lacrimation, urination, diarrhea, GI cramps, emesis). Guillain–Barré is ascending, symmetric weakness with areflexia and albuminocytologic dissociation; monitor vital capacity, negative inspiratory force, swallow, and autonomic instability; treat with IVIG or plasma exchange, not steroids. ALS shows combined upper and lower motor neuron signs with no sensory loss.
Rehabilitation
Goals are functional, not curative: positioning, spasticity management, contracture prevention, bladder and bowel programs, dysphagia screening, VTE prophylaxis, and caregiver teaching.
Traps: labeling a late dose as noncompliance, and waiting for oxygen saturation to fall before assessing respiratory strength.
Rule of thumb: in any neuromuscular patient, the respiratory trend outranks the limb strength exam.