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PT suspects neurological cause of weakness

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    Posted: Aug 13 2012 at 2:11pm
Our user asked: "My 4 year old son is on the autism spectrum and has a host of other conditions - sensory processing disorder, global developmental delay, pervasive development disfunction. He has been receiving OT for two years, but we are at a standstill due to his lack of strength throughout his upper body and neck. At a PT eval today, the PT said the weakness was significant enough to warrant talking to my son's developmental pediatrician about further testing to rule out possible neurological causes for the weakness. What could we be looking at in terms of what is causing this weakness?"
 
Ask a PT Response: "In general, weakness due to neurological causes are rooted in the nerves or spinal cord levels that innervate specific muscles. These are called myotomes. They are a classification based on the level of the cord that the nerves originate from, regardless of which muscle the nerve actually serves. For example, spinal cord levels C2-C8 are generally responsible for innervation of the neck and upper body. Specific muscles are then be innervated by branches from multiple levels. These nerves that innervate muscle are also classified as motor nerves, which are distinct from sensory nerves, but run together. It would not be surprising that motor nerves may be damaged or present with other deficits since there already exist sensory processing disorder as well. As to the nature of what is actually causing these nerves to malfunction, the answers could be widely varied. The pathway of these nerves include the brain, the path from the brain to the spine, then from the spine to the muscles. Deficits could arise from any of these areas. Brain function or signals that travel from the brain to the cord could be disrupted for a number of reasons, from developmental disorders to tramautic injury. If this is intact, the problem could be at the spinal cord, where the transmission relayed does not pass through to the rest of the body. Again there are various reasons for this. If the problem is not here, then it could be with the specific nerve that enters and innervates the muscle. Its ability to recruit muscle units to control and fire may be compromised.
 
These are all valid reason for weakness due to neuro causes, However specific reasons for this are wide and diverse. Therefore, further testing would be warranted."
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