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Acute or Chronic Polyneuropathies

Axonal Polyneuropathy


Polyneuropathy (PN) occurs when multiple peripheral nerves are damaged resulting in sensory and/or motor deficits. The damage may be to the axon or myelin and can be caused by diabetes, alcoholism, renal disease, toxic agents, or infections, such as leprosy. Chronic idiopathic axonal PN is seen in the elderly and manifests itself as a progressive numbness of the feet, lower limbs, and at times, the hands.

Medical Red Flags

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Autonomic Polyneuropathy
Symptoms Possible Causes Management
  • Changes in BP and HR; orthostatic hypotension; nausea; vomiting; dyspnea; and/or dizziness are red flags because autonomic neuropathy may mask heart attack signs such as chest tightness and pain in chest, arms, jaw, etc.

  • Heart attack

  • Cease treatment

  • Seek immediate medical attention


  • Peripheral neuropathy may result in unnoticed lower limb injury; any injury or open wound should receive medical attention

  • The patient may not appreciate the importance of sensory loss when some elements of sensation remain intact

  • Charcot foot, or neuropathic arthropathy, develops from longstanding elevated blood glucose levels; it can result in softening of the bone, which may fracture and collapse; it most frequently involves the tarsal bones of the foot and calcaneus

Physical Therapy Examination


Refer to Tab 2 for full history. Include

  • Date of onset

  • Description of progression of symptoms

Tests and Measures

Aerobic Capacity/Endurance


  • Aerobic exercise must be carefully monitored in the presence of autonomic neuropathy as patients may not notice typical signs of a heart attack

  • Diminished thermoregulatory function occurs with autonomic neuropathy so patients should avoid exercising in hot or cold environments

Anthropometric Characteristics


  • Fluid retention can occur in diabetes and can result in tight-fitting footwear, which can cause blisters and skin breakdown


  • Track weight and girth measurement

Assistive and Adaptive Devices


  • The importance of protecting the hands and feet must be stressed

  • Patient should be advised about safety options including the need to always wear foot wear, use gloves for washing dishes, gardening, etc.


  • Determine the need for special footwear, walking casts, splints, and ambulatory assistive devices to protect areas prone to breakdown

  • Footwear needs to be inspected for fit



  • Autonomic neuropathy may mask the perception of orthostatic hypotension and painful symptoms of a heart attack


  • Perform ...

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