Concepts of Neurological and Musculoskeletal Disorders – Part 2

Case Study

74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam - Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact. Mild to moderate dysarthria. Able to protect airway.

Introduction

There are a wide variety of musculoskeletal and neurological disorders that can result in impairment in an individual’s ability to perform basic functions such as speaking, walking, and other important daily activities. Impairment may result from altered muscular, skeletal, neurological, or even cognitive function of an individual. The impairment can lead to motor, sensory, and cognitive deficits, which may negatively affect strength, coordination, various motions, reaction time, visual perception, speed of processing information, judgment, ability to solve problems, attention, self-awareness, memory loss, and the ability of an individual to perform basic actions (McCance & Huether, 2019). In the case scenario above, it is noted that neurological and musculoskeletal played an essential role in the development of the patient’s symptoms, leading to dysarthria. In this paper, the objective is to describe both the neurological and musculoskeletal processes that would account for the patient presenting the symptoms in the case study above.

Neurological and Musculoskeletal Pathophysiologic Processes that Account For the Patient Presenting the Symptoms

In the pathogenesis of dysarthria, both neurological and musculoskeletal pathophysiological processes are involved, leading to an impairment of one or more speech subsystems. One of the most common causes of impairment is circulatory problems in the brain. Conventionally, the normal blood supply is required for the brain to function correctly (McCance & Huether, 2019). However, when there is a problem in the circulatory system, the brain may not get the right amount of blood flow due to a blockage or leakage. High blood pressure may result in damage to nerves in the brain, as noted in the Neuro exam, which showed Mild left facial droop. In the case study, the patient has a history of high blood pressure, which could affect the patient’s brain because it caused leakage of blood from blood vessels carrying blood to the brain.

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The effects on the brain cause malfunctions, thereby creating a sudden change in speech. Even though the brain is the control center of the body, it does not operate alone. Nerves and muscles work with the brain to help the body function correctly. The brain utilizes the nerves to signal the muscles, and when there is any interference, the muscles will not move accordingly, which is why the patient has a speech problem. In mild dysarthria, the muscles in the face, tongue, throat, and lips, as well as the muscles for breathing that move to aid in speech development, are affected, causing a weak or uncontrollable speech (Rampello et al., 2016). Besides, problems with the musculoskeletal system are manifested through the symptoms such as the patient being unable to lift his arm and have trouble standing.

Ethnic Variables that May Impact Physiological Functioning

From the case study, ethnic variables such as culture, racial discrimination, socioeconomic factors, and family functioning may impact the patient’s physiological functioning. For instance, responses to discrimination by the individual may determine the patterns of physiological reactions or may even uncover the neural pathways mediating the physiological effects. Besides, discrimination based on age may also increase the risk of the patient developing problematic behaviors that may interfere with his physiological functioning. Moreover, lower socioeconomic status may also increase problematic behaviors for the patient, thus adversely affect his physiological functioning. Additionally, low-income family functioning factors may result in depression and stress that can significantly influence the patient’s physiological functioning (Yesilot et al., 2017). Lastly, culture can substantially influence the patient physiological functioning. For instance, it seems that the patient in this case study comes from a culture that believes that men are always strong and cannot admit being weak in front of a woman, as noted in his denial when his wife asks him if he is all right. He denied having any difficulty, thus putting his physiological functioning at risk because he could not ask for help early enough before he was paralyzed.