ABSTRACT
Cognitive impairments, often unrecognized in multiple sclerosis, include memory loss, new learning problems, denial and depression. Spasticity and incoordination of the oropharyngeal and respiratory muscles create functional problems with speech and swallowing. Genitourinary problems include sexual dysfunction and neurogenic bladder. Specific measures can be used to alleviate these problems.
Subject(s)
Multiple Sclerosis/complications , Cognition Disorders/etiology , Constipation/etiology , Constipation/therapy , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Humans , Multiple Sclerosis/physiopathology , Multiple Sclerosis/rehabilitation , Propantheline/therapeutic use , Sexual Dysfunction, Physiological/etiology , Speech Disorders/etiology , Speech Disorders/rehabilitation , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder, Neurogenic/therapy , Urination Disorders/drug therapy , Urination Disorders/etiology , Urination Disorders/physiopathologyABSTRACT
Rehabilitation of the multiple sclerosis patient must be individualized because of the varied manifestations and fluctuating course of the disease. The activity schedule must be modified to compensate for muscle weakness and fatigability. Spasticity and the preventable complication of joint contractures may be treated with joint ranging, medications, motor-point blocks and surgical intervention. Mobility problems, such as foot drop, may be improved with an ankle-foot orthosis, but ultimately a patient may require a wheelchair. Measures to prevent pressure sores include position change, pressure release, incontinence management and special equipment.
Subject(s)
Multiple Sclerosis/rehabilitation , Adult , Ataxia/physiopathology , Contracture/physiopathology , Fatigue/physiopathology , Female , Humans , Male , Middle Aged , Multiple Sclerosis/physiopathology , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/physiopathology , Nerve Block , Pressure Ulcer/physiopathology , Tremor/physiopathology , Vision Disorders/physiopathology , WheelchairsABSTRACT
Tissue breakdown is a direct response to external pressure, friction, or shear. The key to management of pressure ulcers is prevention. With good nursing care, as well as education of medical personnel, the patient, and family members, such lesions should rarely occur. The axioms of treatment are to remove all pressure, debride necrotic tissue, keep the ulcer clean, and prevent further injury. There is only empirical evidence attesting to the effectiveness of the various dressings and physical and topical agents used in treatment. Most pressure ulcers can be classified as grade I or II and healed by conservative measures; however, the process can be very time-consuming. Surgery is warranted for some grade III and all grade IV and V pressure ulcers and for potential complications, such as fistulas.
Subject(s)
Pressure Ulcer/therapy , Aging , Biological Dressings , Cost-Benefit Analysis , Economics, Nursing , Humans , Pressure Ulcer/economics , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Skin/pathology , Spinal Cord Injuries/complicationsABSTRACT
Return of neurologic function after a stroke tends to be complete within six months after the insult. Initial flaccidity is superseded by spasticity, which is most prominent distally. Movements initially occur in synergistic patterns. Return of voluntary movements begins proximally in the lower extremity. In the upper extremity, proximal recovery usually occurs first, but finger movement occasionally is the earliest sign. Proper positioning and early, passive range-of-motion exercises help to avoid complications.
Subject(s)
Cerebrovascular Disorders/rehabilitation , Activities of Daily Living , Cerebrovascular Disorders/complications , Early Ambulation , Hemiplegia/etiology , Humans , Movement , Muscle Spasticity/etiology , Patient Discharge , Shoulder , Urinary Bladder, Neurogenic/etiologyABSTRACT
In many cases, the family physician will set the tone for rehabilitation of the stroke patient. It is imperative that the physician understand the recovery process, as well as the nature, benefits and limitations of rehabilitation. Since there are no precise predictors of individual outcome, no patient should be excluded from rehabilitation unless he is too ill or too cognitively devastated to participate.
Subject(s)
Cerebrovascular Disorders/rehabilitation , Cognition Disorders/rehabilitation , Brain/pathology , Brain/physiopathology , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/pathology , Cognition Disorders/etiology , Humans , Intelligence Tests , Language Therapy , Learning/physiology , PrognosisABSTRACT
The cause of amyotrophic lateral sclerosis remains unknown, and no curative treatment is available. From a rehabilitation perspective, however, comprehensive management and symptomatic treatment can minimize complications, increase function and improve the patient's quality of life. Quinine, diazepam (Valium) and phenytoin (Dilantin) may relieve muscle cramps, and orthoses may permit greater participation in daily activities. Problems with respiration and swallowing may require surgical procedures and the use of feeding tubes. Decisions regarding surgical intervention must be made in the context of the patient's overall status.
Subject(s)
Amyotrophic Lateral Sclerosis/therapy , Activities of Daily Living , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/psychology , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Humans , Locomotion , Muscle Spasticity/drug therapy , Quality of Life , Respiratory Insufficiency/etiology , Respiratory Insufficiency/prevention & control , Speech Disorders/etiology , Speech Disorders/therapySubject(s)
Rehabilitation/nursing , Specialties, Nursing , Faculty, Nursing , Nurse Clinicians , WashingtonABSTRACT
Four patients with mobility problems were evaluated in relation to their performances on a standardized mobility test throughout the course of their rehabilitation programs. While each of the four cases demonstrates the value of an objective measurement of independent function, each also reflects individual points of merit. Clinical application demonstrated the test's ability to separate out areas of mobility deficit, evaluate forms of treatment, and indicate need for follow-up. Further, the sensitivity of the test in long-term follow-up of mobility problems was illustrated.
