Identifying poor symptom control in Parkinson's disease.

The range of drugs available to treat people with Parkinson's disease has never been greater. However, patients still encounter difficulties in non-specialist settings where there is often confusion over drug selection, dosage and the timing of dosages. Small adjustments to the type of drug used, dosage and timing can have a significant impact on the control of Parkinson's disease and with it the quality of life of patients, carers and their families. This article provides a brief overview of Parkinson's disease including how to identify poor symptom control.

What can we do about acute extrapyramidal symptoms?

Antipsychotic drugs are the most effective treatment for psychotic disorders such as schizophrenia. However, they are known to cause a range of side-effects including acute extrapyramidal symptoms (EPS) that are both distressing and disabling. Mental health nurses play a critical role in both the detection and the management of these symptoms. A review of the literature was conducted to identify strategies for managing acute EPS. Despite a widely held belief that EPS are associated with noncompliance with medication, the data to support this hypothesis are weak. Although akathisia may negatively affect the treatment outcome, there was little evidence to suggest that parkinsonism or dystonia do. Whilst the use of anticholinergic medication may be helpful in treating acute parkinsonism and dystonia they were associated with their own side-effects and the benefit of long-term prophylactic treatment is doubtful. The literature suggests that logical prescribing and rapid detection and management of acute EPS will result in a substantial reduction in the incidence of these disabling side-effects.

Soft tissue manipulation: neuromuscular and muscle energy techniques.

Muscle rigidity and spasms occur with neurological disease and may contribute to contractures and shortening of muscle fibers that can interfere with motor behaviors, such as ambulation, or activities of daily living, such as combing hair, feeding or dressing. The neuromuscular technique (NMT) and muscle energy technique (MET) are nursing interventions that can reduce pain and muscle rigidity, lengthen muscle fibers and increase range of motion necessary for normal motor behavior. Nurses can use these techniques in patients with acute neurological diseases and those recovering in rehabilitation and long-term care settings. With some neurological diseases, muscle rigidity, increased muscle tone and muscle spasms reduce the range of motion of joints and the quality of movement. These changes often lead to contractures and impairments in performing daily tasks or ambulating, and thus, to loss of independence. Soft tissue manipulation can be used to reduce muscle tension and spasms, reduce pain and enhance the range of motion of joints whose function depends on the involved muscles. Soft tissue manipulation may also improve movement during specific tasks. Although the muscle relaxation achieved with manipulation techniques is primarily short-term, long-term effects occur. This article describes two techniques of soft tissue manipulation, their mechanisms of action, assessment and implementation. A case study is used to illustrate application of the techniques and possible long-term effects.

Positioning and handling: important considerations in the care of the severely head-injured patient.

Control of abnormal posturing is a challenge in the care of severely head-injured adults and must be a component of care in both critical care and acute rehabilitation stages of recovery. Severe head injury is indicated by a Glasgow Coma Scale rating of eight or less for at least six hours post-injury. Long-term disabilities are common among survivors, mostly men under 40 years of age. This paper examines the pathophysiology of abnormal posturing and positioning and handling techniques to prevent and/or control abnormal motor activity. The effect of positioning on intracranial pressure is also discussed.