Empowering Lives | The Crucial Role Of Physiotherapy In Managing Motor Neuron Disease (mnd)

 

Motor Neuron Disease (MND), also known as Amyotrophic Lateral Sclerosis (ALS), is a progressive neurodegenerative disorder that affects the motor neurons in the brain and spinal cord. This devastating disease leads to muscle weakness, atrophy, and ultimately, paralysis. While there is currently no cure for MND, various treatment modalities aim to improve the quality of life and slow down the progression of the disease. One such vital component of MND management is physiotherapy. In this blog post, we will delve into the role of physiotherapy in the management of Motor Neuron Disease, exploring its benefits and techniques that can make a significant difference in the lives of MND patients.

Motor Neuron Disease

Motor Neuron Disease is a rare, yet severe condition that impacts the nerve cells responsible for controlling voluntary muscle movement. These motor neurons gradually degenerate and die, leading to a loss of muscle function and coordination. MND can manifest in various forms, with ALS being the most common type. Other subtypes include Progressive Bulbar Palsy (PBP), Primary Lateral Sclerosis (PLS), and Progressive Muscular Atrophy (PMA). The exact cause of MND is not yet fully understood, and there is currently no cure.

Role of Physiotherapy in MND

Physiotherapy plays a crucial role in the management of Motor Neuron Disease by addressing the physical challenges and complications associated with the condition. While physiotherapy cannot halt the progression of MND, it can significantly enhance the patient's quality of life, slow down muscle deterioration, and provide much-needed support to manage the symptoms effectively. Here are some key ways in which physiotherapy benefits MND patients:

1: Muscle Strength and Endurance: Physiotherapists design customized exercise programs that focus on maintaining and improving muscle strength and endurance. These exercises help counteract muscle wasting and prevent joint contractures, which are common in MND patients.
2: Range of Motion: MND can lead to muscle stiffness and reduced joint mobility. Physiotherapy interventions include stretching exercises to improve and maintain the range of motion, ensuring that patients can move more comfortably and independently.
3: Respiratory Care: As MND progresses, it can affect the muscles responsible for breathing, leading to respiratory difficulties. Physiotherapists teach breathing exercises and techniques to enhance lung capacity and support respiratory function. They also educate patients and caregivers on using assistive devices like BiPAP machines.
4: Posture and Balance: Maintaining proper posture and balance is essential to prevent falls and injuries in MND patients. Physiotherapists provide exercises and strategies to help patients maintain their balance and posture, reducing the risk of falls.
5: Pain and discomfort: Physiotherapy can include modalities such as Heat and Cold therapy, as well as manual techniques like massage, and modalities like TENS, to alleviate pain and improve overall comfort.
6: Assistive Devices: Physiotherapists evaluate the need for assistive devices like wheelchairs, walkers, and braces. They also offer guidance on using these devices safely and effectively to enhance mobility and independence.

Physiotherapy Techniques for MND

Physiotherapy for MND is highly individualized, tailored to the patient's specific needs and stage of the disease. Here are some common techniques used by physiotherapists in the management of MND:

1: Range of Motion Exercises: Gentle, controlled movements to prevent joint stiffness and improve flexibility.
2: Strengthening Exercises: Targeted exercises to maintain muscle strength and delay muscle atrophy. Resistance bands and weights may be used.
3: Balance Training: Balance exercises help patients maintain stability and reduce the risk of falls.
4: Breathing Exercises: Techniques to enhance respiratory function and manage shortness of breath.
5: Hydrotherapy: Aquatic therapy in warm water can provide relief from muscle stiffness and promote relaxation.
6: Electrical Stimulation: Some patients benefit from electrical stimulation to maintain muscle function.
7: Manual Techniques: Hands-on therapies like massage and myofascial release can help alleviate muscle pain and tension.
8: Postural Training: Techniques to maintain proper posture, especially while sitting in wheelchairs or using other assistive devices.

Motor Neuron Disease is a debilitating condition that poses significant challenges to patients and their families. While there is no cure, the role of physiotherapy in managing MND cannot be overstated. Physiotherapists play a crucial role in enhancing the quality of life for MND patients by addressing muscle strength, mobility, breathing, and pain management. Their individualized treatment plans, coupled with education and support, offer a ray of hope and comfort to those affected by this devastating disease. Through a combination of exercise, therapeutic techniques, and emotional support, physiotherapy helps MND patients maintain their independence and live their lives to the fullest for as long as possible.

 

Autism | Top 10 Exercises to Improve Neurodevelopmental Disorders

Does any child or adult around you or known to you is struggling with a problem in motor coordination or postural imbalance? Has he been diagnosed with Autism?  If yes, then physiotherapy can help that individual to improve motor functions by using proper exercise programs. An Exercise Program can be used to boost motor skills, posture, and confidence in children and adults with Autism Spectrum Disorder (ASD). Access to such Physiotherapy exercise programs can help an individual to build strength, improve posture, and enhance hand-eye coordination. In this blog we have mentioned a few exercises that can be done by children and adults with neuropsychiatric disorders, to promote motor skills, with a sense of self-efficacy and physical fitness.

 

Autism:

Autism is a complex neurological and developmental disability that can appear within the early developmental stages of life. Autism affects the normal functioning of the brain, communication as well as social skills of the child. This condition is regarded as a life-long condition and it cannot be cured. Although, severity may decrease through various treatments. The cause of Autism is still unknown, but the most common reason can be genetic, cognitive as well as neurodevelopmental factors that contribute to the characteristic of symptoms of Autism

Individuals with autism struggle with communication, which includes physical gestures to express themselves, and understanding body language, lower postural control, and stability can make basic activities like walking or standing more difficult. Another problem is dyspraxia, this term is used for general clumsiness, associated with developmental disorders, fine motor functions, and lower quality of movement. Autism patient has low muscle tone associated with repetitive motor movements and oral-motor problems, or issues with the tongue and jaw causing challenges with speaking.

 

Physiotherapy:

Physiotherapy helps to improve range of motion, muscle strength and control, and other aspects of physical health that may be impacted by this developmental condition.

A physiotherapist assesses the child's overall motor functioning, identifies the underlying difficulties, and provides an intervention program to help address or improve these difficulties and subsequently the child's overall functioning.  Exercises that may be used as part of a physiotherapy intervention plan include:

 

Exercises:

Here are some of the best exercises that are proven to be beneficial

 

Mirror Exercises

· An individual stands with hands by the side. Face towards the therapist.

· Make small movements for the individual and pursue them to repeat the same.

· Start with small movements like moving the shoulders up and down and eventually moving towards the complex ones.

· After the warm-up session start with the real practice.

· Ask an individual to lift the right hand up while mimicking like a mirror, the therapist picks the left one.

· Repeat the same for the legs, trunk, and neck.

· Continue this exercise for a minute and repeat it 4-5 times.

 

Arm Circles

· An individual is asked to stand with feet shoulder-width apart. and arms resting by the side.

· Slowly extend arms by the sides at shoulder level.

· Keeping the arms straight, start making small circles with the hands.

· Slowly, start making the circles bigger and continue creating the movement.

· First, do the exercise in the clockwise direction and then in the anti-clockwise direction repeat in each direction 20 times.

 

Bear Crawls

· Place hands under the shoulders and knees under the hip.

· Walk forward using the four across the floor.

· Next, move backward in the same position.

· When the person becomes comfortable, progression can be done in distance, speed, and direction.

 

Star Jumps

· Basic locomotor exercises like running and jumping can be performed

· Stand on the floor, with knees bent slightly, and tuck the arms in towards the chest.

· After counting 3, jump up from the squatting position, extending the arms and legs wide open. Making the body look like the symbol X.

· After landing on the floor, return to the starting position and repeat it 20 times.

· For running an individual is asked to start running at low speed over shorter distances, after the patient becomes comfortable the speed of running and distance to be covered are increased.

 

Hurdle Step-overs: -

· In these exercises, low hurdles are used, and the individual steps over each hurdle.

· The knees are raised high and the head is looking forward.

·  If the knees turn inward or outward, the examiner can prompt the individual by tapping the knee or holding a hand next to the foot.

· Walking forwards or backward, and sideways by crossing the hurdles,

 

Medicine Ball Slams

· Ask the person to hold a medicine ball in hand and stand straight.

· Raise the ball over the head with the arms straight.

· Slam the ball down on the floor with full force.

· Then just bend the knees and pick the ball.

· Repeat it 20 times.

 

Grab Ball Complex (GBC): -

· An individual stands in front of the therapist.

· Spot markers can be used.

· The therapist holds a ball at arm's length in various positions in front of the individual.

· The individual should bend, rotate, and reach to grab the object.

· One or both hands can be used in up, down, right, and left directions.

 

Ball Tap Complex (BTC): -

· The individual holds the ball while the therapist holds out a hand or other object.

· The individual taps the hand with the ball.

· The target can be held in a variety of positions and presented in random order or a particular sequence.

 

Activity-oriented Exercises:

To enhance the fine motor skill, tasks like

· Using a pencil.

· Cutting with scissors.

· Playing with pegs.

· Other activities like clapping hands, skipping, hopping and throwing, kicking or catching a ball, and standing on one leg.

· Horse riding.

· Bicycling.

 

Hydrotherapy Exercises:

Hydrotherapy or aquatic therapy has been commonly used to treat Autism patients. Water has a property that can provide sensory input, and improves range of motion and overall mobility. Warm water can decrease the body weight by 90%, relax the muscles, and reduces spasticity, thus making water the ideal medium for rehabilitating the body. This usually takes place in a swimming pool as the pressure and temperature of the water pressing against the body can soothe an autistic individual.

Physiotherapy can be a key intervention in the treatment of motor difficulties for patients with Autism. Access to physiotherapy may be important in early life, and also at various points throughout the person's life, or consistently throughout the entire life. While on the one hand exercises are useful in developing motor and social skills, on the other hand, they also help to manage weight and reduce hyperactivity and aggression. And thus, exercises should be made a part of the lifestyle of kids and adults with autism.

 

Cerebral Palsy | Improving Functional Mobility by Physical Therapy

Cerebral Palsy is the most common cause of disability in children. It encompasses a wide range of neurological motor impairments and can be severely disabling. Cerebral palsy requires treatment for optimizing an individual's motor functions. Physiotherapy being a part of the rehabilitation program is found to be effective in promoting the brain's ability to make adaptive changes. The more the patient performs an action, the stronger the neural pathways in the brain for that action become. In the same way, neglecting an action may cause its neural pathways to weaken.  Physiotherapy helps to identify the functional disability of the patient that needs help. The physiotherapist improves and develops a personalized rehabilitation plan to help the patient. In this blog, we have discussed cerebral palsy and its physiotherapy management.

 

Cerebral Palsy

Cerebral palsy is a non-progressive, nonfatal, and non-curable, chronic motor disability that results from damage to the growing brain before or during birth, or in the postnatal period. It may be associated with brain damage responsible for some defects of vision and hearing, abnormalities of speech & language and perception, apraxias, (restricted movements such acts as writing, drawing, and construction or even dressing), behavioral problems such as distractibility and hyperkinesia, which are based on the organic brain damage.

 

Physiotherapy Management:

The physiotherapist conducts a detailed assessment to find out the functional capacity of the child and the nature and extent of the motor as well as associated deficits. Physiotherapy involves highly repetitive, task-specific exercises, promotes neuroplasticity and achieves their optimal functional potential.  The aim is to achieve the milestones, maximize the tone, maintain muscle length, correct the posture and teach activities of daily living. Physiotherapy improves the functional capacity of the patient and makes the patient independent as much as possible through a planned intervention program.

 

Assistive aids and modifications

The physiotherapist recommends modifications like two-handled cups, angled spoons, etc. can be made to help the patient, a stiff cloth collar can be used to help provide neck support, old stools and boxes can be adapted to provide support during sitting, parallel bars can be constructed with wood logs to help gait training. The patient can use air beds and continuous change in position for pressure relief through bed positioning and seating adaptations. Many such homemade modifications can be made to prevent deformities to develop in cerebral palsied children.

 

Supportive Aids

Supportive devices like lightweight splints may be required to maintain normal postures. Splinting and exercise programs help to achieve the near-normal posture. Casts and splints should not be used for prolonged periods because they may lead to disuse atrophy of the muscles. AFO and calipers may be required to provide stability to the joints in a child who is learning to stand and walk.

 

Braces

Braces are used to correct deformity, obtain an upright position, and control athetosis. Children with spasticity are provided with muscle braces. Athetoid patients are trained to control simple joint motion. Ataxic patients may be given strengthening exercises for weak muscle groups.

 

Progressive patterns

The patient is taught motion according to the development like head and trunk rotation from side to side, arm on the face side in abduction-external rotation, elbow semi-flexed, hand open, and thumb out towards the mouth.

 

Synergistic Movement Patterns

Reflex responses are used initially and voluntary control of these reflex patterns is used later. Head and trunk control is attempted with stimulation of attitudinal reflexes such as tonic neck reflexes, tonic lumbar reflexes, and tonic labyrinthine reflexes, followed by stimulation of righting reflexes and later balance training.

 

Proprioceptive Neuromuscular Facilitation

Movement patterns are based on patterns observed while functional activities. The movement patterns consist of flexion or extension, abduction or adduction, internal rotation or external rotation, sensory stimuli are skillfully applied to facilitate movement. Stimuli used are pressure, touch, stretch, traction, compression, the proprioceptive effect of muscle contracting against resistance, and visual and auditory stimuli. Resistance to motion is also used to facilitate the action of the muscles, and form the components of the movement patterns.

Techniques used are:

·  Relaxation techniques – Hold Relax & Contract Relax

·  Rhythmic Stabilization

·  Repeated Contractions

·  Stimulation of Reflexes

·  Reversals

 

Neuromotor Development

The child is not permitted to use motor skills beyond his/ her level of development. The child is placed in a normal posture to stimulate normal tone, once postural security is obtained, achievements are facilitated and developmental sequences are followed throughout the training.

 

Reflex Inhibition & Facilitation

Reflex inhibitory patterns are used to inhibit abnormal tone, abnormal movement patterns, and abnormal posture. The reversal or breakdown of the abnormalities gives the child the sensation of a more normal tone and movements. The physiotherapist attempts to change the patterns of spasticity making the child prepared for movement. Mature postural reactions use key points of control like head, neck, shoulder, and pelvic girdles, though work is also done from distal key- points.

 

Sensory Stimulation for Activation & Inhibition

Techniques of stimulation, like icing, heating, brushing, stroking, massage, pressure, slow & quick muscle stretch, joint retraction & approximation, and muscle contractions are used to activate, facilitate or inhibit the motor response.

 

Reflex Creeping & other Reflex Reactions

Creeping patterns involve the head, trunk, and limbs and are facilitated at various trigger points or reflex zones. Touch, pressure, stretch, and muscle action against resistance are used to trigger or facilitate creeping, also resistance is recommended for the action of muscles.

 

Balance Interventions

Patients with cerebral palsy have a disorder with multisystem impairments, that affect the visual, vestibular, and somatosensory, inappropriate sequencing of muscle activity, poor postural control, and postural stability that is frequently interrupted by destabilizing synergistic or antagonistic muscle activity in patients. The physiotherapists work with the patient to manage the balance issues.

 

Electrical Stimulation Techniques

Patients with cerebral palsy should receive neuromuscular electrical stimulation (NMES) or transcutaneous electrical stimulation (TENS) in cerebral palsy physiotherapy.

 

Hydrotherapy

Hydrotherapy helps to learn new movement skills, which leads to increased functional skills, and mobility. The body is immersed in warm water, causing muscle relaxation and reducing spasticity, thus resulting in increased joint range of motion and creating better postural alignment.

The physiotherapist provides advice, education, and supervision regarding cerebral palsy to the patient, his/her family, and caretakers.