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.

 

Strength Training for Elderly | A Guide to Build Muscle and Power

Incorporating Strength Training into our routine is a great way to build up our physical strength. Strength Training or resistance training is an important part of any fitness regime. It is the ability to perform a given set of exercises, with ease and comfort. These exercises are a combination of repetition and load.  As an individual gets stronger, the repetition and load for an exercise can be increased. While recommending strength training your physiotherapist has to take care of the proper dosage. In older adults, it is difficult to properly dose strength training as there is a loss in muscle strength and power, which can lead to decreased function and increased fall risk. This article will discuss why proper dosage is important and how to properly dose strength training exercises in older adults.

In older adults, it is difficult to properly dose strength training to avoid any injury. Older adults exert considerably more effort to perform daily tasks. For example, to rise from a chair, a young individual works at 42% relative effort while an older adult works at 80% relative effort. We can increase that capacity through strength training and other forms of exercise so that older adults can function easily and comfortably.

Many older adults have pathologies like osteoporosis, arthritis, decreased tissue elasticity, and decreased recovery capacity. But still, older adults can safely perform and benefit from strength training.  Even though there is a risk of causing adverse cardiac events in older adults. The physiotherapist designs programs specifically for complex patients so that these patients can exercise at a relatively high intensity, simultaneously monitoring their vital signs and symptoms.

To improve strength, we need to give training in the intensity range of 60-85% 1RM, with higher intensities resulting in greater strength gains. An intensity of 60% represents the minimum to get stronger, while the 70-85% range is optimal for strength adaptations.

1RM stands for one repetition maximum. It is the maximum amount of weight an individual can lift for a single repetition. In the same way, 2RM is the maximum amount of weight an individual can lift for two repetitions, 3RM is the maximum weight an individual can lift for three repetitions, and so on.

To test % 1RM, this can become time-consuming when performing various exercises, e.g., assessing % 1RM for a leg press, bench press, lunge, lat pull down, etc. Simultaneously, strength also fluctuates based on a variety of factors.  Also, with rapid gain in the first weeks of training clients will get stronger over time, so the usually % 1RM will not always match the individual's abilities for a given session. Therefore, a target rep range can be used instead and RPE to achieve that intensity.

RPE stands for Rate of Perceived Exertion, which is the measure of exercise intensity, a scale designed for cardiovascular exercise. It gives an estimate of the actual heart rate during activity. To use it, multiply the RPE by 10 to get an estimated heart rate. For example, if RPE is 12, then 12 x 10 = 120 beats per minute.

The use of the OMNI Resistance Exercise Scale has been validated for use in older adults. This scale is explained and shown to older adults. During strength training aim should be to work in the range of 6-15 repetitions, loads that can be performed for 6 reps are approximately 85% 1RM, and loads that can be lifted for 15 reps are approximately 60% 1RM. Starting an individual with higher rep sets of 15 and over several weeks work down to lower rep sets of 6, if appropriate and tolerated.

Use RPE to make sure an individual is working in that 60-85% 1RM range. To assess RPE, ask the patient to rate their exertion level at the set’s end.

An individual should not be pushed till absolute muscle failure. The patient should work up to an RPE of 6-8 ("somewhat hard" to "hard") within that 6-15 rep range, to ensure that enough load is applied to make the patient stronger.

Some patients may start with greater than 15 reps and intensities of less than 6 RPE and that is ok if tolerated. Later. they should be progressed into the 6-15 rep range with RPEs of 6-8 to reach the 60-85% 1RM intensity that is optimal for strengthening.

If an individual performs a given repetition and load combination for several weeks and the RPE increases or stays the same, this could mean that the client is not getting stronger by that exercise. In this case, it might be time to change the strength training program.

To assess the progress an individual over time should be able to perform more reps with heavier loads, and with a similar level of RPE.

High-intensity exercises are often considered important for young athletes, while older adults are given gentle exercises. But at the same time, we need to sufficiently recommend strength training exercises to our older adults so that they can function and live better.