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Medical Management and Potential Complications 

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Medical Management and Potential Complications 

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Pharmaceuticals:

Selegiline will be used first then changed to Levodopa as the disease progresses. Levodopa will block the breakdown of DA and slow the disease progression

Anticholinergics help reduce tremors, and Symmetrel helps with bradykinesia, rigidity, and motor fluctuations.

Potential Complications:

Bradykinesia, rigidity, tremor, and postural instability.

Present with a shuffling gait, punctuated short steps, and increased speed (festination).

Rigidity will occur in the trunk and extremities, and they will lose their ability to swing their arms while walking.

Postural instability will limit their participation in life and increase their risk of falling.

Easily fatigued and can exhibit dementia and intellectual changes that can lead to depression.

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Intervention 1:

Gait initiation and straight walking: pt will ambulate with walking poles to elicit proper gait speed. Markers are placed on the floor to ensure they are ambulating with proper gait mechanics and the use of the mirror is to ensure proper trunk engagement during ambulation.

Pt. will ambulate 50 feet forward and backward x3.

Intervention 2:

Farmer carries to strengthen postural musculature for proper trunk control and postural stability.

50 feet x 4 with 10lb dumbbells

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Cognitive dysfunctions

Easily fatigued

Deep brain stimulation must assess for infection and hemorrhage

Pneumonia

Side effects of medications can cause dyskinesia, nausea, and vomiting

Physical therapy should be performed a few hours after medication is taken

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Rocky Mountain Chapter is a Parkinson's support group located in Colorado, Wyoming, and Utah. Support groups can help individuals with this disease feel less alone, allow the ability to grieve with those who understand what they are going through, and give them access to resources.

The Rocky Mountain Chapter raises money to help aid in medical research to help with the progression of the disease and the possibility of a cure.

https://www.parkinson.org/RockyMountain?_gl=1*1lmreyc*_gcl_au*MTk1Mzk5ODY3NS4xNzQwNTA5MzIw&_ga=2.123049931.1750757739.1740509320-1468153668.1740509320

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Medical Management and Potential Complications

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Medical Management and Potential Complications

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Pharmaceutical management to reduce the frequency and severity of attacks.

Cortisone and corticosteroid side effects: muscle weakness, bone loss, bruising

Provigil side effects: nausea, anxiety, headache, nervousness

Tegretol side effects: fatal allergic reactions, aplastic anemia, blurred or double vision, and continuous back-and-forth eye movements.

Physical Therapy management:

1. minimize progression

2. maintain functional independence

3. prevent secondary complications

4. maintain respiratory function

5. conserve energy/manage fatigue

6. patient and family education

Complications in PT Treatment:

1. fatigue/ exercise intolerance

2. fear of movement

3. Heat intolerance

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Resistance training for LE and UE using functional and PNF patterns. Weight and reps matched to the patient's ability.

Example: biceps curls, triceps press-backs, overhead press, shoulder abduction, front raises. 5# 5-8 reps through circuit 2X

Slow static stretching to reduce spasticity. Use PNF techniques such as hold-relax. Hold the stretched position for 30 to 60 seconds.

Example: Seated HS stretch. Hold 15-20 seconds, contract HS while holding stretch 15-20 seconds, relax, and move further into the stretch. On last repetition, hold relaxed stretch for 30-60 seconds

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Medical Management and Potential Complications 

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Medical Management and Potential Complications 

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Medical Management:

Pharmaceuticals: Riluzole is the only medication approved for ALS. Other medications can assist with muscle cramping, spasticity, sialorrhea, and depression.

Speech therapy to address swallowing difficulties.

Nutritionist and dietitian for feeding.

Feeding tube or endoscopic gastrostomy tube

Ventilator

Potential Complications:

They will have limb loss, bulbar loss, asymmetric weakness in the arm/leg, difficulty with swallowing and speaking, twitching, muscle cramps, weakness, atrophy, fatigue, and loss of cranial nerves.

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Patients may be less tolerant of exercise, especially during a flare-up. May need to adjust exercise intensity accordingly. Patients may have heat intolerance during exercise. Patients may experience isolation and depression. Patients may experience side effects of medication. Medication may need to be frequently adjusted by MD.

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The Colorado/Wyoming chapter provides information to patients and their families about MS, does fundraising for research to develop treatments, links patients with resources, and provides community in person and online.

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Empowering people affected by MS to live their best lives

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The National Multiple Sclerosis Society exists because there are people with MS. Our vision is a world free of MS.

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Pressure relief protocol

Proper orthosis wear

High-risk fall risk

Use of a ventilator and feeding tube

Spasticity

Airway clearance

Easily fatigued

Side effects of Riluzole can cause breathing problems, headaches, fatigue, and diarrhea

Therapy should take place a few hours after medication is delivered

May not feel up to therapy due to depression or increase in symptoms that day

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There are several support groups for patients with ALS and this website allows them to connect with the support groups and seek out resources. They offer groups in person and virtually so if there is none nearby they can still join the groups virtually. These groups provide education, support, and connection between people going through what they are going through.

https://www.als.org/support/support-groups?utm_source=google&utm_medium=paidsearch&utm_campaign=grant&utm_content=eg-pro&s_src=paidsearch&s_subsrc=google-508&gad_source=1&gclid=EAIaIQobChMIqqCQscTfiwMVIDWtBh3sDy2tEAAYASAAEgKyz_D_BwE

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Medical Management and Potential Complications 

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Medical Management and Potential Complications 

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Medical Management:

Medications are not proven to be effective and the best way to manage this disorder is through individualized muscle training programs and physical activity levels.

IVIG could potentially help with pain but it is not approved to be used.

Potential Complications:

Easily fatigued

Overuse can lead to increased muscular weakness

Impaired balance can lead to falls

May need an assistive device and be fitted properly for one

Pain is a huge factor when it comes to therapy

Unstable joints

Increased risk of depression

Cold intolerance

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Medical Management and Potential Complications

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Medical Management and Potential Complications

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Medical management

IVIG (infusion of intravenous immunoglobulins) is the preferred treatment.

Treatment may need to be repeated

20% of patients treated unable to ambulate after six months

Three stages

acute

plateau

recovery

25% of patients may require mechanical ventilation (days to months)

Physical Therapy Management

Acute phase

minimize signs and symptoms

support pulmonary function

prevent skin breakdown and contracture formation

managing pain

Only exercises without pain or excessive fatigue

Plateau phase

acclamation to upright posture

maintenance of ROM

improvement in pulmonary function

avoidance of fatigue and overexertion

Recovery phase

strengthening/maximizing functional abilities

goals from acute and plateau phases

exercise needs to be dosed appropriately to minimize muscle damage

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Intervention 1:

Stationary bicycling for 15 minutes to reach the target heart rate, avoid joint trauma, and target the strongest muscle groups in the LE (quads).

Intervention 2:

short arc quads 10x3 with no weight to decrease joint stress and progress to long arcs when quadriceps have the strength to progress without causing joint trauma.

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Fatigue: Incorporate low fatiguing protocols during exercise

Uninvolved muscles may become weakened, or muscle weakness may occur from chronic overuse

Patient may experience pain due to chronic overuse and misalignment

Patients may experience cold intolerance

Stretching may be contraindicated because of joint instability

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Post Polio Health International is "here to support the community of polio survivors and spread knowledge on the late effects of polio." This site contains information for patients, providers, family and friends. There is an ask the doctor section, and a provider directory where patients can connect with providers from all over the world.

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Latest News and EventsKeep up-to-date with the latest articles and news regarding the late effects of polio.WHAT’S NewOur newly-revised Handbook on the Late Effects of Polio is now available!Information for Family & FriendsPHI’s “Healthcare Considerations for Families & Friends” contains helpful information to assist in caring for a loved one aging with polio.GET STARTEDAsk the DoctorHave a medical question? PHI ... Read More

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LE and UE strengthening exercises with low repetitions and short, frequent breaks (sets of 5-8 with rest breaks)

Example: seated LE strengthening with band marching, clamshells, ball squeezes, STS, HS curls, LAQ. 8-10 reps 2X ea. Low intensity, target 60-70% target HR

Functional activity and gait training gradually weaning off of AD as appropriate.

Example: ambulate in parallel bars, ambulate with FWW, ambulate w/ SPC, ambulate w/ no assistive device.

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The patient will need different treatment in different stages

Intensity will need to be carefully monitored to avoid excessive fatigue and damage to muscles

High intensity exercise may be beneficial, but more study needs to be done

Use of non-fatiguing exercise protocols.

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GBS/CIDP International provides information and resources for Guillain-Barre syndrome, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and Multi-Focal Motor Neuropathy (MMN). Specific resources for GBS include information about children and adults with GBS, treatment of GBS, guidelines for treatment and diagnosis, access to GBS experts, and information about vaccines.

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Learn about Guillain-Barré Syndrome or GBS, connect for support and information from our esteemed professional healthcare partners.

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Intervention 1:

Early intervention can use the benefits of aquatic therapy to reduce stress on the joints, maintain motion, and assist with balance and coordination.

Pt will ambulate in the shallow end of the water where the water is at 50% weight-bearing with standing marches and leg lifts for 30 seconds x3.

Intervention 2:

Seated balance on the plinth with perturbations in every direction to address core stability and seated posture for 15 seconds x 3

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1.

Suzanne "Tink" Martin, Kessler M. Neurologic Interventions for Physical Therapy. Elsevier Saunders; 2016.

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