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Medical Management and Potential Complications

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Medical Management and Potential Complications

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Pharmacological Treatment:

L-dopa and carbidopa to replace lost dopamine

Monoamine oxidase inhibitors to slow progression of PD

Anticholinergics to help reduce tremors

Surgical Management:

Deep brain stimulation: electrodes implanted into brain to stop nerve signals that produce symptoms

PT Management:

Gait Interventions and fall prevention

Postural extensor strengthening

LSVT BIG

Potential Complications:

Slow movement or inability to initiate movement

Speech and swallowing problems

Postural instability and impaired balance

Difficulty performing ADLs due to tremors/rigidity

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Medical Management & Potential Complications

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Medical Management & Potential Complications

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Medical Management:

Synthetic immune system modulators are most common form for relapsing-remitting

Avonex, Betaseron, Copaxon

Spasticity:

Klonopin, Tegretol, Valium

Bladder/Urinary Issues:

Ditropan, Pro-Banthine, Urecholine

Fatigue

Provigil, Symmetrel

Physical Therapy Management:

Strength and endurance training

combat weakness, improve mobility, and improve overall functioning

HIIT for improvements in strength and aerobic fitness

Stretching and ROM for spasticity

Balance training and postural stability

Reduce fall risk, provide stability, improve ataxia

Potential Complications:

Weakness

Spasticity

Fatigue

Ataxia

Visual symptoms

Urinary symptoms

Pain

Depression

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Dual Task Training:

Balance on BOSU while turning head side to side 3x30 sec

Balance on BOSU while turning head side to side while counting backwards by 3s from 50

Gait Training:

Forward ambulation focusing on long steps and arm swings 3x50 feet; rest 1 min in between sets

Walk backward in parallel bars 3 sets x 20 feet, rest 30 sec between sets

Lateral hurdle step-overs 3x20 feet ea direction; rest 1 min between sets

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Early Intervention!

Maximize function

Address primary deficits

Gait abnormalities and function

Postural instability and balance issues

Address secondary complications

Loss of muscle mass, deconditioning, MSK changes, stiffness

Dual task activities to address cognitive dysfunction

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Parkinson's Foundation:

Understanding the disease

Living with the disease

Resources and support

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This Parkinson's Foundation initiative offers genetic testing and counseling at no cost for people with Parkinson's disease (PD). When you participate, you can help scientists in their journey to better understand how Parkinson's works, leading to new, more effective therapies.

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This Parkinson's Foundation initiative offers genetic testing and counseling at no cost for people with Parkinson's disease (PD). When you participate, you can help scientists in their journey to better understand how Parkinson's works, leading to new, more effective therapies.

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Medical Management and Potential Complications

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Medical Management and Potential Complications

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Medication(s) is based on symptoms, activity level, muscle training program

Medications for fatigue and strength not proven effective

Complications:

Severity relative to severity of original infection

Fatigue (overwhelming, exhaustion with minimal effort)

Headache

Sweating

Muscle weakness (new and those affected originally)

P!

Decline in strength

Impact on quality of life (QOL)

Cold intolerance

Falls

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Avoid overuse, fatigue

Short duration tx sessions at submax level

Energy conservation (slower pacing, alternating rest with physical activity/exercise)

P! management

Work on mobility and stretching

Education (energy conservation for exercise and ADLs)

Monitor HR, BP, and RPE

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Short intervals

Every other day schedule:

cardio: 3X/wk, 15-30 min. > 2-3 min intervals c 1 min rest for 15-20 min progress to 4 min intervals c 1 min rest)

strength: 3X/wk, 5-10 reps

Cardio -- walking, pool walking, stationary bike, swimming, arm ergometer

Strength: use light weights or resistance bands

SH horiz ABD (flex SH to 90 -- hold hands together on band, knuckles up and move hands apart "stretching" the band) 3X5-10 c 30 sec rest between reps

Heel raises (3X5-10 c 30 sec rest between reps)

Note: stretching overworked muscles may not be indicated (potential to increase joint instability)

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Medical Management & Potential Complications

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Medical Management & Potential Complications

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Pharmacological Treatment:

Intravenous immunoglobulins (IVIGs)

*Preferred treatment: availability/greater convenience

Plasmapharesis

Plasma exchange

Physical Therapy Management:

Acute Phase Goals: minimize acute signs/symptoms, support pulmonary function, prevent skin breakdown & contracture formation, and manage pain

PROM, postural drainage/percussion for airway clearance, positioning, splinting, massage, TENS

Plateau Phase Goals: acclimation to upright posture, maintain ROM, improve pulmonary function, and avoidance of fatigue and overexertion

Pressure relief positional changes

Initiate upright seated postures

Work on movement patterns for swallowing, eating, & speaking

Stretching to maintain ROM

Recovery Phase Goals: strengthen and maximize functional goals and carry over goals from previous phases

High intensity exercise program

Focus on strengthening that improves function

Endurance Training

Potential Complications:

Patients may be immobilized for lengthy periods of time => risk for DVTs

Patients are at risk of aspiration after oral intake of food/fluids

Exercise intensity must be monitored closely

Decreases in strength or function require returning patient to bed rest

Avoid overuse and DOMs

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Motor involvement usually more involved than sensory involvement

Progression may impair breathing

diaphragm (~25% of patients require mechanical ventilation) and cranial nerves

Monitor v/s:

BP fluctuations, tachycardia, and arrhythmia (~50% of patients)

Edema/blood pooling (poor venous return)

P!

Fear and anxiety

Impaired speaking and swallowing (aspiration a concern)

alternate way to communicate

Diplopia (impaired/double vision)

P!

DTR absent

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Bed Mobility & Positioning:

Rolling supine <> side-lying; side-lying <> sitting

3 sets of each with 30-60 second rest period between each set

Non-fatiguing Aerobic Interval Training

Arm ergometer

2 min bout followed by 1 min rest

Repeat 5x for total time of 15 min

Intensity: HR 60-70% max HR

Progress to 20 min bout when 15 min is comfortable

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Guillain-Barré Syndrome | Chronic Inflammatory Demyelinating Polyneuropathy

https://www.gbs-cidp.org/

Medical resources

Lifestyle tips

Education

ADs

Education for Various Phases:

Acute: p! management, positioning, respiratory support

Plateau: "gradual" increase to activity

Recovery: "be mindful" (rest breaks, no overuse, reduce intensity of interventions)

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The GBS|CIDP Foundation is committed to sharing the most accurate information from the world's leading experts, many from our Global Medical Advisory Board. The COVID-19 situation changes daily and we will continue to share updates that are vetted by the experts in GBS. In addition, we are in regular contact with the FDA representing the patient voice in the top-level decision-making. We understand that there are many opinions creating confusion so please consider the source of your information before drawing conclusions. As always, all decisions should be made with your personal physician based on your own health. Please continue to check our website for updated information. Continue reading...

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Home - GBS/CIDP Foundation International

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The GBS|CIDP Foundation is committed to sharing the most accurate information from the world's leading experts, many from our Global Medical Advisory Board. The COVID-19 situation changes daily and we will continue to share updates that are vetted by the experts in GBS.

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Medical Management and Potential Complications

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Medical Management and Potential Complications

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Medical Management

*Based on symptoms

*Rizuzole (only Rx currently approved for tx of ALS)

*Other medications given for spasticity, muscle cramping, depression, sialorrhea

Multidisciplinary Approach

*Bulbar (ST - swallowing)

*Nutrition (registered dietitian or nutritionist)

--Augmented feeding

(percutaneous endoscopic

gastrostomy tube)

*Respiratory (mechanical ventilation)

Potential Complications

*Progressive

*Early signs: weakness, atrophy, fatigue, muscle cramping

*Limb loss onset (asymmetric arm/leg weakness)

*Bulbar loss onset (difficulty swallowing or speaking)

Stages

Early: mild-mod muscle weakness; difficulty with gait,

ADLs and speech

Middle: reduced mobility and ADLs; w/c for long distances; increased fall risk; p! from decreased ROM, poor posture, spasticity

Late: dependent for ADLs and mobility, dysarthia,

dysphagia, p!, respiratory compromise

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Preventive Exercises (as early as possible):

Increase strength and mobility (to help preserve activities)

Mod load/resistance improves function in early stages

Avoid eccentric interventions

If 3/5 muscle grade (overuse not an issue)

Balance rest and activity (consider alternating exercise days with days they have other appointments/activities)

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Shoulder and elbow flexion with Therabands (3X15, 3X/week, start with least resistance and progress as tolerated)

Ambulation (with AD such as a WBQC or FWW) 15-20 min, 3X/week

SLS standing 4-Way Hip (add, abd, flex, ext) 3X15, 3X/week

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Stretching Program:

Seated heel cord stretch on mat using strap or towel 3 sets of 30-60 seconds on each leg

Seated edge of mat hamstring stretch: sit on edge of low mat and extend 1 leg. Lean forward at hips while keeping back straight. 3 sets of 30 seconds each leg

Corner/door stretch: 3 sets of 30-60 seconds

Balance Training in Parallel Bars:

Tilt board weight shifting

Side-to-side: 2 sets of 30 seconds; 30-60 second rest in between

Front to back with staggered stance: 2 sets of 30 seconds; 30-60 seconds rest

Marching on 2 DynaDiscs

Stand w/ 1 foot on each disc

Raise the right foot and the left arm at the same time and alternate with the left foot and the right arm

2 sets of 10 reps; 1 min rest in between

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Fatigue is common

Training for respiratory muscles

Aerobic capacity is severely reduced

Submax levels of exercise are safest!

Start at 50-60% of max HR & progress up to 85% as tolerated

Do not exercise to fatigue as it can exacerbate symptoms

Heat exacerbates symptoms

Precooling, exercise in cool environments, fans/personal cooling devices

Aquatic therapy between 80-85 degrees F

Emotional lability

MS patients may demonstrate volatile mood swings

Manage abrupt mood changes with calmness & firm direction

Nystagmus and/or vertigo

Be careful with sudden head movements to prevent loss of balance

Ambulation w/ ataxia is challenging

Patient may need AD such as wheeled walker w/ handbrakes and seat for rest

Motorized scooter may be indicated for extreme fatigue, weakness, or tremors

Orthoses may aid in gait mechanics

AFO is common

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Information about understanding and living with MS, finding doctors, online community and support, etc

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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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ALS Association

https://www.als.org/navigating-als/resources

Life at home

Info. on speech and cognitive changes, breathing difficulty

Nutrition (recipes)

Support groups

Home modifications and safety

Education

Positioning (to avoid pressure ulcers)

Transfers (bed mobility, stand-pivot, squat-pivot)

Energy conservation (spread high-energy need activities over several days/throughout the day)

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We're committed to providing you with quick, easy access to a variety of resources related to ALS - from fact sheets and publications and videos produced by the Association to book recommendations and resource guides.

Links to websites outside of The ALS Association are provided for your browsing convenience but do not represent formal endorsement of their content.

To order physical copies of these resources, visit our order portal.

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We're committed to providing you with quick, easy access to a variety of resources related to ALS - from fact sheets and publications and videos produced by the Association to book recommendations and resource guides. Links to websites outside of The ALS Association are provided for your browsing convenience but do not represent formal endorsement of their content.

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Melioguide.com

Blog, videos, information about post-polio syndrome

Exercise program (videos)

https://melioguide.com/osteoporosis-exercises/post-polio-syndrome-exercise-program/

Post Polio Health International

Education for pt, family and friends

Living with polio

Online resources

Exercises

https://post-polio.org/

Education

Energy conservation (slower pacing, alternating rest with physical activity/exercise)

Modifications for home and work environments