Motor Neuron Disease (MND) is a group of progressive neurological disorders in which motor neurons, the cells controlling voluntary muscle activities such as breathing, speaking, walking and swallowing undergo degeneration.
Normally, upper motor neurons in the brain which control motor functions descend to the spinal cord and activate lower motor neurons. The lower motor neurons directly activate muscles as they exit the spinal cord. With disruption of signals between lowest motor neurons and muscles, the muscles stop working properly, weaken and waste and develop uncontrolled fasciculations. With disruption of signals between upper and lower motor neurons, limb muscles develop stiffness (spasticity) due to which movements become slow and effortful. Overtime, one’s ability to control movements voluntarily can be lost. This disease can affect a person’s ability to speak, breath, walk and swallow.
Motor Neuron Disease Physical Therapy
MND has its various subtypes. Symptoms in each type start in different ways. However, with progression of the disease, the symptoms of each type tend to overlap i.e. in the later stages; symptoms of each MND become more or less similar. Following are the main types of MND:
- Amyotrophic Lateral Sclerosis (ALS) – ALS is the classical and most common type of MND. In ALS, the muscles tend to become stiff and weak at first with symptoms more commonly starting to appear in hands and feet. The disease affects both upper and lower motor neurons.
- Progressive Bulbar Palsy (PBP) – In this type of MND, the muscles used for chewing, talking and swallowing (bulbar muscles) are the first ones to be affected as the lowest motor neurons of brain stem are most affected.
- Progressive Muscular Atrophy (PMA) – It is an uncommon type of MND in which muscles of hand and feet are first to be affected but they do not become stiff. The disease affects only lower motor neurons in the spinal cord.
- Primary Lateral Sclerosis (PLS) – It is a rare form of MND which mainly causes weakness of leg muscles. It is a disease of the upper motor neurons. Some people with PLS may also develop speech problems and clumsiness in the hands.
The exact cause of motor neuron disease is not known. Some MNDs are inherited whereas sporadic or non-inherited MNDs are linked with viral, toxic, genetic or environmental factors.
Often, early symptoms of MND are mild and may include:
- Weakness of hand muscles leading to difficulty holding objects
- Stumbling owing to weakness of leg muscles
- Difficulty swallowing
- Slurring of speech
- Muscle cramps and twitching
- Progressive muscle paralysis
- Facial weakness
- Impaired gait
For many people with MND, there is no loss of sensation in the affected areas. The bladder is not directly affected by MND, however changes to bladder control may be experienced by some people. Constipation may also occur in some owing to remaining less mobile and facing swallowing difficulties.
Earlier, it was thought that MND affects only nerves that control muscles involved in speaking, breathing, swallowing and moving. However, over 50% of people with MND experience changes in personality, cognition, behavior and language. Cognitive and behavior changes may occur in people with MND owing to affection of specific areas of brain called frontal and temporal lobes. Most people show relatively mild changes. However, a small portion may show significant changes and may receive diagnosis of “Motor neuron disease with fronto-temporal dementia” or MND/FTD.
The effects of Motor Neuron Disease which involve – initial symptoms, pattern and rate of progression and survival time differ significantly from person to person.
A range of tests are done for diagnosing MND which may include eliminating other conditions. The diagnostic tests may include:
- Electromyography (EMG) and Nerve conduction studies (NCS) which show a characteristic pattern that needs to be carefully interpreted and correlated with the clinical features.
- Blood tests to exclude other conditions
- Muscle biopsy to exclude myopathic conditions
- CT/MRI of brain and spinal cord to exclude other pathologies with similar conditions
Although there is no cure for motor neuron disease but treatment helps in relieving symptoms and slowing down the progression of disease.
Treatment of MND requires a multidisciplinary team approach comprising of healthcare professionals who work together to provide a coordinated care to the patient. The team usually includes General physician, Neurologist, Physical therapist, Occupational therapist, speech –language therapist, palliative care specialists etc.
Riluzole is the medication which has shown a survival benefit for people with MND. Also, a range of treatments are given to relieve symptoms of MND along with medications to improve one’s quality of life.
Medications help in treatment of symptoms such as drooling, muscle pain and stiffness. Physical therapy, Occupational therapy and Speech-language therapy also play a significant role in the treatment of Motor Neuron Disease.
In Motor Neuron Disease, Physical Therapy and Rehabilitation aim to promote patient independence by improving his normal movement patterns i.e. by helping him perform daily activities with best possible coordination and by helping him utilize his energy in the most efficient manner.
OVERSEAS REHABILITATION CARE (ORC) is the most trusted provider of rehabilitation services in India. We aim to provide holistic rehabilitation to people with Motor Neuron Disease through our physical therapy, Occupational therapy and speech- language therapy programs. Physical therapy and Occupational therapy help in improving an individual’s posture, slowing down muscle weakness and wasting, preventing joint immobility, reducing spasticity through stretching and strengthening exercises and increasing range of motion. Speech therapy helps in easing out speech, chewing and swallowing difficulties.
Our specialized physical therapy for Motor Neuron Disease includes following exercises which help an individual carry out daily activities easily:
- Strengthening and mobilization exercises for increasing muscle strength.
- Mobilization and strengthening exercises for improving postural alignment
- Providing seating and mobility aids and postural re-education programs for improving balance and mobility
- Stretching programs for reducing stiffness, spasms and pain
- Gait re-education and training and improving balance work for reducing the risk of falls
- Management of positioning in bed and seating for increasing patient’s independence and quality of life.
- Teaching breathing exercises and chest clearance techniques
- Minimizing secondary complications associated with Motor Neuron Disease.
We provide comprehensive rehabilitation program to our patients and aim at:
- Increasing patient’s quality of life
- Reducing stiffness
- Reducing pain and muscle spasm
- Enhancing patient independence
- Enhancing patient’s energy levels
- Reducing chest infection
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