1/13. Neuromuscular disease, respiratory failure and cor pulmonale.Respiratory muscle weakness is an uncommon cause of chronic respiratory failure and a rare cause of cor pulmonale. The problem may not be apparent unless specific physical signs are sought or appropriate investigations performed. We present three patients who presented diagnostic difficulty for prolonged periods until the presence of respiratory muscle weakness was considered. Once the diagnosis was established treatment with nocturnal nasal intermittent positive pressure ventilation produced a dramatic improvement in symptoms and allowed a return to a near normal lifestyle.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Neuromuscular disorders in clinical practice: case studies.Neuromuscular disorders represent a large group of highly varied and interesting clinical disorders, many of which have major general medical manifestations. These disorders can be diagnosed largely based on the patient's history and physical examination with a little help from modern technology. Despite the outdated belief that neurologic conditions are diagnosed but rarely treatable, all cases discussed herein represent disorders for which there are extensive options and opportunities for meaningful management. These 16 brief case overviews challenge and refresh diagnostic skills and provide the framework for selected comments regarding management options.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Bronchial involvement in the cramp-fasciculation syndrome.BACKGROUND/AIMS: Cramp-fasciculation syndrome (CFS) is an acquired, chronic, usually benign and rather heterogeneous condition with isolated fasciculations and muscle cramps generally induced by physical exercise. They commonly involve calf and quadriceps muscles. The pathophysiology of CFS is related to peripheral nerve hyperexcitability, most often located at the motor nerve terminal or intramuscular arborization. methods: A 21-year-old man presented with a progressive syndrome of bronchospasm, cramps and muscle twitches related to physical exercise. Spirography showed bronchial hyperresponsiveness, so he received inhaled corticosteroids and beta2-agonists that improved respiratory symptoms. Electrodiagnostic studies were consistent with CFS. Gabapentin was then introduced. RESULTS: Both respiratory and muscle symptoms improved. A new spirogram after all inhaled medication had been discontinued was normal. CONCLUSION: This picture suggests a concomitant involvement of the peripheral motor nerves of both skeletal and airway autonomic smooth muscle, a presentation not previously reported in CFS.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/13. Management of individuals with Parkinson's disease: rationale and case studies.In this article, we present a systematic approach to physical therapy management of individuals with Parkinson's disease. This approach is based on a model that relates knowledge of the underlying pathology of the disease to impairments and disability. We discuss use of the model to evaluate, interpret, and treat impairments and disabilities of the patient with Parkinson's disease. We emphasize the relative influence of impairments that arise directly from the neuroanatomical pathology and those that arise indirectly through subsequent musculoskeletal alterations. We illustrate the use of the model in setting goals and in developing a treatment program. Two case studies are presented to illustrate the application of this approach to specific patient care. These case studies suggest the efficacy of physical therapy initiated early in the disease process. The first case study illustrates improvements of balance, gait, and functional movement made by an individual who was not yet receiving medication for Parkinson's disease. The second case study illustrates improvements of balance, gait, and functional movement made by an individual who was already receiving medication for the disease. These case studies illustrate the dramatic improvements that can be achieved in the patient with Parkinson's disease.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/13. Physical therapy management of the patient with post-polio syndrome. A case report.This case report documents the treatment of a patient who experienced progressive muscle weakness and a decrease in function over time that did not appear to be related to any secondary neuromuscular disease. We discuss the relationship between age and maximal muscle function in addition to some general guidelines for rehabilitation. This type of patient can represent a challenge for the physical therapist. This case report, however, illustrates the degree of muscular and functional recovery that can result with a physical therapy program aimed at reducing levels and intensity of exercise, daily activity, and stress. Such a combination of short-term goals appears to be essential to the successful management of a patient with post-polio syndrome.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/13. Immunodeficiency associated with motor neuron disease treated with intravenous immunoglobulin.A man with symptoms of amyotrophic lateral sclerosis and immunodeficiency was treated with intravenous immunoglobulin. After four weekly intravenous injections of 2.5 gm of immunoglobulin, his condition showed progressive improvement when measured by clinical, neurological, and physiological parameters. There was a noticeable increase in general physical well-being, an 80% reduction in fasciculations, and the normalization of sensory and motor nerve conduction velocities.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/13. Dysphagia: an evaluation and treatment program for the adult.Dysphagia, or difficulty swallowing, can interfere with independent feeding in the physically disabled adult. The physiology of normal swallowing and neuromuscular pathology of dysphagia applicable to the occupational therapist are reviewed in this paper. Pertinent nursing care of the respiratory and gastrointestinal tracts are described. Normal and pathological reflexes involved in swallowing include gag, bite, and suck-swallow. head, neck, and jaw stability are necessary for swallowing. methods for evaluating the appropriate reflexes, sensation, and orofacial movement of the adult neurologically impaired patient are presented. Proper positioning is described and treatment suggestions are offered and applied to four case studies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/13. Management of functional disability in homebound patients.Five percent of the population aged over 65 years, or more than 1 million people, are homebound. Musculoskeletal dysfunction is the final common pathway of all forms of arthritis and many neuromuscular disorders and is the prime cause for being homebound. The US health care system, with its emphasis on acute illness, does not address adequately the functional problems of homebound patients. Many can be helped by modification of the home environment or physical and occupational therapy. This paper outlines the diagnosis and management of common functional disabilities found in homebound patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/13. Clinical EMG feedback in motor speech disorders.electromyography (EMG) feedback techniques used in physical and occupational therapies were applied successfully in the treatment of three patients with speech/language disorders. The Hyperion Bioconditioner, Model 4080, a microprocessor-based EMG that provides on-line, real-time computation, was used to record and display EMGs from two muscle groups. Results of three case studies reconfirm the effectiveness of biofeedback for all types of neuromuscular reeducation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. Operant treatment of orofacial dysfunction in neuromuscular disorders.The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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