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Cerebral Palsy, Multiple Sclerosis, and Muscular Dystrophy

Alyssa Felix and Raquel Willman

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Cerebral Palsy

http://www.youtube.com/watch?v=qMSrpZi_6WM&noredirect=1

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Cerebral Palsy

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture
The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don't worsen over time

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Spastic Cerebral Palsy

Damage to motor cortex or upper motor neuron
Most common (70%-80%) of cases
Characterized by tight and stiff muscles (hypertonia)

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Dyskinetic (Athetoid) Cerebral Palsy

Damage to basal ganglia
Characterized by both hypertonia and hypotonia

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Ataxic Cerebral Palsy

Damage to cerebellum
Rarest cerebral palsy, only about 5% of cases
Characterized by weak muscles (hypotonia)

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Diagnosis

Based off of patient's history and physical examination
Further tests-CT and MRI, to check for lesions and further brain issues

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Treatment

The brain injury that causes cerebral palsy cannot be healed.

The overriding treatment goal for those with cerebral palsy is to:

Optimize mobility
Manage primary conditions
Control pain
Prevent and manage complications, associative conditions and co-mitigating factors
Maximize independence
Enhance social and peer interactions
Foster self-care
Maximize ability to communicate
Maximize learning potential
Enhance quality-of-life

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Multiple Sclerosis

Chronic disease in which the nerves of the CNS begin to degenerate
MS causes inflammation and destruction of myelin sheath.
http://www.youtube.com/watch?v=Naecv3h868c&noredirect=1

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Demyelination

The electrical impulses

that travel along the

nerves decelerate

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Types Of Multiple Sclerosis

Relapsing-Remitting MS

Primary-Progressive MS

Secondary-Progressive MS

Progressive-Relapsing MS

People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.

Primary-Progressive MS

This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.

Secondary-Progressive MS

Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.

Progressive-Relapsing MS

In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

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Symptoms

Over the course of the disease, some symptoms will come and go, while

others may be more lasting. Symptoms can also range from mild to severe.

The more common symptoms include:

Fatigue

Numbness

Walking (Gait), Balance, & Coordination Problems

Bladder Dysfunction

Bowel Dysfunction

Vision Problems

Dizziness and Vertigo

Sexual Dysfunction

Cognitive Dysfunction

Emotional Changes

Spasticity

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Diagnosis

In order to make a diagnosis of MS, the physician must:

1. Evidence of damage in at least 2 places of the CNS

2. Find evidence that damaged occurred at least one month apart

3. Rule out all other possible diagnoses

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Treatment

Although there is still no cure for MS, effective strategies are available to

Modify the disease course
Treat exacerbations (also called attacks, relapses, or flare-ups)
Manage symptoms
Improve function and safety
Provide emotional support.

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Muscular Dystrophy

Group of muscle diseases that weaken the musculoskeletal system and hamper locomotion
Characterized by progressive skeletal muscle weakness, defects in proteins and the death of muscle cells and tissues

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Muscular Dystrophy

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Duchenne Muscular Dystrophy

Affects only boys (except in very rare cases)
Caused by absence of gene that creates the protein dystrophin
Loss of ability to walk by around 12
Lifespan from 15-50

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Becker Muscular Dystrophy

Less severe form of Duchenne Muscular Dystrophy
Produce truncated and partially functional dystrophin
Normal lifespan

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Cogenital Muscular Dystrophy

A group of muscular dystrophies that occur at or around birth
Over 30 different types
Most have to do with faulty proteins in extracellular matrix around muscle fibers

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Distal Muscular Dystrophy

Group of muscular dystrophies characterized by onset in limbs (namely hands and feet)
Slow progressing and non-life threatening
Can affect both men and women

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Emery-Dreifuss Muscular Dystrophy

Characterized by contracture of joints, muscle wasting, and heart dysfunction
Mostly in males

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Facioscapulohumeral muscular dystrophy (FSHD)

Muscular dystrophy affecting muscles of face, shoulders, and upper arms
Occurs in both males and females

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Limb-girdle Muscular Dystrophy

Most severely affect hips and shoulders
Affects both genders
Age of onset, 10 to 30 years
Can also affect other muscles and even heart and lungs as it progresses

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Myotonic muscular dystrophy

Characterized by delayed relaxation of muscles
Usually accompanied by heart problems
Affects both genders
Onset either in childhood or later as an adult, depending on type

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Oculopharyngeal Muscular Dystrophy

Affects muscles of face, eyelids, and throat. Progresses to pelvic and shoulder muscles.
Onset between 40 to 70 years

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Diagnosis

Diagnosis is based of off muscle biopsy and genetic testing/DNA analysis.
Further testing done-Electromyography and electrocardiography (EKG)

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Treatment

Medication to strengthen muscle and delay progression (though used too long can weaken the bones).

Therapy. Therapy. Therapy. Range of motion exercises are very important AND can be done using TR methods. Also mobility aids and breathing assistance can be used.

Surgery can help correct Scoliosis, Contractures, eye-surgery to correct cataracts, and heart surgery.

Mobility aids- Braces can provide support for weakened muscles and help keep muscles and tendons stretched and flexible, slowing the progression of contractures. Other devices — such as canes, walkers and wheelchairs — can helfp maintain mobility and independence.

Breathing assistance. As respiratory muscles weaken, a sleep apnea device may help improve oxygen delivery during the night. Some people with severe muscular dystrophy may need to rely on a ventilator — a machine that forces air in and out of their lung

Surgery

Contractures. Tendon surgery can loosen joints drawn inward by contractures.
Scoliosis. Surgery may also be needed to correct a sideways curvature of the spine that can make breathing more difficult.
Heart problems. Some people who have heart problems related to muscular dystrophy may be helped by the insertion of a pacemaker, which prompts the heart to beat more regularly.

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TR Application

Its important to remember that most people with these disabilities will not get “cured.” Treatment can focus on dealing with symptoms or addressing other diagnoses that can come along with these conditions, such as depression, anxiety, etc.

Muscular Dystrophy

Be Patient
Work on Range of motion
Use of Adaptive Activities is important

Multiple Sclerosis

Symptom reduction and management.

Maximize the individuals independent functioning and to maintain as much of his or her pre-illness lifestyle as possible.

Cerebral Palsy

Help become a well rounded individual
Teach adaptive strategies
Enhance inclusion

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Professional Organizations

Multiple Sclerosis

National Multiple Sclerosis Society

Multiple Sclerosis Association of America (MSAA)

Muscular Dystrophy

Muscular Dystrophy Association- www.mdausa.org

Band Back Together- www.bandbacktogether.com

Cerebral Palsy

United Cerebral Palsy

Cerebral Palsy International Research Foundation

MS

The National Multiple Sclerosis Society is the largest and most famous of MS organizations with chapters in every state. The MS Society joins researchers and celebrities to raise the awareness of MS nationwide. Whether you are looking for a support group or trying to understanding the latest research, the MS Society can help.

(MSAA)- Founded in 1970, the MSAA is a national organization that provides programs and services for people affected by MS. The MSAA has regional offices and can help connect you with MS resources in your area. The organization conducts fundraising, educational and support events regularly.

MD

The MDA is a national resource that gives information you can find in each and every state in the United States. You can find resources near you by going to

This is an important organization that helps those living with MD know that they are not alone. They specialize in helping fight against abuse to those with MD as well as depression of those who have MD. They offer information about the diagnosis and other resources in the area. You can find them at

CP