Neurodegenerative diseases: rehabilitation in cases of Parkinson and Alzheimer diseases

REHABILITATION OF PATIENTS SUFFERING FROM NEURODEGENERATIVE DISEASES: WHOM AND HOW IT MAY HELP

Rehabilitation and habilitation play a huge role in the life of people suffering from neurodegenerative diseases. To a greater extent such activities are indicated to patients with sloe disease progression – Parkinson, Alzheimer. But in cases of rapid disease progression rehabilitation can also be effective. The core task for the specialists is the maximally prolonged preservation of the following functions: psychic, cognitive, motor. The slower is the disease progression, the better is the result of rehabilitation in such a case.

WHAT ARE NEURODEGENERATIVE DISEASES?

It includes a vast group of congenital or acquired diseases of the nerve system. It represents various diseases which have one thing in common: all of them in some manner or other impair the nerve tissue– nerve cells, fibers, membranes of the nerve fibers, resulting in the progressive death of the neurons. Nervous system begins to die slowly. The reasons of impairment may include various mechanisms: defects of protein synthesis or functioning, nerve damage, impairment of axons (nerve fibers that conduct the impulse) or it may include direct damaging the nerve tissue of the brain, making it insensible.

In other cases the brain itself may become impaired, in that case the disease results in the development of dementia, psychic disorders, as, for example, it occurs in case of Alzheimer disease. Huntington’s disease is caused by genetic defect and, respectively, by developing a new protein in the organism, multiple sclerosis affects the whole nerve system. Impairment may develop in the nerve fibers of the peripheral system, of the spinal cord, and this results in the damage of, firstly, motor functions, as it is in cases of amyotrophic lateral sclerosis and spinal muscular amytrophy. These are terrible diseases and they are characterized by one thing in common – starting from paralysis of the upper limbs, lower limbs, some peripheral nerves, they end up with a paralysis of the respiratory system and of the heart. In cases of lateral sclerosis it develops quite rapidly, while in cases of spinal muscle atrophy the disease develops slowly, taking up to 10 or even 20 years. The task of rehabilitation is to maximally slow down the course of the diseases and to make the life of a patient as comfortable, as it is possible in the settings available.

HELPING THE WHOLE FAMILY

In patients suffering from neurodegenerative diseases, the problems are quite various. The common thing is the fact that, until the person’s psychiatric functions are intact, he clearly realizes, what is going on with the patient and what awaits ahead. Besides, hard times because of the disease are experienced not only by the patient, but by all the patient’s family and friends.

ALEKSANDRA SLAVYANSKAYA

marketing director of the IRC

«In the western countries there is a term– “Loss without loss” – which is when you see, that your beloved person is alive, but you can not recognize the one you love in that person. The surrounding community, just like the patient, needs help and support»

Another problem for the patient is taking care for the patient, for at some moment of time the patient loses the self-sustaining ability, stops doing household duties, becoming not self-maintained. The relatives have to learn to live and work in such settings. You need to learn how to manage the patient – to relocate, to treat the skin in a special way to prevent the development of bed-sore, making breathing exercises, while in case of complete immobility – to tap on the patient’s lungs to prevent the development of pneumonia.

VASILIY KUPREYCHIK

Head rehabilitation therapist of the IRC

«the main thing in such a situation – to preserve your own health: to avoid stressing the back, developing hernias and not to drop the patient, to avoid traumas and falling into the bath, not to let the patient get burns etc. This is a usual thing we teach the family members. This is a one big direction of our work. We are helping to gain new necessary habits, provide information and, of course, provide psychological aid and support»

HELP PROVIDED TO THE PATIENTS

The directions of working with the patients are quite various. Everything depends on the diagnosis and the status of the patient. The programs are always compiled in an individual order. We use only the methods that are scientifically proven: training exercises, balancing exercises, aerobic training sessions, Chinese Taiji gymnastics sessions and yoga. We actively use the method by Ronnie Gardiner, which allows for training simultaneously the cognitive and the motor aspects using a combination of dancing, rhythm, music and words.

For example, Parkinson’s disease is characterized by disorders in motor functions and cognitive deficit. Cognitive deficit develops very slowly, which means the patient slowly loses the ability of logical thinking, speaking and forming sentences. Plus, the patient shows changes in the personality, becoming more inhibited-thinking, inconstant, obtrusive, but the main suffering of the patient is caused by physical disability. That includes impaired coordination, developing tremors, the body becomes “rigid” with a possibility of sudden falling down. Which is why the rehabilitation of such patients pays much attention to motor rehabilitation or to combinations of methods aimed at motor, cognitive and psychological rehabilitation.

DENIS DYATLOV

Head of ergotherapy section of the IRC

«During our visiting the Center headed by Joaquin Ferreira in Portugal (which is the leading center on the treatment of Parkinson disease worldwide) we saw the principles of training the patients: during the exercises on a treadmill the patient was asked to put hands up when seeing colors of one type or another or to do certain activities when hearing specific sounds. This is the way cognitive system is trained, coordination of motions, concentration, along with training speech and (simultaneously) stamina. We are trying to keep up with the leading techniques of rehabilitation, using similar methods»

In cases of spinal-muscular amyotrophy the essential moment is working with the family, for the main problem of the patient is immobility. If we are talking about dementia, about Alzheimer disease, in such cases the primary roles belongs to psychological deviations. This is why the essential necessary component is cognitive training and, secondly, the training aimed for motor functions.

VASILIY KUPREICHIK

Head rehabilitation therapist of the IRC

«The motor and the mental functions are closely related in a human body – Remember this: to make a child to start talking faster, we teach him fine motor skills. The same applies to adult patients. You want to improve the cognition – you must work on you motions. But, nevertheless, “the balance” of such methods for each specific patient is going to vary»

SELECTING SPECIAL DEVICES AND RE-CONFIGURATION OF THE APARTMENT

Another direction of working with neurodegenerative diseases is selecting specialized equipment and re-configuration of the apartment. This is a very important aspect of rehabilitation and even the abilitation, for properly organized space can several fold improve the quality of life, both for the patient and for his relatives.

ALEKSANDRA SLAVYANSKAYA

marketing director of the IRC

«We had a patient suffering from lateral sclerosis and she was doing therapeutic exercises, logopaedics – for her speech was already partially impaired. And she was interested in selecting specialized equipment that could help her generate voice in case when speaking is completely lost. And, of course, we managed to help her. Another case included a 14-year old female patient presenting with spinal –muscular amyotrophy. A completely unique girl, for such a diagnosis usually causes lethal outcomes already at the age of 9 years, nut her age was 14! Our main goal was to restore household habits, specifically, not rehabilitation but abilitation, teaching her to do what she was never able to do. The second goal was psychological – we needed to induce the process of separation with “weaning” her from her mother and to teach the mother on how to normally interact with the patient, both в physically and psychologically. We trained Yulia (name changed) to get up from the bed, to sit into the wheelchair, but the main problem was that the mother was always willing to this for her daughter. Psychologically she was afraid to let her go, afraid that the daughter would fall or anything else would happen, thus, not giving Yulia any chances for self-sustained activity. We were working on that problem. And they left us being very happy! Before leaving, Yulia cooked us a cake by herself. Before the admission to our center she was not able to do this. She started cooking at the kitchen, riding along the apartment in a wheelchair, which means that, instead of a bed-bound patient, we have created a human being that is able to transport herself within an apartment, able to take care of herself, to do some activities and, generally, to have quite a social life».


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