Monday, October 18, 2010

Improving mobility

Sometimes the body does not do what you want it to do. When the cause is an accidental injury or a disease coming later in life, you know what you have lost and can motivate yourself to recover some functions through physical therapy. But when you are born with a problem, you are surrounded by the abled. Wherever you look, you can compare yourself to others. So the approach is as much psychological as physical. Say, for example, someone is born with cerebral palsy. The doctors may warn that he or she may never be able to walk without assistance. But with the right medical interventions and a positive attitude, people can overcome their disabilities and lead active lives. It's all about making the best of what you have. The technical name for muscles that will not respond properly is spasticity. It's a motor disorder with the most usual cause being a breakdown in the nervous system causing the muscles to remain tensed or tight. Over time, this distorts the way the body grows or moves, changing the skeleton and affecting coordination. In the "best" cases, the loss of movement is slight. The muscles move but not quite in the way we intend. For most people, the most effective treatment is physical therapy. The aim is to teach the muscles how to relax and contract more smoothly. The therapist will be able to devise a series of exercises to produce a better synchronization between mind and body - so the body does what we want it to do. The work is often slow and everyone involved has to avoid growing frustrated and depressed. With patience, most people reach a level of performance they find satisfactory. A few go way beyond what the therapist believed possible. There are always going to be some people whose disability is too serious for physical therapy on its own. Now it's down to the patient and doctors to discuss the strategy. In the most severe cases, it may be necessary to consider surgery to correct the alignment of joints, e.g. derotation surgery involves breaking bones to allow the rotation of the leg to a more normal position and putting in a plate to hold it in the new position. There are also several drugs and different delivery systems to discuss. This is all about costs and benefits. When surgery is used, there will inevitably be pain and the need to go through rehabilitation therapy to recover and learn new movements. This is only justified when the expected improvement in mobility is real enough to justify going through the pain. It's the same with drugs. Will there be a real improvement to justify running the risk of side effects? Fortunately, Baclofen has a good track record. People are able to take it at lower dosages over long periods of time without it losing effectiveness. But when taken orally, there is a greater risk of side effects, e.g. drowsiness. Hence, in the more severe cases, a Baclofen pump can be fitted to deliver lower doses directly into the spinal fluid. The decision to fit a pump is not one to take lightly because there is always a risk of infection. But, in the best cases, it produces significant improvement with fewer side effects.

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