Kinds of Physical Disabilities

Physical Disabilities

There are various kinds of Physical Disabilities

Disability due to Spinal Muscular Atrophy

The disease

Spinal muscular atrophy (SMA) is a collection of different muscle diseases. It is the second leading cause of neuromuscular disease, the first one is Duchenne muscular dystrophy. It is an autosomal recessive hereditary disease characterized by progressive hypotonia and muscular weakness. SMA is the most common diagnosis in girls with progressive weakness.

About 4 out of every 100,000 people have the condition. There are four types of this disorder:

• SMA type I (acute infantile, Werdnig-Hoffmann disease)
• SMA type II (chronic infantile)
• SMA type III (chronic juvenile, Kugelberg-Welander syndrome)
• SMA type IV (adult onset)

Symptoms

The most severe form of spinal muscular atrophy and begins before birth. Usually, the first symptom is reduced movement of the fetus that is first seen between 30 and 36 weeks of the pregnancy. After birth, these newborns have little movement and have difficulties with swallowing and breathing.

Type I spinal muscular atrophy (called Werdnig-Hoffman disease) is another severe form of SMA. Symptoms of type 1 may be present at birth or within the first few months of life. These infants usually have difficulty breathing and swallowing, and they are unable to sit without support.

Children with type II SMA usually develop muscle weakness between ages 6 and 12 months. They cannot stand or walk without help.

Type III symptoms appear between early childhood (older than age 1 year) and early adulthood. Individuals with type III SMA are able to stand and walk without help. They usually lose their ability to stand and walk later in life. There are two other types of spinal muscular atrophy, type IV and Finkel type that occur in adulthood, usually after age 30. Symptoms of adult-onset SMA are usually mild to moderate and include muscle weakness, tremor and twitching.

Treatment

There is no treatment for the weakness caused by the disease. Supportive care is very necessary. Attention has to be paid to the respiratory system because affected people might have the problem of choking. Breathing complications are common.

Physical therapy is important to prevent contractions of muscles and tendons and abnormal curvature of the spine (scoliosis). It’s important to protect joints from stiffness or injury, preserve range of motion (flexibility in the joints), maintain circulation and, especially for children, allow enough mobility for exploration of the environment. Exercising in a warm pool (85 to 90 degrees) may be particularly beneficial. A person with SMA shouldn’t swim alone, and appropriate safety precautions should be provided.

Bracing may be required. Activity is not to be avoided, but rather used in such a way as to prevent deformity, contracture and stiffness and to preserve range of motion and flexibility; therefore, it should not be done to the point of exhaustion. Energy conservation is very important. Good nutrition will enable the patient to utilize their muscles. High protein and low fat diet is recommended. Breathing exercises and Pranayaam can prove to be beneficial.

Prevention

Genetic counseling is recommended for people with a family history of spinal muscular atrophy who want to have children.

Disability due to Multiple Sclerosis

The disease

Multiple sclerosis (MS) is a disease in which there is degeneration of the nerves of the central nervous system (brain and spinal cord).There is slowing down of the electrical impulses that travel along the nerves. In addition, the nerves also get damaged. A person faces problems with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.

Symptoms

Visual disturbances like patch of blurred vision, red-to-orange or red-to-gray distortions (color desaturation),loss of vision in one eye or pain in the eye. Limb weakness Attention deficit Muscle spasms, fatigue, numbness, and prickling pain. Difficulty in judgement Sometimes loss of sensation, speech impediment, tremors, or dizziness. Some degree of memory loss Depression Sexual dysfunction and bladder control problems

Treatment

Medications can help ease MS attacks and possibly slow the disease.Sometimes surgical methods are also used. Physical therapy and other treatments help control symptoms -- and improve the quality of life.Alternative therapy includes a variety of disciplines that range from diet and exercise to mental conditioning to lifestyle changes. Examples inclusion of acupuncture, yoga, aromatherapy, relaxation, herbal remedies, and massage.

Management

With pain and difficulty in movement, one may feel it a too heavier load to bear.The patient needs to manage the life style to cope up with the problem. The patient needs to learn to manage stress and maintain a positive physical, emotional and spiritual attitude towards life.A counselor can help the patient in that by designing strategies to gain a sense of control over life and thus improving the quality of life.. One needs to take care of oneself. Healthy , exercise, de-stressing techniques can help along with enough rest. One needs to consider life-planning issues, such as finances, work, adapting of home, and other practical issues. One needs to be proactive in health and educated.

Disability due to Polio

Three types of viruses cause Poliomyelitis (Polio).It is a highly contagious disease. It can be transmitted from person to person contact. The virus enters through mouth and nose and multiplies in the intestinal tract. It moves inside the blood stream and can also be transported by the lymphatic system. The entire body is attacked and severe damage is is caused to the nervous system. It can result in paralysis of muscles.

Symptoms:

There are 3 kinds of infection:

1.Sub clinical Infection General discomfort or uneasiness (malaise)

· Headache . Red throat . Slight fever · Sore throat · Vomiting

People with subclinical polio infection might not show symptoms, or may last 72 hours or less.

Central nervous system i.e. brain and spinal cord may be affected by Clinical poliomyelitis and is divided into nonparalytic and paralytic forms.

2.Non Paralytic Poliomyelitis ·Back pain or backache ·Diarrhea ·Excessive tiredness, fatigue ·Headache ·Irritability ·Leg pain (calf muscles) ·Moderate fever ·Muscle stiffness ·Muscle tenderness and spasm in any area of the body · Neck pain and stiffness · Pain in front part of neck · Pain or stiffness of the back, arms, legs, abdomen · Skin rash or lesion with pain · Vomiting

Symptoms usually last for 1 - 2 weeks.

3.Paralytic Poliomyelitis ·Fever 5 - 7 days before other symptoms ·Abnormal sensations in an area ·Bloated feeling in abdomen ·Breathing difficulty ·Constipation ·Difficulty beginning to urinate ·Drooling ·Headache ·Irritability or poor temper control ·Muscle contractions or muscle spasms in the calf, neck, or back · Muscle weakness, asymmetrical (only on one side or worse on one side) o Comes on quickly o Location depends on where the spinal cord is affected o Worsens into paralysis · Sensitivity to touch; mild touch may be painful · Stiff neck and back . Swallowing difficulty

Treatment and Rehabilitation

There is no medical cure but it can be prevented by an effective vaccine. Supportive treatment is given to person. It includes Bed rest, lots of fluids, heating pads, and analgesics may be recommended for muscle pain. Insertion of breathing tube can required if there is paralysis of the respiratory muscles in order to open up the windpipe. Catheterization may be needed in case of abnormal bladder function. Muscle damage can be prevented by physical therapy. It also helps in retaining muscle function. Many times braces or corrective shoes, or orthopaedic surgery is required to help recover muscle strength and function. To improve functional ability of polio patents, occupational therapy can also prove to be useful. A counsellor’s knowledge and understanding of the individual's chronic illness can prove to be useful in order to promote successful vocational assessment and placement.

Disability due to Muscular Dystrophy

पेशीय दुर्विकास (मस्कुलर डिस्ट्रोफी)

Muscular Dystrophy, a genetic disorder, effects a quarter of a million kids and adults. The disease is not contagious. The disorder weakens the muscles of the body that help in movement. Those suffering from the problem are unable to walk, sit, breathe easily, and move the arms and hands. The increasing muscular weakness can be the cause of other health problems. In some types of muscular dystrophy, the heart, the gastrointestinal system, endocrine glands, the skin, the eyes and other organs may be affected.

Symptoms: In some cases muscle problems are shown in infancy; in others, symptoms don't appear until adulthood. Symptoms that a child may exhibit are • Stumbling • Waddling • Difficulty in climbing up stairs and toe walk • Struggle to get up from a sitting position • Hard time in pushing things like a wagon or a tricycle. • Enlarged calf muscles as muscle tissue is destroyed and replaced by fat. • Stiffening of the muscles near the joints

Treatment There is no cure. Exercises and physical therapies are given. Sometimes surgeries are performed to reduce pain and increase the movements. Special braces may be given to the patients for moving. Canes, powered wheelchairs, and other rehabilitative devices can help sufferers maintain mobility and independence. Deep breathing and coughing exercises are often recommended. Those with respiratory problems have to use respiratory aids and ventilators. Medications including steroids too are administered in certain cases. Researchers are investigating the potential of certain muscle-building medicines to slow down or reverse the progression of muscular dystrophy.

Disability due to Amputation

Sometimes it may be necessary to remove a limb or a part of limb from the body because of peripheral vascular disease, malignant disease, injury (trauma), or congenital deformity. In elderly people gangrene of part of the lower limb can be the reason behind amputation. Congenital absence of limbs or parts of limbs may have much the same effect as amputation.

After amputation one needs to use an artificial limb, or part of a limb, is known as prosthesis. It may be functional or cosmetic like many of those used in upper limbs. Their effectiveness depends on the level of amputation. Mobility will not be much affected but there can balance problems.

Complications after amputation

There can swelling (oedema) of the stump, infection, friction which may lead to blisters and sore areas, or skin problems. Bony spurs or of bone and painful nerve swellings may be there.

The person may feel that the lost limb is still there (phantom sensation) and occasionally this may be painful (phantom pain). There may be problems in other areas such as the back or the remaining limb. There can be onset of arthritis because of dependence on the remaining limb. Walking may be fatiguing, and the quality of walking will be less than that of a person whose amputation is at a lower level. Balance problems may occur with amputation at any level, even the toes, especially the great toes. There can twisting of the spine (scoliosis) causing chronic back pain and balance problems.

Rehabilitation

Once the wound is healed the person is given prosthesis and is trained to walk with the help of aids such as a stick or walking frame.

Achievement of functional level would depend on the age, physical and mental fitness of the person; their motivation; the level of amputation and construction of the stump; and the availability of rehabilitation programmes. Rehabilitation cab be delayed due to obesity. Some people with above knee amputation may have to depend on wheelchairs.

Treating Pain after Amputation

The pain after amputation is quite complicated and can be very difficult to treat.

Appropriate for pain management include but not limited to :

1. Proper fitting of prosthesis

2. Physical therapy, exercises, transcutaneous electrical nerve stimulation (TENS) units and related treatments

3. Techniques of relaxation and stress management

4. Therapies including biofeedback, cognitive and behavior

5. Medications that are Non-steroidal anti-inflammatory(NSAIDs)

6. Sometimes there is use antidepressants and neuroleptic agents

7. Oral opiod analgesics

8. Muscle relaxants

Disability due to Spina bifida

स्पाइना बिफ़िडा

The term spina bifida is taken from Latin word which means "split" or "open" spine. It also can be called "cleft spine". It is a disabling birth defect.It is not contagious. The spine is not closed properly during the first month of pregnancy. The problem is related to spinal cord or its coverings. Nerve damage can cause some paralysis of the legs but paralysis does not always occur. Those having the problem may even have to face learning difficulties, urinary and bowel problems or hydrocephalus, (a build up of fluid in the brain). In severe cases, the spinal cord protrudes through the back and may be covered by skin or a thin membrane. Obesity (due to inactivity) and urinary tract disorders (due to poor drainage) are common complications of spina bifida. Foot or leg deformities, hip dislocation, or scoliosis are also seen in some cases.

Treatment:

There is no cure for the problem. Prevention can be brought about by giving folic acid to the expecting mothers during the early stages of pregnancy. Sources of folic acid include whole grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits.

Surgery to close a newborn's back is generally performed within 24 hours after birth to minimize the risk of infection and to preserve existing function in the spinal cord but this does not restore normal function to the affected part of the spinal cord. Hydrocephalus is controlled by a surgical procedure called "shunting" which relieves the fluid build up in the brain. Medicines and physical therapies are given. At least 60 minutes of physical therapy is must.

Parents of children with spina bifida can get support from a medical team including neurosurgeons, urologists, orthopaedic surgeons, rehabilitation specialists, and general paediatricians, a nurse practitioner, physical and occupational therapists, and a social worker.

These children need to be independent and have to learn mobility skills. They can use crutches, braces, or wheelchairs. With many new techniques they can become independent in managing their bowel and bladder problems. There emotional and social development has to be taken care of. It is important that health care professionals, teachers, and parents understand the child's physical capabilities and limitations.

People with spina bifida should be seen frequently by the appropriate professionals so that they can be checked for progressing deformities, disabilities, or complications that may require intervention.

Disability due to Cerebral Palsy

सेरिब्रल पैल्सि

Cerebral palsy is chronic condition that affects the body movements and muscle coordination. "Cerebral" means brain and "Palsy" means a disorder of movement or posture. Those who have the ailment may not be able to walk, talk, eat or play in the same ways as most other children.

Cerebral palsy is neither progressive nor communicable. It is also not "curable". People with cerebral palsy may experience one or more of the following:

Muscle tightness or spasm Involuntary movement Disturbance in gait and mobility Abnormal sensation and perception Impairment of sight, hearing or speech Seizures

Cerebral palsy may be caused by an injury to the brain before or after the birth. Or it may also be due to genetic factors, lack of oxygen during birth, infection etc a large number of factors which can injure the developing brain may produce cerebral palsy. Thus there are two problems that can cause cerebral palsy:

1. Failure of the brain to develop properly

2. Neurological damage to the child's developing brain

Symptoms:

A child over 2 months with cerebral palsy:

■ Has difficulty in controlling head when picked up

■ Has stiff legs that cross or “scissor” when picked up

A child over 6 months with cerebral palsy might:

■ Continue to have difficulty in controlling head when picked up

■ Reaches with only one hand while keeping the other in a fist

A child over 10 months with cerebral palsy

■ Crawsl by pushing off with one hand and leg while dragging the opposite hand and leg

■ Cannot sit by himself or herself

A child over 12 months:

■ Cannot crawl

■ Cannot stand with support

Child over 24 months with cerebral palsy might:

■ Cannot walk

■ Cannot push a toy with wheel

Treatment:

It includes:

Physical Therapy

Occupational Therapy

Speech and Language Therapy

Medical Treatment: Surgery

Drug Therapy

Sensory Integration Therapy

Adaptive Equipment

Tips to cope up with Cerebral Palsy