ankylosing spondylitis

Ankylosing spondylitis (AS) is a painful inflammatory rheumatic condition characterised by swelling of structures in the spine. AS typically starts in your 20’s, affecting both men and women. If you have AS, joint stiffness, joint and muscle pain and fatigue are key issues you’ll need to learn to manage.

How do I know if I have ankylosing spondylitis?

You will need to confirm a diagnosis of AS through your doctor or a rheumatologist (a medical specialist in bone, joint and muscle problems). AS only affects a very small proportion of the population, about 0.5 per cent. Both men and women are affected, with the condition being more common among males. There is a familial predisposition to AS, meaning that the risk of developing AS is increased if a relative is affected. A gene called HLA B27 is associated with AS and can be detected in a blood test. You can ask your doctor about this test. Your doctor may suggest x-rays or scans which can also help with making a diagnosis.

The most commonly affected region when you have AS is the sacroiliac joints, where the spine joins onto the pelvis. Sometimes, if the only symptom is recurrent back pain, the diagnosis is missed, especially because AS can start when you are younger (usually in your 20s, but can also start in younger and older people). Often the symptoms come and go, or you have ‘flare ups’.

If you are experiencing stiffness and pain in your spine and other joints and/or tendon pain that is impacting your ability to do your daily activities (work, exercise, sleep), then it is important to see your health professional.

Here are some of the common symptoms:

• pain and stiffness in the lower back, buttocks, mid-back or neck
• pain and stiffness that is often worse at night or after a long period of rest
• pain and stiffness which often improves as you move more
• pain and swelling most often in the larger joints
• tendon pain (for example Achilles tendinopathy and tennis elbow)
• reduced ability to do your usual daily activities
• fatigue or tiredness
• inflammation of the eyes (red eyes), the skin, the lungs and the gastrointestinal tract can also occur
• weight loss
• anaemia

I’ve had pain for three months, if it’s not ankylosing spondylitis what could it be?

Exercises to Improve Grip Strength With a Digi flex Hand Exerciser

Digi flex Hand exercises is a small, handheld device designed to effectively strengthen your fingers and hand. The device can be used for whole-hand gripping exercises or for individual finger exercises. A small rubber pad on one side of the device helps prevent discomfort during gripping exercises.

If you have suffered a hand or finger injury, you may benefit from physical therapy to help improve your range of motion and strength in order to regain full function in your hand. Strengthening exercises may be a key component of your rehabilitation program, and your physical therapist will likely have many different tools at her disposal to help you achieve full strength in your hand or fingers. One of these tools may be a Digi flex Hand Exerciser

Digi flex Hand exerciser comes in 5 different grip strengths. Each colour gripper represents a different amount of resistance. You can purchase a Digi flex Hand exerciser online Via www.orthodyna.com

Conditions that May Benefit from Digi flex Hand Exerciser

Digi flex Hand exerciser may be used with any condition that causes finger or hand weakness. Your physical therapist or occupational therapist will determine if using a Digi flex Hand exerciser is right for you. Some common injuries and conditions that may benefit from hand grip strengthening with Digi Flex include, but are not limited to:

• Tendon injury or surgery
• Carpal tunnel syndrome
• Trigger finger
• Colles’ fracture or Smith’s fracture of the wrist
• Cervical radiculopathy with hand weakness
• Ulnar nerve entrapment (cubital tunnel syndrome)
• Stroke or other neurological conditions where hand weakness is present

If you are suffering from hand weakness and your physical therapist feels that using a Digi-Flex may be of benefit, you can try these exercises. You must speak with your doctor or physical therapist before performing these exercises to ensure that they are safe for your specific condition.

Before starting any exercise program for hand grip strength, your PT may get a baseline measurement of your grip power. This is done with a simple test using a handgrip dynamometer. You just give it a squeeze, and it displays a readout of how much force you generated. By having a baseline of your strength, you can see how you improve over time with your Digi-Flex exercise program.

1.

Lateral Key Grip

 

The lateral key grip involves using your thumb and side of your index finger to pinch something as if you were holding a key. Weakness in your thumb muscles may make performing the lateral key grip difficult.

To use the Digi-Flex to strengthen your lateral key grip, hold the device with the black rubber grip against your finger and the individual finger key under your thumb.

Press down gently with your thumb as if you were trying to hold a key. Hold this position for 3 seconds, and slowly return to the starting position. Repeat the exercise 10-15 repetitions. Be sure to stop if you feel any lasting pain.

2

Pistol Trigger Grip

 

If you have a trigger finger and are experiencing weakness in one of your finger flexor tendons, then the pistol grip is the exercise for you to do.

Grip your Digi-Flex as if you were holding a firearm, and slowly pinch the individual finger flexor button as if you were pulling the trigger.  Hold this position for 3 seconds, and repeat 10-15 times. Remember to stop if this motion causes pain or causes your finger to lock into flexion (a common symptom of trigger finger). You can perform this manoeuvre for any of your fingers.

3.

Digit Claw Grip

 

The claw grip involves gripping your Digi-Flex with your fingertips.  To perform this exercise, hold the Digi-Flex in your palm and place the tips of your fingers on the individual buttons. Press your fingertips into the Digi-Flex to compress it, and hold this position for 3 seconds.  Slowly release and repeat the exercise 10-15 repetitions.

4.

Individual Finger Flexion

 

If you are experiencing weakness or an injury in one tendon, you can perform single finger flexion with your Digi-Flex. Simply hold the device with the rubber pad in your palm and use one finger to grip the Digi-Flex. hold this position for 3 seconds, and perform 10-15 repetitions.

5.

Power Grip

 

The power grip is a great exercise to improve the grip strength of your entire hand. This exercise is important for grasping items such as suitcases or grocery bags.

To perform this exercise, grip your Digi-Flex in your hand with the rubber end in your palm. Use all of your fingers and palm to make a fist. Hold this position for 3 seconds, and slowly return to the starting position. Perform the power grip for 10-15 repetitions.

6

Digit Flexion with All Finger Pads

 

You can use the Digi-Flex to work specific muscles and tendons responsible for gripping by changing the position of your fingers on the device.

To perform digit flexion with the pads, place the soft, squishy pads of your fingers on the individual digit keys and squeeze. Hold this position for 3 seconds and repeat the exercise 10-15 times.

A Word from Orthodynamic

If you have difficulty with hand strength due to an injury or illness, you may find that performing simple tasks is troublesome. Don’t worry; your PT can help you get things working again with various treatments and exercise tools.

The Digi-Flex can be a great tool to improve the strength and function of your fingers, thumb, and hand.  By improving your hand strength after injury or illness, you can be sure to quickly and safely return to your previous level of function.

Cupping therapy is an ancient practice that is now considered part of the complementary and alternative (CAM) medicine category, along with acupuncture and aromatherapy. During a cupping therapy session, a massage or acupuncture therapist applies suction cups to various areas of the body. The cup may be made of bamboo, plastic, or glass; traditionally, horns and shells have also been used. While the cup is in place, suction stimulates blood flow and even causes blood to leak into the skin and produce a hickey-like red or purple bruise. Reported benefits include joint and muscle pain relief increased blood flow and reduced inflammation.

Types

There are different methods of cupping, including:

• Dry
• Wet

During both types of cupping, your therapist will put a flammable substance such as alcohol, herbs, or paper in a cup and set it on fire. As the fire goes out, he puts the cup upside down on your skin.

As the air inside the cup cools, it creates a vacuum. This causes your skin to rise and redden as your blood vessels expand. The cup is generally left in place for up to 3 minutes.

A more modern version of cupping uses a rubber pump instead of fire to create the vacuum inside the cup. Sometimes therapists use silicone cups, which they can move from place to place on your skin for a massage-like effect.

Wet cupping creates a mild suction by leaving a cup in place for about 3 minutes. The therapist then removes the cup and uses a small scalpel to make light, tiny cuts on your skin. Next, he or she does the second suction to draw out a small quantity of blood.

The Health Benefits of Cupping Therapy

According to advocates, cupping increases blood flow to the areas where the cups are placed, making it an effective way to relieve muscle pain and accelerate recovery. Some proponents insist that cupping helps the body repair muscle damage by pulling nutrients into the affected areas, but there’s no hard, scientific data to support the idea.

Alternatives to Cupping Therapy for Muscle Pain
Of course, there are other methods for relieving discomfort that have stronger scientific evidence. An ice compress is an excellent way to relieve sore muscles because the cold helps control inflammation in the affected area. Ointments that contain menthol are especially helpful for soothing stiff, sore muscles.

What natural methods or therapies do you use to relieve muscle soreness? Leave a comment below and tell us!

Lungs Breathing; Chronic lung disease is a term for a group of long-term conditions that affect the lungs. The most common conditions are a chronic obstructive pulmonary disease (COPD, also known as emphysema, chronic bronchitis), asthma, bronchiectasis, cystic fibrosis, pulmonary hypertension, interstitial lung disease, mesothelioma and lung cancer. These diseases are characterized by symptoms such as breathlessness and cough. Physiotherapy plays an important role in the management of lung disease by offering pulmonary rehabilitation (exercise training, education, and support), education on physical activity, airway clearance and breathing exercises.

Wheelchairs are chairs with wheels, used when walking is difficult or impossible due to illness, injury, or disability. Wheelchair Variety comes in different formats to meet the specific needs of their users. They may include specialized seating adaptions, individualized controls, and may be specific to particular activities, as seen with sports wheelchairs and beach wheelchairs. The most widely recognized distinction is between powered wheelchairs (“powerchairs”), where propulsion is provided by batteries and electric motors, and manually propelled wheelchairs, where the propulsive force is provided either by the wheelchair user/occupant pushing the wheelchair by hand (“self-propelled”), or by an attendant pushing from the rear (“attendant propelled”).

Wheelchairs Variety from us

Manual self-propelled wheelchairs
A self-propelled manual wheelchair incorporates a frame, seat, one or two footplates (footrests) and four wheels: usually two caster wheels at the front and two large wheels at the back. There will generally also be a separate seat cushion. The larger rear wheels usually have push-rims of slightly smaller diameter projecting just beyond the Tyre; these allow the user to manoeuvre the chair by pushing on them without requiring them to grasp the tyres. Manual wheelchairs generally have brakes that bear on the tyres of the rear wheels, however, these are solely a parking brake and in-motion braking is provided by the user’s palms bearing directly on the push-rims.
Manual attendant-propelled wheelchairs
An attendant-propelled wheelchair is generally similar to a self-propelled manual wheelchair, but with small diameter wheels at both front and rear. The chair is manoeuvred and controlled by a person standing at the rear and pushing on handles incorporated into the frame. Braking is supplied directly by the attendant who will usually also be provided with a foot- or hand-operated parking brake.
These chairs are common in institutional settings and as loaner-chairs in large public venues. They are usually constructed from steel as the lightweight is less of a concern when the user is not required to self-propel.
Specially designed transfer chairs are now required features at airports in much of the developed world in order to allow access down narrow airliner aisles and facilitate the transfer of wheelchair-using passengers to and from their seats on the aircraft.
Powered wheelchairs
An electric-powered wheelchair, commonly called a “powerchair” is a wheelchair which additionally incorporates batteries and electric motors into the frame and that is controlled by either the user or an attendant, most commonly via a small joystick mounted on the armrest, or on the upper rear of the frame. For users who cannot manage a manual joystick, head switches, chin-operated joysticks, sip-and-puff controllers or other specialist controls may allow independent operation of the wheelchair. Ranges of over 10 miles/15 km are commonly available from standard batteries. Powerchairs are commonly divided by their access capabilities. An indoor-chair may only reliably be able to cross completely flat surfaces, limiting them to household use. An indoor-outdoor chair is less limited but may have restricted range or ability to deal with slopes or uneven surfaces. An outdoor chair is more capable, but will still have a very restricted ability to deal with rough terrain. A very few specialist designs offer a true cross-country capability.
Powerchairs have access to the full range of wheelchair options, including ones which are difficult to provide in an unpowered manual chair but have the disadvantage of significant extra weight. Where an ultra-lightweight manual chair may weigh under 10 kg, the largest outdoor power-chairs may weigh 200 kg or more.
Smaller power chairs often have four wheels, with front or rear wheel drive, but large outdoor designs commonly have six wheels, with small wheels at front and rear and somewhat larger powered wheels in the centre.
Reclining wheelchairs
Reclining or tilt-in-space wheelchairs have seating surfaces which can be tilted to various angles. The original concept was developed by an orthotist, Hugh Barclay, who worked with disabled children and observed that postural deformities such as scoliosis could be supported or partially corrected by allowing the wheelchair user to relax in a tilted position. The feature is also of value to users who are unable to sit upright for extended periods for pain or other reasons. Various designs are now available and wheelchairs with the feature may either tilt the seat-back and leg rests in relation to the seat or may tilt the entire back, seat and leg rest as one, depending on the need of the user. Here are images Of Wheelchair Variety stocked at Othodynamic Ltd

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Button Folding  Height Adjustable Walker

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Walking Crutch stick

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Rollator walking frame

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Commode Seat With Wheels

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Standard Wheelchair With Chromed Steel Frame – Manual

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Commode Wheelchair With Flip Down Armrests & Detachable Footrests

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Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Symptoms of the Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease symptoms often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years.

Other signs and symptoms of the Chronic obstructive pulmonary disease may include:

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Having to clear your throat first thing in the morning, due to excess mucus in your lungs
• A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
• The blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs

People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.

Causes of Chronic obstructive pulmonary disease

The main cause of COPD in developed countries is tobacco smoking. In the developing world, the Chronic obstructive pulmonary disease often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.

Only about 20 to 30 per cent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.

How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).

The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. The chronic obstructive pulmonary disease causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale.

Causes of airway obstruction

Causes of airway obstruction include:

• Emphysema. This lung disease causes the destruction of the fragile walls and elastic fibres of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.
• Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.

Cigarette smoke and other irritants

In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 per cent of smokers may develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes.

Alpha-1-antitrypsin deficiency

In about 1 per cent of people with a Chronic obstructive pulmonary disease, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAT) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can occur in infants and children, not only adults with long smoking histories.

For adults with COPD related to AAT deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAT protein, which may prevent further damage to the lungs.

Risk factors

Risk factors for COPD include:

• Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
• People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more.
• Occupational exposure to dust and chemicals. Long-term exposure to chemical fumes, vapours and dust in the workplace can irritate and inflame your lungs.
• Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.
• Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
• Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

Complications

The chronic obstructive pulmonary disease can cause many complications, including:

• Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.
• Heart problems. For reasons that aren’t fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk.
• Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk.
• High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).
• Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to the development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.

Prevention

Unlike some diseases, COPD has a clear cause and a clear path of prevention. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now.

If you’re a longtime smoker, these simple statements may not seem so simple, especially if you’ve tried quitting — once, twice or many times before. But keep trying to quit. It’s critical to find a tobacco cessation program that can help you quit for good. It’s your best chance for preventing damage to your lungs.

Occupational exposure to chemical fumes and dust is another risk factor for COPD. If you work with this type of lung irritant, talk to your supervisor about the best ways to protect yourself, such as using the respiratory protective equipment.

Diagnosis

The chronic obstructive pulmonary disease is commonly misdiagnosed — former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective.

To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you’ve had to lung irritants — especially cigarette smoke. Your doctor may order several tests to diagnose your condition.

Tests may include:

• Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you’ll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of a disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.
• Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.
• CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer.
• Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.
• Laboratory tests. Laboratory tests aren’t used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAT) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.

Treatment of Chronic obstructive pulmonary disease

A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of a disease, effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Smoking cessation

The most essential step in any treatment plan for COPD is to stop all smoking. It’s the only way to keep COPD from getting worse — which can eventually reduce your ability to breathe. But quitting smoking isn’t easy. And this task may seem particularly daunting if you’ve tried to quit and have been unsuccessful.

Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. It’s also a good idea to avoid secondhand smoke exposure whenever possible.

Medications

Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed.

Bronchodilators

These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both.

Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza).

Inhaled steroids

Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of the Chronic obstructive pulmonary disease. Fluticasone (Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others) are examples of inhaled steroids.

Combination inhalers

Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers.

Oral steroids

For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

Phosphodiesterase-4 inhibitors

A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhoea and weight loss.

Theophylline

This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose-related, and low doses are recommended.

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate Chronic obstructive pulmonary disease symptoms. Antibiotics help treat acute exacerbations, but they aren’t generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn’t clear whether this is due to its antibiotic effect or its anti-inflammatory properties.

Lung therapies

Doctors often use these additional therapies for people with moderate or severe COPD:

• Oxygen therapy. If there isn’t enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options.
• Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice and counselling. You’ll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about a referral to a program.

Managing exacerbations

Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don’t receive prompt treatment.

Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it’s important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing.

When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible.

Surgery

Surgery is an option for some people with some forms of severe emphysema who aren’t helped sufficiently by medications alone. Surgical options include:

• Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival.
• Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it’s a major operation that has significant risks, such as organ rejection, and it’s necessary to take lifelong immune-suppressing medications.
• Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve airflow.

Clinical trials

Lifestyle and home remedies

If you have COPD, you can take steps to feel better and slow the damage to your lungs:

• Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing more efficiently throughout the day. Also be sure to discuss breathing positions and relaxation techniques that you can use when you’re short of breath.
• Clear your airways. With COPD, mucus tends to collect in your air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help.
• Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular exercise can improve your overall strength and endurance and strengthen your respiratory muscles. Discuss with your doctor which activities are appropriate for you.
• Eat healthy foods. A healthy diet can help you maintain your strength. If you’re underweight, your doctor may recommend nutritional supplements. If you’re overweight, losing weight can significantly help your breathing, especially during times of exertion.
• Avoid smoke and air pollution. In addition to quitting smoking, it’s important to avoid places where others smoke. Secondhand smoke may contribute to further lung damage. Other types of air pollution also can irritate your lungs.
• See your doctor regularly. Stick to your appointment schedule, even if you’re feeling fine. It’s important to steadily monitor your lung function. And be sure to get your annual flu vaccine in the fall to help prevent infections that can worsen your COPD. Ask your doctor when you need the pneumococcal vaccine. Let your doctor know if you have worsening symptoms or you notice signs of infection.

Coping and support

Living with COPD can be a challenge — especially as it becomes harder to catch your breath. You may have to give up some activities you previously enjoyed. Your family and friends may have difficulty adjusting to some of the changes.

It can help to share your fears and feelings with your family, friends and doctor. You may also want to consider joining a support group for people with COPD. And you may benefit from counselling or medication if you feel depressed or overwhelmed.

Preparing for your appointment

If your primary care doctor suspects that you have COPD, you’ll likely be referred to a pulmonologist — a doctor who specializes in lung disorders.

What you can do

Before your appointment, you might want to write a list of answers to the following questions:

• What symptoms are you experiencing? When did they start?
• What makes your symptoms worse? Better?
• Does anyone in your family have COPD?
• Have you had any treatment for COPD? If so, what was it and did it help?
• Have you ever taken beta blockers for your high blood pressure or heart?
• Are you being treated for any other medical conditions?
• What medications and supplements do you take regularly?

You might want to have a friend or family member accompany you to your appointment. Often, two sets of ears are better than one when you’re learning about a complicated medical problem, such as COPD. Take notes if this helps.

What to expect from your doctor

Your doctor may ask some of the following questions:

• How long have you had a cough?
• Do you get short of breath easily?
• Have you noticed any wheezing when you breathe?
• Do you or have you ever smoked cigarettes?
• Would you like help in quitting?

Treatment for COPD

Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.

Medication

Bronchodilators are medications that help relax the muscles of the airways so you can breathe easier. They’re usually taken through an inhaler. Glucocorticosteroids can be added to reduce inflammation in the airways.

To lower risk of other respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, and a tetanus booster that includes protection from pertussis or whooping cough.

Oxygen therapy

If your blood oxygen levels are low, you can receive oxygen through a mask or nasal prongs to help you breathe better. A portable unit can make it easier to get around.

Surgery

Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have emphysema. One type of surgery is called bullectomy. That’s when surgeons remove large air sacs (bullae) from the lungs. Another is lung volume reduction surgery, which removes damaged lung tissue.

Lung transplant is an option in some cases.

Lifestyle changes

Certain lifestyle changes may also help alleviate your symptoms or provide relief.

These include:

• If you smoke, quit. Your doctor can recommend appropriate products or support services.
• Whenever possible, avoid secondhand smoke and chemical fumes.
• Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
• Talk to your doctor about how much exercise is safe for you.

 

MEDICATION

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling typically triggers symptoms such as a headache, fever and a stiff neck. Most cases of meningitis are a viral infection, but bacterial and fungal infections are other causes. Some cases improve without treatment in a few weeks. Others can be life-threatening and require emergent antibiotic treatment.

Possible signs and symptoms in anyone older than the age of 2 includes:

• Sudden high fever
• Stiff neck
• A severe headache that seems different than normal
• A headache with nausea or vomiting
• Confusion or difficulty concentrating
• Seizures
• Sleepiness or difficulty waking
• Sensitivity to light
• No appetite or thirst
• Skin rash (sometimes, such as in meningococcal meningitis)

Signs in newborns

Newborns and infants may show these signs:

• High fever
• Constant crying
• Excessive sleepiness or irritability
• Inactivity or sluggishness
• Poor feeding
• A bulge in the soft spot on top of a baby’s head (fontanel)
• Stiffness in a baby’s body and neck

Infants with meningitis may be difficult to comfort, and may even cry harder when held.

When to see a doctor

Seek immediate medical care if you or someone in your family has symptoms, such as:

• Fever
• Severe, unrelenting headache
• Confusion
• Vomiting
• Stiff neck

Bacterial meningitis is serious and can be fatal within days without prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage or death.

It’s also important to talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent getting the infection.

Causes of Meningitis

Viral infections are the most common cause of meningitis, followed by bacterial infections and, rarely, fungal infections. Because bacterial infections can be life-threatening, identifying the cause is essential.

• Bacterial 
• Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or, rarely, after some surgeries. Several strains of bacteria can cause acute bacterial meningitis, most commonly:

• Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, young children and adults. It more commonly causes pneumonia or ear or sinus infections. A vaccine can help prevent this infection.
• Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. These bacteria commonly cause an upper respiratory infection but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that affects mainly teenagers and young adults. It may cause local epidemics in college dormitories, boarding schools and military bases. A vaccine can help prevent infection.
• Haemophilus influenzae (Haemophilus). Haemophilus influenza type b (Hib) bacterium was once the leading cause of bacterial meningitis in children. But new Hib vaccines have greatly reduced the number of cases of this type of meningitis.
• Listeria monocytogenes (listeria). These bacteria can be found in unpasteurized cheeses, hot dogs and luncheon meats. Pregnant women, newborns, older adults and people with weakened immune systems are most susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may be fatal to the baby.

Viral 

Viral meningitis is usually mild and often clears on its own. Most cases are caused by a group of viruses known as enteroviruses, which are most common in late summer and early fall. Viruses such as herpes simplex virus, HIV, mumps, West Nile virus and others also can cause viral meningitis.

Chronic 

Slow-growing organisms (such as fungi and Mycobacterium tuberculosis) that invade the membranes and fluid surrounding your brain cause chronic meningitis. Chronic meningitis develops over two weeks or more. The symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis.

Fungal

Fungal meningitis is relatively uncommon and causes chronic meningitis. It may mimic acute bacterial meningitis. Fungal meningitis isn’t contagious from person to person. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It’s life-threatening if not treated with an antifungal medication.

Other causes

It can also result from noninfectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.

Risk factors

Risk factors include:

• Skipping vaccinations. Risk rises for anyone who hasn’t completed the recommended childhood or adult vaccination schedule.
• Age. Most cases of viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
• Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at greater risk of meningococcal meningitis. This is probably because the bacterium is spread by the respiratory route, and spreads quickly through large groups.
• Pregnancy. Pregnancy increases the risk of listeriosis — an infection caused by listeria bacteria, which also may cause meningitis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
• Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs and other factors that affect your immune system also make you more susceptible to meningitis. Having your spleen removed also increases your risk, and patients without a spleen should get vaccinated to minimize that risk.

Complications

Meningitis complications can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure
• Shock
• Death

With prompt treatment, even patients with severe meningitis can have a good recovery.

Prevention

Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette.

These steps can help prevent meningitis:

• Wash your hands. Careful hand-washing helps prevent germs. Teach children to wash their hands often, especially before eating and after using the toilet, spending time in a crowded public place or petting animals. Show them how to vigorously and thoroughly wash and rinse their hands.
• Practice good hygiene. Don’t share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach children and teens to avoid sharing these items too.
• Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
• Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.
• If you’re pregnant, take care with food. Reduce your risk of listeriosis by cooking meat, including hot dogs and deli meat, to 165 F (74 C). Avoid cheeses made from unpasteurized milk. Choose cheeses that are clearly labelled as being made with pasteurized milk.

Immunizations

Some forms of bacterial meningitis are preventable with the following vaccinations:

• Haemophilus influenza type b (Hib) vaccine. Children should receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don’t have a spleen.
• Pneumococcal conjugate vaccine (PCV13). This vaccine also is part of the regular immunization schedule for children younger than 2 years. Additional doses are recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
• Pneumococcal polysaccharide vaccine (PPSV23). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger adults and children age 2 and up who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anaemia, and for those who don’t have a spleen.
• Meningococcal conjugate vaccine. The Centers for Disease Control and Prevention recommends that a single dose is given to children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between ages 13 and 15, the booster shot is recommended between ages 16 and 18. If the first shot is given at age 16 or older, no booster is necessary. This vaccine can also be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It’s approved for use in children as young as 9 months old. It’s also used to vaccinate healthy but previously unvaccinated people who have been exposed to outbreaks.

Diagnosis

Your family doctor or paediatrician can diagnose based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine.

You or your child may undergo the following diagnostic tests:

• Blood cultures. Blood samples are placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide and stained (Gram’s stain), then studied under a microscope for bacteria.
• Imaging. Computerized tomography (CT) or magnetic resonance (MR) scans of the head may show swelling or inflammation. X-rays or CT scans of the chest or sinuses may also show infection in other areas that may be associated with meningitis.
• Spinal tap (lumbar puncture). For a definitive diagnosis of meningitis, you’ll need a spinal tap to collect cerebrospinal fluid (CSF). In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein.CSF analysis may also help your doctor identify which bacterium caused meningitis. If your doctor suspects viral meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification or a test to check for antibodies against certain viruses to determine the specific cause and determine proper treatment.

Treatment

The treatment depends on the type you or your child has.

Bacterial

Acute bacterial meningitis must be treated immediately with intravenous antibiotics and, more recently, corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.

The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of meningitis.

Your doctor may drain any infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear.

Viral 

Antibiotics can’t cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild cases of viral meningitis usually includes:

• Bed rest
• Plenty of fluids
• Over-the-counter pain medications to help reduce fever and relieve body aches

Your doctor may prescribe corticosteroids to reduce swelling in the brain, and an anticonvulsant medication to control seizures. If a herpes virus caused your meningitis, an antiviral medication is available.

Other types of meningitis

If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while the cause is determined.

Chronic meningitis is treated based on the underlying cause. Antifungal medications treat fungal meningitis and a combination of specific antibiotics can treat tuberculous meningitis. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal. Chronic meningitis is treated based on the underlying cause.

Noninfectious meningitis due to an allergic reaction or autoimmune disease may be treated with corticosteroids. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer-related meningitis requires therapy for individual cancer.

Preparing for your appointment

Meningitis can be life-threatening, depending on the cause. If you’ve been exposed to bacterial meningitis and you develop symptoms, go to an emergency room and let medical staff know you may have meningitis.

If you’re not sure what you have and call your doctor for an appointment, here’s how to prepare for your visit.

What you can do

• Be aware of any pre- or post-appointment restrictions. Ask if there’s anything you need to do in advance, such as restrict your diet. Also, ask if you may need to stay at your doctor’s office for observation following your tests.
• Write down symptoms you’re having, including changes in your mood, thinking or behaviour. Note when you developed each symptom and whether you had cold or flu-like symptoms.
• Write down key personal information, including any recent moves, vacations or interactions with animals. If you’re a college student, your doctor likely will ask questions about any similar signs or symptoms in your roommates and dorm mates. Your doctor will also want to know about your vaccination history.
• Make a list of all medications, vitamins or supplements you’re taking.
• Take a family member or friend along. Meningitis can be a medical emergency. Take someone who can help remember all the information your doctor provides and who can stay with you if needed.
• Write down questions to ask your doctor.

For meningitis, some basic questions to ask your doctor include:

• What kinds of tests do I need?
• What treatment do you recommend?
• Am I at risk of long-term complications?
• If my condition is not treatable with antibiotics, what can I do to help my body recover?
• Am I contagious? Do I need to be isolated?
• What is the risk to my family? Should they take preventive medication?
• Is there a generic alternative to the prescription medicine you’re recommending?
• Do you have any printed information I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you begin experiencing symptoms?
• How severe are your symptoms? Do they seem to be getting worse?
• Does anything seem to improve your symptoms?
• Have you been exposed to anyone with meningitis?
• Does anyone in your household have similar symptoms?
• What is your vaccination history?
• Do you take any immunosuppressant medications?
• Do you have other health problems, including allergies to any medications?

What you can do in the meantime

When you call your doctor’s office for an appointment, describe the type and severity of your symptoms. If your doctor says you don’t need to come in immediately, rest as much as possible while you’re waiting for your appointment.

Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever and body aches. Also, avoid any medications that may make you less alert. Don’t go to work or school.

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Cerebral palsy is a disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain, most often before birth.

Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these.

People with cerebral palsy may have problems swallowing and commonly have eye muscle imbalance, in which the eyes don’t focus on the same object. People with cerebral palsy also may suffer a reduced range of motion at various joints of their bodies due to muscle stiffness.

Cerebral palsy’s effect on functional abilities varies greatly. Some affected people can walk while others can’t. Some people show normal or near-normal intellectual capacity, but others may have intellectual disabilities. Epilepsy, blindness or deafness also may be present.

Symptoms of Cerebral palsy

Signs and symptoms can vary greatly. Movement and coordination problems associated with cerebral palsy may include:

• Variations in muscle tone, such as being either too stiff or too floppy
• Stiff muscles and exaggerated reflexes (spasticity)
• Stiff muscles with normal reflexes (rigidity)
• Lack of muscle coordination (ataxia)
• Tremors or involuntary movements
• Slow, writhing movements (athetosis)
• Delays in reaching motor skills milestones, such as pushing up on arms, sitting up alone or crawling
• Favouring one side of the body, such as reaching with only one hand or dragging a leg while crawling
• Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
• Excessive drooling or problems with swallowing
• A difficulty with sucking or eating
• Delays in speech development or difficulty speaking
• A difficulty with precise motions, such as picking up a crayon or spoon
• Seizures

The disability associated with cerebral palsy may be limited primarily to one limb or one side of the body, or it may affect the whole body. The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, muscle shortening and muscle rigidity may worsen if not treated aggressively.

Brain abnormalities associated with cerebral palsy also may contribute to other neurological problems. People with cerebral palsy may also have:

• A difficulty with vision and hearing
• Intellectual disabilities
• Seizures
• Abnormal touch or pain perceptions
• Oral diseases
• Mental health (psychiatric) conditions
• Urinary incontinence

When to see a doctor

It’s important to get a prompt diagnosis for any movement disorder or possible delays in your child’s development. See your child’s doctor if you have any questions or concerns about episodes of loss of awareness of surroundings or of abnormal bodily movements (also known as seizures), abnormal muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.

Causes

Cerebral palsy is caused by an abnormality or disruption in brain development, usually before a child is born. In many cases, the exact trigger isn’t known. Factors that may lead to problems with brain development include:

• Mutations in genes that lead to abnormal brain development
• Maternal infections that affect the developing fetus
• Fetal stroke, a disruption of blood supply to the developing brain
• Infant infections that cause inflammation in or around the brain
• Traumatic head injury to an infant from a motor vehicle accident or fall
• Lack of oxygen to the brain (asphyxia) related to difficult labour or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

Risk factors

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or health problems during pregnancy can significantly increase the cerebral palsy risk to the baby. Infections of particular concern include:

• German measles (rubella). Rubella is a viral infection that can cause serious birth defects. It can be prevented with a vaccine.
• Chickenpox (varicella). Chickenpox is a contagious viral infection that causes itching and rashes, and it can cause pregnancy complications. It too can be prevented with a vaccine.
• Cytomegalovirus. Cytomegalovirus is a common virus that causes flu-like symptoms and may lead to birth defects if a mother experiences her first active infection during pregnancy.
• Herpes. Herpes infection can be passed from mother to child during pregnancy, affecting the womb and placenta. Inflammation triggered by infection may then damage the unborn baby’s developing nervous system.
• Toxoplasmosis. Toxoplasmosis is an infection caused by a parasite found in contaminated food, soil and the faeces of infected cats.
• Syphilis. Syphilis is a sexually transmitted bacterial infection.
• Exposure to toxins. Exposure to toxins, such as methylmercury, can increase the risk of birth defects.
• Zika virus infection. Infants for whom maternal Zika infection causes microcephaly can develop cerebral palsy.
• Other conditions. Other conditions may increase the risk of cerebral palsy, such as thyroid problems, intellectual disabilities or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

• Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
• Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
• Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.

Other factors of pregnancy and birth

While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:

• Breech births. Babies with cerebral palsy are more likely to be in a feet-first position (breech presentation) at the beginning of labour rather than headfirst.
• Complicated labour and delivery. Babies who exhibit vascular or respiratory problems during labour and delivery may have existing brain damage or abnormalities.
• Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drop.
• Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. If one or more of the babies die, the chance that the survivors may have cerebral palsy increases.
• Premature birth. A normal pregnancy lasts 40 weeks. Babies born fewer than 37 weeks into the pregnancy are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
• Rh blood type incompatibility between mother and child. If a mother’s Rh blood type doesn’t match her baby’s, her immune system may not tolerate the developing baby’s blood type and her body may begin to produce antibodies to attack and kill her baby’s blood cells, which can cause brain damage.

Complications

Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or later during adulthood, including:

• Contracture. Contracture is muscle tissue shortening due to severe muscle tightening (spasticity). Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation.
• Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This may cause impaired growth and weaker bones. Some children may need a feeding tube for adequate nutrition.
• Mental health conditions. People with cerebral palsy may have mental health (psychiatric) conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression.
• Lung disease. People with cerebral palsy may develop lung disease and breathing disorders.
• Neurological conditions. People with cerebral palsy may be more likely to develop movement disorders or worsened neurological symptoms over time.
• Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of painful degenerative bone disease (osteoarthritis).
• Osteopenia. Fractures due to low bone density (osteopenia) can stem from several common factors such as lack of mobility, nutritional shortcomings and antiepileptic drug use.
• Eye muscle imbalance. This can affect visual fixation and tracking; an eye specialist should evaluate suspected imbalances.

Prevention

Most cases of cerebral palsy can’t be prevented, but you can lessen risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:

• Make sure you’re vaccinated. Vaccination against diseases such as rubella may prevent an infection that could cause fetal brain damage.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that may result in cerebral palsy.
• Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
• Practice good child safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on beds and appropriate supervision.

Diagnosis

If your family doctor or paediatrician suspects your child has cerebral palsy, he or she will evaluate your child’s signs and symptoms, review your child’s medical history, and conduct a physical evaluation. Your doctor may refer you to a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist).

Your doctor will also order a series of tests to make a diagnosis and rule out other possible causes.

Brain Scans

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests may include the following:

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of your child’s brain. An MRI can often identify any lesions or abnormalities in your child’s brain. This test is painless, but it’s noisy and can take up to an hour to complete. Your child will likely receive a mild sedative beforehand. An MRI is usually the preferred imaging test.
• Cranial ultrasound. This can be performed during infancy. A cranial ultrasound uses high-frequency sound waves to obtain images of the brain. An ultrasound doesn’t produce a detailed image, but it may be used because it’s quick and inexpensive, and it can provide a valuable preliminary assessment of the brain.

Electroencephalogram (EEG)

If your child has had seizures, your doctor may order an electroencephalogram (EEG) to determine if he or she has epilepsy, which often occurs in people with cerebral palsy. In an EEG test, a series of electrodes are affixed to your child’s scalp.

The EEG records the electrical activity of your child’s brain. If he or she has epilepsy, it’s common for there to be changes in normal brain wave patterns.

Laboratory tests

Laboratory tests may also screen for genetic or metabolic problems.

Additional tests

If your child is diagnosed with cerebral palsy, you’ll likely be referred to specialists for assessments of other conditions often associated with the disorder. These tests may identify:

• Vision impairment
• Hearing impairment
• Speech delays or impairments
• Intellectual disabilities
• Other developmental delays
• Movement disorders

Treatment

Children and adults with cerebral palsy require long-term care with a medical care team. This team may include:

• Paediatrician or physiatrist. A paediatrician oversees the treatment plan and medical care.
• Pediatric neurologist. A doctor trained to diagnose and treat children with brain and nervous system (neurological) disorders may be involved in your child’s care.
• Orthopaedic surgeon. A doctor trained to treat muscle and bone disorders may be involved to diagnose and treat muscle conditions.
• Physical therapist. A physical therapist may help your child improve strength and walking skills, and stretch muscles.
• Occupational therapist. An occupational therapist can provide therapy to your child to develop daily skills and to learn to use adaptive products that help with daily activities.
• Speech-language pathologist. A doctor trained to diagnose and treat speech and language disorders may work with your child if your child suffers from speech, swallowing or language difficulties.
• Developmental therapist. A developmental therapist may provide therapy to help your child develop age-appropriate behaviours, social skills and interpersonal skills.
• Mental health specialist. A mental health specialist, such as a psychologist or psychiatrist, may be involved in your child’s care. He or she may help you and your child learn to cope with your child’s disability.
• Recreation therapist. Participation in art and cultural programs, sports, and other events that help children expand physical and cognitive skills and abilities. Parents of children often note improvements in a child’s speech, self-esteem and emotional well-being.
• Social worker. A social worker may assist your family to find services and plan for care transitions.
• Special education teacher. A special education teacher addresses learning disabilities determines educational needs and identifies appropriate educational resources.

Medications

Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

It’s important to talk about drug treatment risks with your doctor and discuss whether medical treatment is appropriate for your child’s needs. Medication selection depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:

• Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend onabotulinumtoxinA (Botox) injections directly into the muscle, nerve or both. Botox injections may help to improve drooling. Your child will need injections about every three months. Side effects may include pain, mild flu-like symptoms, bruising or severe weakness. Other more serious side effects include difficulty breathing and swallowing.
• Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen). Diazepam carries some dependency risk, so it’s not recommended for long-term use. Its side effects include drowsiness, weakness and drooling. Dantrolene side effects include sleepiness, weakness, nausea and diarrhoea. Baclofen side effects include sleepiness, confusion and nausea. Note that baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.

Your child also may be prescribed medications to reduce drooling. Medications such as trihexyphenidyl, scopolamine or glycopyrrolate (Robinul, Robinul Forte) may be helpful, as can Botox injection into the salivary glands.

Therapies

A variety of nondrug therapies can help a person with cerebral palsy enhance functional abilities:

• Physical therapy. Muscle training and exercises may help your child’s strength, flexibility, balance, motor development and mobility. You’ll also learn how to safely care for your child’s everyday needs at home, such as bathing and feeding your child. For the first 1 to 2 years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments. Braces or splints may be recommended for your child. Some of these supports help with function, such as improved walking. Others may stretch stiff muscles to help prevent rigid muscles (contractures).
• Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child’s independent participation in daily activities and routines in the home, the school and the community. Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.
• Speech and language therapy. Speech-language pathologists can help improve your child’s ability to speak clearly or to communicate using sign language. Speech-language pathologists can also teach your child to use communication devices, such as a computer and voice synthesizer if communication is difficult. Another communication device may be a board covered with pictures of items and activities your child may see in daily life. Sentences can be constructed by pointing to the pictures. Speech therapists may also address difficulties with muscles used in eating and swallowing.
• Recreational therapy. Some children may benefit from recreational therapies, such as therapeutic horseback riding. This type of therapy can help improve your child’s motor skills, speech and emotional well-being.

Surgical or other procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

• Orthopaedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms, hips or legs in their correct positions. Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. The procedures may also make it easier to use a walker, braces or crutches.
• Severing nerves. In some severe cases, when other treatments haven’t helped, surgeons may cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can also cause numbness.

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Parkinson’s Disease is a neurodegenerative brain disorder that progresses slowly in most
people. Symptoms can take years to develop, and most people live for many years with
the disease. The symptoms caused by Parkinson’s include an ongoing loss of motor
control (resting tremors, stiffness, slow movement, postural instability) as well as a
wide range of non-motor symptoms (such as depression, loss of sense of smell, gastric
problems, cognitive changes and many others).
Although Parkinson’s Disease is not fatal, the complications caused
by Parkinson’s are a leading cause of death. The average age
of diagnosis is around 60, but approximately 15% of people with Parkinson’s Disease are
diagnosed before age 50 and are said to have young-onset Parkinson’s disease.

What is Parkinsonism?

Parkinsonism is a general term that refers to a group of neurological disorders that
cause movement problems similar to those seen in Parkinson’s Disease, such as
tremors, slow movement, and stiffness. Under the category of Parkinsonism, there are a
number of disorders, some of which have yet to be clearly defined or named. Early in the
disease process, it is often hard to know whether a person has idiopathic (meaning “of
unknown origins”) Parkinson’s Disease or a syndrome that mimics it. Parkinsonisms, also
known as atypical Parkinson’s Disease or Parkinson’s plus, represent about 10% of all
diagnosed cases of Parkinsonism (about 100,000 individuals). They tend to progress
more rapidly than Parkinson’s, present with additional symptoms such as early falling,
dementia or hallucinations, and do not respond or respond only for a short time to
levodopa therapy.
Following are descriptions of some of the most common Parkinson’s plus disorders.
It is important to remember that many people will not exhibit the cardinal symptoms
necessary for a diagnosis of a specific disorder and will simply be labelled “Parkinsonism.”

Drug-Induced Parkinsonism can be difficult to distinguish from Parkinson’s, though
the tremors and postural instability may be less severe. It is usually the side effect of
drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium
channel blockers and stimulants like amphetamines and cocaine. If the affected
person stops taking the drug(s), symptoms usually subside over time but may take as
long as 18 months to do so.

Progressive Supranuclear Palsy (PSP) is slightly more common than ALS (also
called Lou Gehrig disease). Symptoms usually begin in the early 60s. Common early
symptoms include forgetfulness, personality changes, and loss of balance while
walking that results in unexplained falls. The visual problems associated with PSP
generally occur three to five years after the walking problems and involve the inability
to aim the eyes properly because of weakness or paralysis of the muscles that move
the eyeballs. Individuals with PSP may have some response to dopaminergic treatment
but may require higher doses than patients with Parkinson’s disease.

Multiple System Atrophy (MSA) (also referred to as Shy-Drager syndrome) is the
term for a group of disorders in which one or more systems in the body stop working.
In MSA, the autonomic nervous system is often severely affected early in the course of
the disease. Symptoms include bladder problems resulting in urgency, hesitancy or
incontinence and orthostatic hypotension (nOH). In nOH, the blood pressure drops so
low when standing that fainting or near fainting can occur. When lying down, the
person’s blood pressure can be quite high. For men, the earliest sign may be a loss of
erectile function. Other symptoms that may develop include impaired speech,
difficulties with breathing and swallowing and inability to sweat. Like the other
Parkinsonisms, MSA symptoms either don’t respond very much or don’t respond at all
to Parkinson’s medications.

Vascular Parkinsonism is usually caused by clotting in the brain from multiple small
strokes. People with vascular Parkinsonism tend to have more problems with gait than
tremor and have more problems in the lower body. The disorder progresses very
slowly in comparison to other types of Parkinsonism. People might report an abrupt
onset of symptoms or step-wise deterioration (symptoms get worse then plateau for a
while). Symptoms of vascular Parkinsonism may or may not respond to levodopa.

Dementia with Lewy bodies (DLB) is second only to Alzheimer’s as the most common
cause of dementia in the elderly. It causes progressive intellectual and functional
deterioration. In addition to the signs and symptoms of Parkinson’s disease, people
with DLB tend to have frequent changes in thinking ability, level of attention or
alertness and visual hallucinations. They usually do not have a tremor or have only a
slight tremor. The Parkinsonian symptoms may or may not respond to levodopa.

Corticobasal degeneration (CBD) is the least common atypical Parkinsonism. It
usually develops after age 60. Symptoms include a loss of function on one side of the
body, involuntary and jerky movements of a limb and speech problems. It may become
difficult or impossible to use the affected limb, although there is no weakness or
sensory loss. The individual may feel as if the limb is not under his/her voluntary
control. There is no specific treatment at this time for CBD.

Diagnosis of Parkinson’s Disease

There is no definitive test to detect Parkinson’s disease or Parkinsonism. For diagnosis,
doctors take a thorough medical history and may request a number of movement tests.
Because of the observational nature of the diagnosis, Parkinson’s can sometimes be
confused with Parkinsonism, and the diagnosis may need to be revised over time-based
on a speed of disease progression, response to medications and other factors. All the
Parkinsonisms have a loss of dopamine, so a DatScan cannot be used to differentiate
between them and idiopathic Parkinson’s disease.

Treatment of Parkinson’s Disease

There is overlap in treatment for Parkinson’s and Parkinsonisms. Dopaminergic therapy
(the first line treatment for Parkinson’s) can be effective in some Parkinsonisms. Other
common treatments for both Parkinson’s and Parkinsonisms include physical therapy,
occupational therapy and speech therapy; antidepressants and botulinum toxin (Botox) for
dystonia. For all the conditions, healthcare providers aim to treat the symptoms that
most affect a person’s quality of life.

What should I do next?

If you or a loved one is unsure if you have Parkinson’s disease or a form of Parkinsonism,
make an appointment with a movement disorders specialist (MDS). An MDS is a
neurologist who has completed specialized training in Parkinson’s disease and other
movement disorders including the Parkinsonisms discussed in this article.