The majority of neurological diseases present in the natural course of the disease as conditions that cause disability and make patients dependent on daily life activities. For this reason, an intensive rehabilitation program should be implemented from the early stages to ensure physical independence in neurological diseases.
In the past, it was believed that damaged nerve tissue had almost no capacity to repair itself and that lost functions could not be replaced again. Nowadays, it has been shown that the nerve tissue that has lost its functions has the function of repairing itself after the event, and that the brain tissue has the ability to adapt and restructure to environmental effects, experiences and tissue changes caused by damage. Recent studies have shown that exercises based on intense use of the extremity and task-specific exercises applied in the early period (especially in the first 3 months) provide improvement in limb functions by restructuring the brain, that is, by creating new neural networks.
In stroke (cerebral palsy) patients. Rehabilitation evaluation should be made within 48 hours for strokes due to vascular occlusion, and within 5 days for strokes due to bleeding. Since many of the clinical problems in stroke patients arise from inactivity and deconditioning, movement as early as possible is essential.
The risk of complications due to inactivity is increased in neurological diseases. Decrease in muscle strength and wasting of muscles, decrease in muscle endurance, abnormal shortening of muscle or tendon tissue, loss of bones due to lack of load on the bones, calcification in joints, decrease in heart functions, decrease in blood pressure due to position change, lung problems (respiratory distress, infection), loss of appetite, Complications such as constipation, pressure sores on the skin, restlessness, increased irritability, insomnia, decrease in pain threshold, depression, intellectual regression, loss of attention and motivation may develop due to inactivity.
In summary, in the light of current information, exercise provides restructuring in the brain, It was concluded that it improves cognitive, sensory and behavioral functions. It also regenerates in the brain Exercise has an unquestionably important place in preventing and reducing neurological disorders and other complications caused by sedentary life, along with aging.
STROKE REHABILITATION
Stroke is a set of clinical conditions that occur suddenly and can range from weakness, sensory impairment, balance disorder, speech and mental function loss, vision problems to coma due to occlusion or bleeding of the brain vessels. Stroke means loss of voluntary movement and paralysis in the right or left half of the body. It is the second most common cause of death after heart diseases. Age, gender and genetic predisposition are risk factors that cannot be changed. The risk increases from the age of 55. The risk is higher in men than in women.
Modifiable risk factors include high blood pressure, cardiovascular diseases, heart rhythm disorders, diabetes, high cholesterol, smoking, alcohol, weight, and inactivity.
Patients with acute stroke due to vascular occlusion should be evaluated for rehabilitation within 48 hours, and patients with stroke due to bleeding should be evaluated for rehabilitation within five days. For a comprehensive rehabilitation program, the severity of the stroke and movement, self-care, communication, bladder and bowel control, swallowing, cognitive status, communication ability, physical condition should be evaluated and achievable goals should be determined. Treatments should be carried out with sufficient intensity and task-specific training should be provided. In rehabilitation, methods such as maintaining joint range of motion, flexibility, strengthening, coordination and endurance, neurophysiological treatment, walking, balance exercises, compulsory use treatment, electrical stimulation and acupuncture are used. Care should be taken to ensure that each learned movement becomes a part of daily life activities. The aim is to make the patient independent in self-care activities such as eating, cleaning, dressing and undressing.
CEREBRAL PALSY REHABILITATION
Cerebral palsy is one of the leading causes of disability in childhood. It is a physical developmental disorder that occurs after damage to the immature brain in the womb and in the neonatal period. Permanent brain damage does not progress. With this Movement, tone, posture and balance coordination disorders change over time. Physical disability may be accompanied by sensory-perception, mental, communication and behavioral problems, seizures and musculoskeletal system disorders.
The frequency of cerebral palsy is reported to be 2-3 per 1000 live births in the society. Genetics, lack of oxygen to the brain tissue, infection, traumatic or metabolic reasons can cause damage to the immature brain tissue. Brain damage can occur before, during and after birth. 70-80% of cerebral palsy occurs before birth, less than 10% occurs during birth, and 10-20% occurs due to postnatal causes. Frequently, the cause cannot be determined in most of the cases in the prenatal period. During birth, the cause is often birth trauma and lack of oxygen to the brain.
The most common form is the spastic type, accompanied by excessive contractions in the arms and legs. Additionally, there may be athetoid or ataxic types with involuntary movements. Mental retardation may occur in up to 30% of cerebral palsy.
The first symptoms are usually detected by the delay in sitting and standing during the child's development. Parents need to be very careful about this. It is necessary to know the child's development calendar and follow it. The main stages in the development of a healthy child can be summarized as follows; At 2 months old, he can hold his head while sitting. At 6 months, he can sit without support. He can walk on his own when he is 12 - 15 months old.
If there is a delay in these developments, if there are abnormal contractions in the arms and legs, if there is significant squint in the eyes, if there is dullness in the gaze, it is necessary to consult a specialist doctor immediately. After diagnosis, a rehabilitation program should be started as soon as possible. Treatment of a child with cerebral palsy is a team effort. In this team, in addition to the physical therapy and rehabilitation specialist, the physiotherapist, occupational therapist, parents, special educator, orthopedist, orthotist and psychologist should undertake separate duties. Rehabilitation of a child with cerebral palsy is an extremely complex process. Physical therapy and occupational therapy methods, neurodevelopmental treatment, gaining functional skills, assistive walking devices called orthoses and adapted tools constitute general rehabilitation methods.
MUSCLE DISEASES REHABILITATION
Myopathies may occur due to hereditary, acquired and systemic diseases. It is a group of diseases characterized by progressive degeneration of skeletal muscles without any disorder in the nervous system, causing muscle weakness and wasting.
Duchenne muscular dystrophy (DMD)
DMD. It is the most common and most severe muscular dystrophy. Mutation in the dystrophin gene causes the disease. It is seen in 1 in 3500 male births. Affected boys are usually normal at birth. Difficulty keeping the head upright may be the first sign of muscle weakness. Motor development such as rolling over, sitting, crawling and standing may be carried out in accordance with the age of the child or may be slightly delayed. The disease starts insidiously. The disease is usually noticed around the age of 3-4. The earliest symptoms are delay in walking and running, frequent falls, and enlargement of the calf muscles. After the child squats on the ground, he gets up by holding on. This finding is known as the Gowers sign. Around the age of 5, a duck-like gait is observed due to the involvement of bilateral hip muscles. Around the age of 7-12, untreated patients become wheelchair dependent. Scoliosis is an important problem due to the disproportionate weakness of the back and waist muscles. Life expectancy is 20-25 years. There is no treatment that provides complete relief. With a rehabilitation program, it is possible to prevent complications, preserve function, and achieve a reasonable quality of life. The family should be informed about progressive muscle weakness, decreasing endurance, deterioration in mobility and lung functions, limitations in the extremities, scoliosis, and heart failure due to heart muscle involvement.
Becker muscular dystrophy (BMD)
It has a milder clinical course than DMD. It is seen in 3-6 people per 100,000 in the male population. Weakness is seen in the same muscles as in DMD, but the age of onset is later (10-15 years). Around the age of 15-20, increasing muscle weakness and enlargement of the calf muscles develop. Difficulty climbing stairs and heart problems occur in the thirties. They can walk until the age of 25-45. Approximately 70% of patients have heart muscle involvement.
After the diagnosis is made in rehabilitation, it is necessary to treat or slow down the disease, prevent complications and It is aimed to increase the quality of m. For this purpose, exercise prescriptions and orthoses are used depending on the type of myopathy, the area of involvement and its severity.
MULTIPLE SCLEROSIS REHABILITATION
Multiple sclerosis (MS) is a disease of the myelin sheath surrounding the nerves. Nerve cells and axons may be affected. The disease is usually seen in women who live in cities and have high education and socio-economic levels. It is considered an autoimmune disease that can be caused by many infection, genetic, hormonal and environmental factors. The age of onset is common in young adulthood (10-50 years of age). It is approximately twice as common in women than in men. Signs and symptoms vary depending on the affected area. In cases of brain and spinal cord involvement, weakness in the arms and legs may develop. Fatigue, sleep disturbance, and cognitive disorders may occur. Affective disorders may be observed. Optic nerve inflammation, which is usually unilateral and causes pain with eye movements, is the most common condition. It causes deterioration in visual pathways. Speech and swallowing disorders may occur due to involvement of the muscles in the neck area. Tremors and balance disorders may occur due to the cerebellum being affected.
The basis of rehabilitation practices is exercises. Decreased physical activity and exercise in people with MS causes muscle strength, decreased condition, increased muscle tension, fatigue, anxiety and depression. Inactivity aggravates the clinic even more. Exercise type, duration and frequency are determined by the physical therapy and rehabilitation specialist according to the patient's medical condition. Exercise practices can have a positive effect on patients with MS. Studies have shown that exercise reduces inflammation in the nerve sheath. The classical rehabilitation program consists of stretching, balance, coordination, breathing, transfer and walking exercises to maintain joint range of motion, increase muscle strength, and eliminate joint limitations. Since MS will last a lifetime, exercises should be continued for a long time.
Read: 0
