Motor Neuron Disease (MND) is a condition which affects the nerve cells (neurons), causing weakness in the muscles that gets worse and eventually leads to paralysis.
The cause is not known, although around 1 in 10 cases are ‘familial’ (meaning the condition is inherited).
Early diagnosis of MND can present similarly to other neurological conditions (i.e. Multiple Sclerosis).
MND usually starts slowly, sometimes starting on one side of the body and then spreading. Usually, the first things people notice are:
- weakness in the hands and grip
- slurred speech
- weakness in the legs, and a tendency to trip
- weakness of the shoulder, making lifting difficult
- cramps and muscles twitching
Later on, people with MND:
- have little or no movement
- have trouble talking, breathing and swallowing
A few people with MND develop a type of dementia.
MND leads to degeneration of the motor neurons and eventually leads to loss of function in muscles. MND primarily affects a person’s ability to move, speak and swallow.
At Total Health Physio, we have a caring and empathetic team of Physiotherapists and Occupational Therapists who possess clinical experience treating MND patients.
Although there is no treatment that can halt or reverse the progression of the disease, with Trust, Compassion and Care we work with MND patients to help them live as independently as possible and maintain muscle function for as long as possible. We work with our MND patients to help them live a more meaningful life.
Although there is no treatment that can halt or reverse this progressive condition, there are many opportunities for interventions that can lead to improved quality of life for the patient and caregiver. Physical and occupational therapy can assist with mobility and activities of daily living.
Total Health Physio has the ability to liaise with Speech Pathologists if there are swallowing issues or other speech impairments. Interventions by speech pathology can optimise nutrition and communication. We have relationships with experienced speech pathologists in Melbourne and are happy to recommend these services to help work together as a multidisciplinary team to achieve the best outcomes for our patients.
Physiotherapy for MND
The basic goal of Physiotherapy is to help the patient maintain as much functional capacity as possible, ideally within a short period of time.
We provide clinically sound, evidence-based rehabilitation for each patient. We also prescribe an exercise program the individual can complete on their own or with a family member.
We help individuals reduce their pain and optimise their movement to improve mobility. We work with patients on their weaknesses and aim to help reduce the rate of decline.
The frequency of Physiotherapy sessions would vary depending on the progression of the condition and meaningful goals of the person.
Occupational Therapy for MND
Our OTs work to optimise the person’s movement and independence in their residence and community.
Our OTs specifically help with
- Environmental assessments
- Identifying and reviewing assistive equipment
- Minor home modifications (i.e. bathroom and kitchen safety).
- Optimising movement in the environment
MND patients may experience peripheral neuropathy (weakness of the hands and legs) which is a facet our OTs are experienced with.
Our OTs can assist with the manual handling component (i.e. training the care staff how to move the patient safely).
Motor Neuron Disease FAQ
Can you describe upper and lower motor neurons?
Upper motor neurons are located in the brain and spinal cord, these send signals from the brain to the lower motor neurons.
Lower motor neurons are located in the brain stem (the brainstem is a lower part of the brain near the spinal cord) and spinal cord. Lower motor neurons receive and transmit signals from the upper motor neurons to nerve endings in muscles. Lower motor neurons are responsible for activating and contracting muscles.
MND is a progressive condition which means the severity of the symptoms can vary. MND can affect upper and lower neurons individually or simultaneously.
Can you give an example of exercises the person can perform with their care staff?
When prescribing exercises to a person to do themselves, or with the assistance of care staff, we are very mindful of safety.
We may prescribe grip-strength related rehabilitation. This could be assisting the person to squeeze a stress ball in their hand, because that improves and strengthens the finger flexes.
How does Physiotherapy improve the respiratory component?
We apply respiratory/cardiothoracic Physiotherapy principles to achieve optimal lung capacity for our patients.
We often do breathing exercises in our Physiotherapy sessions and incorporate cardio exercises that can increase heart rate to help improve overall fitness. We continually assess oxygen levels using portable handheld oxygen saturation monitors.
For patients with Motor Neuron Disease or lifelong disabilities, is your service ongoing? Do you ever work with people for a short time frame?
This largely depends on status, goals and funding. At times, we may simply be engaged to perform a rehabilitation program (approx 4-12 weeks) or prescribe a single piece of assistive equipment, in which case our service length is quite short. On the other hand, we can work with MND patients on an ongoing basis.
A patient may be on an insurance scheme (i.e.Home Care Package or NDIS) and have funding in their package for a certain amount of core supports, and we advocate for them to have as much Physiotherapy as possible to maintain their function in order to allow them to live a more meaningful life..
Some individuals may be privately funded, so we provide our recommendations according to their budget and take into consideration the frequency and duration of our service based on achieving realistic goals.
There are also individuals with care staff who can perform our prescribed exercises and rehabilitation with them, so we may visit less frequently and just continuously review the program. Total Health Physio also has an amazing personal trainer we can engage with the patient.
We pride ourselves on working with patients we can create realistic, positive outcomes for.
What outcome measures would you use to test the effectiveness of your therapy?
For readers who are unfamiliar, outcome measures are various testing tools Physiotherapists use to evaluate the degrees of disabilities. These outcome measures are standardised and endorsed by the Physiotherapy community.
We use outcome measures as both initial assessment and reassessment tools, allowing us to set the benchmark to measure the effectiveness of our treatment.
In general, for MND patients we may use:
- Functional Rating Index – 10 questions relating to pain intensity, frequency of pain, sleeping, personal care, travel, work, recreation, lifting, walking & standing.
- Low Extremity Functional Scale (LEFS) – 20 questions relating to a person’s ability to perform everyday activities. This test is intended to measure initial function, progress and outcomes specific to their lower extremities (leg, ankle and foot).
- Time Walk Test – Using this test, we would measure how far someone can walk in a certain period of time. We would also measure how many rests the person had, and also measure the respiratory rate (i.e. if the participant is short of breath).
Total Health Physio uses outcome measures such as these to measure the effectiveness of our compassionate healthcare services!