How to treat motor neuron disease with occupational therapy?

The main purpose of occupational therapy for this disease is to delay the progress of the disease, flexibly apply residual functions, and promote patients to maintain their daily lives and lead meaningful lives. The main objectives of occupational therapy are: ① to maintain function (muscle endurance to prevent disuse and overuse); (2) Ensure daily activities (posture maintenance and self-help); ③ Methods to ensure communication; ④ Psychological support for patients and their families (see Table 8-2-4).

Table 8-2-4 Contents of ALS Exercise Therapy and Occupational Therapy

(A) the purpose and function of treatment

Although rehabilitation training has no obvious effect on symptoms such as muscle atrophy, myasthenia and dyskinesia directly caused by motor neuron degeneration, it has a good effect on disuse motor dysfunction caused by limb inactivity. Through proper rehabilitation treatment, most patients can see a temporary improvement in motor function. At the same time, it can effectively delay the decline of motor function. The purpose of occupational therapy for this kind of patients is to maintain and prolong the time of daily activities and prolong the survival time. Therefore, the prescription of occupational therapy must be formulated and applied according to the individual differences of each patient's functional status. If muscle strength enhancement training and resistance activities are carried out, symptoms may be aggravated. Therefore, all training activities should be relaxed to avoid fatigue. It can achieve the purpose of preventing contracture and maintaining muscle strength, but it is also necessary to provide some auxiliary appliances and self-help appliances as far as possible to protect the patient's remaining functions, compensate for the lost functions, and maintain daily activities as much as possible. The role of occupational therapy can be summarized as follows:

1. Keep muscle strength, endurance and activities of daily living consistent with the disease level.

2. Keep the range of motion of joints through correct posture placement and joint range of motion practice, and prevent joint contracture and deformity.

3. Provide adaptive appliances and self-help AIDS, and teach patients to use them correctly.

4. Teach patients to use the knowledge of energy saving, work simplification and safety appropriately, so as to maximize the activities related to their roles.

5. Put forward suggestions to improve or transform the home environment, so as to reduce the architectural and environmental obstacles and help patients better play their existing functions.

(2) Treatment method

1. According to the classification of ALS disorders, the basic contents of ADL training are as follows:

(1)ADL self-care period (1~3 grade) This period is mainly to prevent disuse sexual dysfunction, which requires avoiding the tendency of overuse and misuse, choosing appropriate load for exercise, weighing the key points according to clinical types, avoiding myalgia and fatigue after exercise, and carrying out joint mobility and muscle strength enhancement training. Prevention of joint deformation and contracture caused by muscle strength imbalance All types of ALS patients should take daily exercise centered on standing and walking. For patients with spherical ALS, breathing exercises should be done. Because the condition of ALS is progressing rapidly, they should estimate the prognosis and take countermeasures as soon as possible, such as equipped with orthoses and wheelchairs.

(2)ADL auxiliary stage (Grade 4-5) For ALS of upper limbs, it is necessary to maintain diet. The specific method is to use forearm balance brace and use it flexibly in ADL training according to personal function. At the same time, we should also train other self-rescue devices. For ALS of lower limbs, it is necessary to use walker and lower limb orthosis according to the prediction of its progress. Consider a wheelchair with a reclining respirator. With this wheelchair, patients can sit and lie in various positions. This kind of wheelchair is suitable for home patients. All kinds of ALS patients need breathing exercises, especially spherical patients. They must continue to actively carry out breathing training and learn new communication methods, while practicing swallowing. In addition, family members should be instructed to learn how to take care of patients' ADL and practice for a long time.

(3) Total auxiliary period of 3)ADL (Grade 6~7) During this period, all kinds of patients need to continue breathing exercises and learn communication means. It is best to exercise within the range of joint activity to maintain residual muscle strength.

Trainers should design and provide patients with various complex appliances with the functions of word information processing and communication according to their residual functions. These appliances can be manipulated by the tongue and jaw.

2. Training according to the onset period.

Occupational therapy is divided into early and late stages according to stages. Because patients mainly show severe hand weakness, unbalanced muscle strength, fatigue and decreased functional activity, patients may have difficulties in daily life and even communication obstacles caused by speech difficulties. Therefore, the main purpose of this period is to review and evaluate patients' difficulties regularly, meet the needs of patients' families and help patients cope with daily and weekly functional changes. And discuss with patients the methods of improving lifestyle and environment, as well as the methods of adaptation and adjustment. In the later stage, the main manifestations are progressive muscle weakness and decreased activity. The main purpose of treatment is to maintain the functional independence of patients as much as possible.

(1) Early treatment

1) The specific treatment methods to maintain and improve exercise ability and relieve pain are as follows: For patients with muscle spasms and involuntary contraction of muscle fibers, teach them how to take positions that can relieve spasms and how to change positions frequently to avoid increasing muscle spasms; Patients with difficulty in chewing and swallowing should pay attention to the quantity and speed of eating and the shape of food in their body position, because this will affect the eating function of patients with soft food or pasty food, reduce the chewing times of patients, facilitate swallowing, and urge patients to chew slowly, choose small pieces of food, reduce the amount of food eaten per meal, increase the number of meals per day, and eat in a sitting position at an early stage. You can exercise by swimming and cycling. Maintaining patients' physical strength and endurance can help pain patients cope with pain. Appropriate exercise plan and activity plan are very important to maintain the range of motion, physical strength, endurance and balance ability of patients.

2) Training of daily activities For patients with hand muscle weakness, in order to protect muscles, it is necessary to give help and guidance at an early stage, maintain their daily activities and habits as much as possible, and help patients plan future problems. Ways include: changes in methods and skills to complete daily activities; Help provided by nursing staff (when and where needed); The specific methods of providing patients with necessary appliances and equipment are as follows: ① The clothes should be spacious, light, warm, comfortable, easy to put on and take off, and easy to clean. The clothes should be placed in a spacious and accessible place, and the patients should be taught the simplest way to put on and take off; ② Diet: Patients can be advised to use light tableware with long handle, use light wide-mouthed cups with straws or double handles to drink water, and observe the eating posture of patients at any time. If the patient's upper limbs are weak, it needs to be supported on the table with both arms or one arm. It is necessary to choose a chair with armrests, which can make patients safer and more stable, and help patients concentrate on eating, regardless of balance and posture. Step 3 wash your hands. In order to maintain the ability of washing hands independently, patients can wash their hands in the washbasin in a sitting position. 4. The bathtub is equipped with non-slip handrails and necessary bath self-help to provide patients with necessary support, functions and security. 5. Brush your teeth. In order to help patients brush their teeth independently, you can provide them with a toothbrush with a suitable handle. Or suggest that the patient use an electric toothbrush ⑥ If the patient's lower limbs are weak, you can install a handle next to the toilet and use the raised toilet ⑥ to move. If the symptoms affect the lower limbs, the occupational therapist should evaluate the patient's activity ability with the physical therapist, discuss and propose the most suitable way for the patient's activity, recommend the necessary mobile equipment and instructions, use crutches and crutches at first, use walkers indoors and wheelchairs outdoors.

3) Housekeeping should continue to maintain indoor settings suitable for patients and their families, and encourage patients to continue to undertake previous housework. With the progress of the disease, the family can be renovated to adapt to the functional state of patients, especially in the case that family members can't help, patients should be taught to avoid excessive fatigue. Patients are advised to use household electronic appliances such as food processors, rice cookers, refrigerators and microwave ovens as much as possible.

4) The specific training methods of entertainment and communication skills include: ① providing patients with opportunities to successfully show themselves through group activities such as computer games and songs and dances in handicrafts, so as to enhance their self-confidence and relieve negative emotions such as depression; ② Improve recreational activities, such as using assistive devices or changing the rules of activities, so that patients can continue to participate in such activities and discuss new recreational activities within their physical ability with patients; ③ Training of communication skills. When patients' verbal communication ability is affected, they should be evaluated by speech therapists as soon as possible and given training guidance. People with serious dysarthria can consider changing the communication mode, such as using a language communication board with words, pictures or letters to help patients choose communication AIDS and guide their use. These auxiliary devices include different types of telephones and improved computer control devices. Join a self-help group with patients and their families to discuss and reposition patients' family roles and responsibilities.

5) Psychological counseling and supportive techniques provided by occupational therapists are very necessary for patients and their families. Therapists need to listen patiently to patients' complaints, worries and anxieties, discuss patients' current situation and needs with patients and their families, and encourage patients to face life changes that may or have been brought about by diseases in an objective and positive manner.

6) The application of orthoses and assistive devices requires orthoses and assistive devices at all stages of a patient's illness. The most commonly used orthoses and assistive devices are: hand functional splint ankle-foot orthoses, soft neck-ankle braces, wheelchairs and so on. In addition, there are self-help appliances such as button-type auxiliary appliances, zipper rings, double cups, plates with edge protection, wristbands into which spoons can be inserted, and eating and washing with extended handles.

7) Environmental adjustment and transformation cultivate patients' sufficient safety awareness, and provide specific measures to reduce environmental restrictions, such as adjusting the position of furniture, installing handrails, using remote control devices such as shower chairs when taking a bath, such as remote control of lamps, televisions and radios, and improving or transforming the working environment as much as possible so that patients can continue to work as much as possible.

8) Publicity and education to introduce disease-related knowledge to patients and their families, and guide the methods of controlling disease progress, work simplification and energy-saving technology.

(2) Post-treatment On the basis of early treatment, the key points of maintaining patients' maximum self-care are as follows:

1) Self-care ① Dressing: With the gradual decrease of the degree of independence in dressing, the therapist needs to find the most suitable method to make the patient dress independently or with the least help ② Eating: prolonging the period when the patient has the ability to eat independently as much as possible, and using long-handled buffet utensils and auxiliary appliances can help the patient eat independently; For those who have difficulty eating in the later stage, nasal feeding tube can be used to maintain nutrition and prevent aspiration. Because of swallowing and obstruction, patients with progressive bulbar palsy must adjust their diet to maintain a balanced diet. (3) Bathing: If they are seriously ill, they can be carried to the bathtub by the indoor elevator to take a bath. ④ Going to the toilet: With the development of the disease, it is more and more difficult for patients to go to the toilet. Suitable toilets and toilet paper holders are very helpful for patients to take care of themselves. ⑤ Brush your teeth: People who have difficulty in holding a toothbrush can reduce the difficulty by changing the thickness and shape of the toothbrush handle. ⑤ Body position conversion and handling: In order to facilitate body position conversion and handling, and ensure the safety of patients, an electrically controlled bed and lifting devices required for movement can be used.

2) Housework: At the late stage of illness, the patient's ability to complete housework gradually declined. Therapists should encourage patients to perform their roles and obligations at home as much as possible, actively participate in family activities, and ask for social or other help when necessary.

3) Training of recreational communication ability Due to progressive muscle weakness and ball paralysis, patients' verbal communication ability is becoming more and more limited. Therapists can use blackboard cards and computers to guide patients to express their wishes, encourage patients to continue to engage in their own entertainment hobbies, and advise patients to keep in touch with society by listening to music and watching TV, so as to obtain spiritual enjoyment.

4) Orthopedics and assistive devices Because wheelchairs often become the main mobile tools for patients in the later period, it is necessary to choose suitable wheelchairs suitable for indoor or outdoor use for patients. In severe cases, consider an electric wheelchair.

5) The severity and prognosis of patients' illness must be fully considered in the setting of houses and houses. Doctors, therapists, patients and their families should seriously discuss and plan together, so as to realize common environmental transformation that can make patients feel comfortable and convenient, and minimize changes to existing facilities, including widening access roads and building slopes.

(3) Precautions

1. In the course of treatment, gradual resistance method is usually not used to increase the muscle strength of patients, because this training method can not change the course of disease, but will aggravate the involuntary contraction and fatigue of patients' muscle bundles.

2. Close observation of patients with signs of decreased respiratory function.

3. Pay attention to avoid fatigue in training activities.

4. When choosing assistive devices, we should give full consideration to their price appearance and the acceptance of patients and their families.