Νευροχειρουργός Νίκος Μαραθεύτης


  Επικοινωνία : 210 5021743

All Posts Tagged: Cerebral Palsy

Rehabilitation

 

What is rehabilitation?

Rehabilitation is a process that requires the cooperation of physicians with different specialties, in order to restore the patient’s skills and help the patient’s family to adapt and help them cope with the consequences of their condition. The main idea for rehabilitation needs to be a rational approach to the improvements that can be achieved.

The family

The family is an integral part for rehabilitation. The stress and pressure put on the family is significant, because the outcome, the duration of recovery, and the severity of the condition are all uncertain. However, there are special programs and centers that can help the patient suffering from traumatic brain injury along with their family.
Family members need to learn to walk like a marathon runner. When the risk to the patient’s life is over, a return to a daily routine is encouraged so that family activities are maintained to the best extent possible, and used for the benefit of the patient throughout recovery.

Family and friends need to be well informed in order to cope with the problem and help the patient. There are many sources of information, including the treating physician, the nursing staff, and rehabilitation centers. Information contributes to a better understanding of this condition. Understanding is essential to making the right decisions, in order to offer the best possible care to the patient.

At the hospital

Rehabilitation begins in the hospital, with the team treating the trauma patient as an acute case (neurosurgeon, nursing staff, physical therapists, occupational therapists, speech therapists, social workers). Once the patient’s condition is stable, the patient can then be transferred to a rehabilitation center, where psychiatrists, neuropsychologists, and rehabilitation specialists continue to coordinate the rehabilitation effort.

After getting discharged from the hospital

After getting discharged from the hospital If specialized nursing care is needed, then a special infrastructure may be needed. The level of care and intensification of rehabilitation is based on the patient’s level of functionality, recovery progress, return, and availability. We should keep in mind that rehabilitation does not cause recovery, but offers the possibility for the patient to recover.

Read More

Types of residual damage

 

Memory

  • memory loss
  • forgetfulness
  • loss of train of thought
  • inability to memorize instructions
  • inability to complete a thought

Spectrum of Attention

  • difficulty concentrating
  • easy distraction
  • inability to focus when a competing stimulus coexists

Reaction time

  • slow reactions
  • taking more time to think before answering

Personality

  • increased impulsivity
  • reduction of inhibitions
  • irritable, raising objections
  • reduced interest
  • difficulty coping with stress and change
  • emotional changes

Thought processes

  • difficulty in making decisions
  • flat thinking (interpreting only literally)
  • reduced interest in disabilities
  • reduced judgment and problem-solving ability
  • difficulty understanding humor, abstract, or ambiguous expressions
  • difficulties in executing a procedure
Read More

Recovery from coma

 

 

When the patient begins to wake up, the thought processes (cognitive functions) begin to become discernible and can be assessed. Patients usually wake up very gradually. Progress is made in slow steps that take time. Low-intensity controlled stimuli, such as speech, touch, sound, or visual stimuli, are more beneficial than longer stimuli, which confuse the patient.

Each patient has their own pace, going through these stages at a rate that depends on the severity of the injury. This progress may take days, weeks, months, or even years. There may also be no progress and the patient could remain with their eyes open, but without specific reactions to environmental stimuli (“vegetative state”). The longer this lasts, the less likely the patient is to recover.

As the patient continues to show progress towards recovery, some permanent problems (residual damage) may be identified. The type and severity of these problems vary depending on the extent of the brain damage.

Read More

Contemporary Treatment of Spasticity

 

 

Under normal circumstances, our muscles are in a state of a partly continuous contraction. This normal phenomenon is called muscle tone and is necessary for our body to maintain its natural posture, as well as to keep our muscles in a state of readiness when we want to perform a movement. The control of this system is done against our will (subconsciously) and is subject to multiple regulatory mechanisms of our nervous system.

Spasticity is a form of muscle tone disorder in which there is excessive muscle contraction, to the point that even people with near normal muscle strength, find it impossible to perform voluntary movements smoothly. Diseases such as cerebral palsy, traumatic brain injury, spinal cord injuries (injury, tumors, ischemic damages) can cause spasticity. Other conditions such as multiple sclerosis and other neurodegenerative conditions are also causes of spasticity. In addition to the obstruction of the harmonious movement of the muscles, there are also muscular pains as well as disturbance of the physical posture of the body due to hypertonia. These factors have a very negative effect on the quality of life of the patients.

Modern neurosurgical methods

In the treatment of patients with spasticity physicians and physiotherapists specialised in rehabilitation should be involved. The modern neurosurgical approach plays an important role in the treatment of these patients. Unfortunately, both patients and their families, as well as therapists, are often unaware of the existence of modern neurosurgical methods that can dramatically improve in many cases the life and functionality of these patients.

Therefore, providing all the necessary information to the individuals concerned and their families is an important parameter.

Thespastikotita1 Oral medication, administered by the treating physician (usually a neurologist) is often effective but is sometimes insufficient or accompanied by systemic side effects. A more modern method is the intrathecal baclofen injection. Baclofen is a powerful muscle relaxant. Pump administration constitutes a significant innovation in the treatment of spasticity because even a very small dose (1% of the oral dose) is effective in reducing spasticity. Pump placement surgery is a simple operation lasting about 30 minutes, under general anesthesia. The pump can then be operated for years, delivering the required dose to the nearest millimeter, on a 24-hour basis, without external intervention. Dosage adjustment, if necessary, is done with a special remote control, which can be used by the patients themselves. In order to substantiate the benefit of intrathecal baclofen administration, a lumbar puncture test should be performed prior to surgery. If there are no side effects such as drowsiness, dizziness, nausea, hypotension, and clinical improvement of spasticity is observed, then the patient is suitable for surgery.

 

Reducing spasticity also requires intensive physiotherapy (eg range-of-motion exercises, hydrotherapy, kinesiotherapy, etc.). By increasing functionality, patients can strengthen their muscles and have a dramatically better quality of life.

 

Read More