No obvious symptoms. At this time, electromyography, nerve conduction velocity, magnetic resonance vibration and other necessary examinations should be carried out by neuromuscular doctors to make a clear diagnosis. 2. Hard work period: the body is obviously weak or even shrinking, and life can take care of itself, but obstacles have appeared in the workplace. At this time, you need a moderate rest to avoid getting worse. Assessed by rehabilitation doctors to provide necessary rehabilitation, and assisted by social workers for psychological adjustment and social resources. 3. Difficulties in life: the course of the disease enters the middle stage, and there are serious obstacles in hands or feet, or both hands and feet, so they can't take care of themselves, and they may not be able to walk, dress, hold chopsticks, and have unclear speech. 4. Dysphagia: In the middle and late stage, the limbs are almost completely weak and the speech is seriously damaged. Eating is easy to choke, and some need tube feeding, otherwise it will easily lead to aspiration pneumonia. 5. Dyspnea: The respiratory muscles are affected and it is difficult to breathe. Patients may stay in bed and need a respirator. Some patients will live in a respiratory treatment center or choose home care, while others will be served by a hospice care team. [ 1]
therapeutic method
physiatrics
Maintain good muscle strength and athletic ability, and maintain the independence of daily life function under the condition of physical and mental comfort, so as to improve the quality of life and highlight the brilliance of life. According to the pain situation, physiotherapists can use various hyperthermia and electrotherapy, such as hot compress, wax therapy, short wave, laser, ultrasound, transcutaneous nerve stimulation and so on. , or help him massage and exercise with omnipotent hands, all have the function of relieving, especially caring massage. Although the intensity is light, all muscle, bone and joint pains caused by hypoxia, spasm and tension can be relieved immediately through the tactile judgment of the therapist. Convenient and practical. Muscle weakness gradually leads to the gradual decline of sports ability, which is another common and troublesome problem. This can't be helped by passively waiting for a massage. You must take action on your own. Don't take a wheelchair if you can walk. Don't lie in bed if you can sit up. Just follow the therapist's instructions, don't be forced, don't be too tired, do a full-body stretching exercise every day to keep your muscles flexible and strong. You can do it yesterday. If some functions have been lost, under the principle of maintaining independence as far as possible, we can also consider using assistive devices to compensate and help. For example, if you can't walk, you can use crutches or even wheelchairs to walk. Only under what circumstances, the professional judgment of the therapist is needed to avoid using AIDS too early or excessively, hindering the self-function, or using them too late to worsen the physical condition.
Whole body hydrotherapy
Hydrotherapy is rehabilitation exercise therapy in water. The deeper the water, the greater the pressure, which is very helpful for blood and lymphatic reflux. When the whole body is immersed in water, warm water can reduce abnormal muscle tension, and water provides good support and protection for the body. Water sports are safe and effective, and the buoyancy of water greatly reduces the weight. Although walking on land is not good, it is easy to move and walk in water, and limb movement can be induced by buoyancy of water. You can use the resistance of water for proper exercise training. For severe patients, some floating tools can be used to support and protect them, so that they can float freely in the water. According to the patient's situation, needs and progress, different degrees of water sports therapy are given, from simple to difficult, designed by physiotherapists. Spa must first have a good barrier-free environment, suitable water temperature and room temperature. First of all, doctors should make a correct diagnosis, and physiotherapists should give patients different underwater sports treatments according to their needs and progress. In terms of revitalizing the rehabilitation medical center, the whole body spa pool is 1 1 m long, 6.5m wide and 90cm-1/0cm deep. Stainless steel handrails are arranged around the spa pool, and a set of parallel bars are arranged on both sides of the spa pool, which can be used for standing, walking, training or sports therapy in the water. The underwater training chair is used for patients to rest and exercise in the water. An automatic lifting shifter is added along the pool edge to facilitate wheelchair users to move from the outside to the inside of the spa pool. Non-slip floors and seating, changing clothes and showering are all necessary facilities.
Edit the nursing methods in this paragraph.
Nutrition nursing
1) Olfactory phase: the foraging motivation caused by food aroma stimulating the forebrain. This motivation can be enhanced by the stimulation of gastrointestinal hormones caused by the decrease of liver sugar, or weakened by depression and melancholy. Patience: Be optimistic and enterprising, and ask without hesitation. Medical staff: use all effective communication channels to communicate. Nutritional countermeasures: Eat a normal diet and avoid a diet high in tryptophan, such as corn. Nutrition goal: keep appetite. 2) Chewing period: the patient can't chew effectively, and can't start swallowing effectively because of the strong mandibular and lingual muscle reflex. Patient: Do soft massage, hot compress and oral and dental care with family members before and after meals. Medical staff: Use effective muscle relaxants and painkillers. Nutrition countermeasures: increase liquid diet and strengthen the ratio of fat and protein in diet. Nutrition goal: keep weight. 3) Swallowing stage: Patients are prone to aspiration pneumonia due to glottic muscle weakness and poor coordination. Patient: Gastrostomy should be carefully considered, and family members should be asked to clean the wound after operation. Medical staff: provide detailed information of gastrostomy for patients' reference and hand it over to relevant operation departments. Nutritional countermeasures: Full liquid diet, strengthening the ratio of fat and protein in diet, special formula to improve immunity, and total parenteral nutrition should be considered several weeks before and after operation. Nutrition goal: keep weight and prevent infection. 4) Gastrointestinal peristalsis: Patients are prone to intestinal obstruction, constipation and diarrhea due to long-term bed rest, insufficient drinking water and bacterial infection. Patient: Total parenteral nutrition should be carefully considered, and family members should clean the bathroom regularly. Medical staff: provide detailed total parenteral nutrition data for patients' reference, and avoid using central intestinal drugs such as Novartis. Nutritional countermeasures: Whole liquid food, special formula to enhance the ratio of fat and protein in diet, and intermittent total intravenous nutrition at home should be considered. Nutritional goals: keep weight, prevent infection, avoid imbalance of body fluids and electrolytes, and supplement rare elements and vitamins.
Respiratory nursing
The inspiratory and expiratory muscles of patients with motor neuron disease are violated, and ventilation and cough will be affected. Therefore, if the patient has a cold, it is difficult to cough up phlegm, which may easily lead to lung atrophy and pneumonia.
Anning nursing
It is generally believed that hospice care is only for patients with terminal cancer and painful symptoms. In fact, hospice care is just an idea and movement. At the end of any disease, as long as the curative treatment has been given as far as possible, those who still have discomfort symptoms such as pain and dyspnea and need palliative medical care and psychological and spiritual help belong to the scope of hospice care. Therefore, patients with motor neuron disease have the care needs of body, mind, spirit, family members and patients in the course of disease development, which is in line with the care spirit of hospice care. In other words, to provide a home-like environment, in addition to the companionship and care of relatives and friends, the medical professional team also includes neuromuscular doctors, rehabilitation doctors, physiotherapists, occupational therapists, speech therapists, social workers, respiratory therapists, nutritionists, practical nurse, mechatronics experts, psychological and spiritual tutors, volunteers and so on. Take care of patients together, so that their body and mind can be fully taken care of, and in the development of each course,
Edit other relevant paragraphs.
motor neuron
Motor neurons are nerve cells that control our body activities and can be divided into upper motor neurons and lower motor neurons. Generally speaking, motor neurons in the brain are called upper motor neurons, and motor neurons in the brain stem and spinal cord are called lower motor neurons. The lower motor neurons in the spinal cord control most of the body, while the lower motor neurons in the brain stem control the muscles of the head, face and throat. The upper motor neuron finely and complexly controls the lower motor neuron, which makes the movement stable and direct under various tension changes. The lower motor neuron is directly connected with the muscle and sends motion signals to the muscle.
harmful effect
Generally, when motor neurons are eroded, muscle atrophy is the main symptom, which usually appears in the palms and fingertips, and gradually deteriorates into atrophy of shoulder, neck, tongue and swallowing muscles, leading to dysphagia and respiratory failure. If the upper motor neurons are also damaged, the patient will become prone to spasm, stiffness and enhanced reflexes due to high muscle tension, which is manifested as jumping when the patient walks, and sometimes the patient's knees will keep shaking. For ALS, due to the gradual death of upper and lower motor neurons, these symptoms usually appear together, including muscle weakness and atrophy, as well as muscle stiffness and spasm.
Computer-aided communication tool
With the development of science and technology, there is now a tool that can control computers through eye-tracking technology and help people who are gradually frozen communicate with others. Now, the eye care system has been developed to operate without wearing anything on the gradually frozen person, as long as the head of the gradually frozen person is within a certain distance, about 30 cm to 80 cm. At present, it is mainly represented by the all-round eye control nursing system of Beijing Qixin Yiwei and TOBII abroad. TOBII abroad is very expensive. Relatively speaking, the domestic eye protection system seems to be a better choice for people who are gradually frozen in China. Over the years, Qi Xin Yiwei has donated money for the frozen people and paraplegics, and has been commended by the mayor of Beijing and the chairman of the Disabled Persons' Federation for many times. If the hand movements of the gradually frozen people are relatively normal, you can get the "key elf" specially developed by Beijing Qixin Yiwei for the gradually frozen people for free; If the head movement of the gradually frozen person is relatively normal, you can use the shadowless hand visual control nursing system for 3 months free of charge, and you can apply for renewal free of charge at the expiration. If the eyeball can move normally, you can apply for free use of the omni-directional eye control nursing system for 3 months. The use of computer-aided communication tools plays an irreplaceable role in reducing the difficulty of communicating with others, preventing losses caused by communication mistakes and increasing confidence in life. Through the computer, people can enjoy music and movies, browse photos, send and receive short messages, increase fun, adjust their mood, delay the development of their illness, and even some people gradually use computer communication tools to write, publish articles and books, and continue to realize the value of life. Therefore, it is very important for people who are gradually frozen to use computer communication AIDS in advance according to their own conditions, both physically and psychologically. For details, please visit Baidu Angel Eye Visual Control Computer System Encyclopedia.