According to the severity of the lesion, two symptoms can be seen: 1. Symptoms of superior neurons include: poor fineness, muscle weakness, spasm, pathological reflex, bending spasm and false marrow sign. 2. Symptoms of lower neurons include muscle weakness, muscle atrophy, decreased reflexes, muscle tremor, and easy cramping. At first, it may only be common symptoms such as limb weakness, muscle twitching and fatigue, which will gradually progress to muscle atrophy, dysphagia and finally lead to respiratory failure. 2) According to the different initial symptoms, it can be divided into two disease development modes: 1, which begins with limb invasion: limb muscles atrophy and weaken from one place, then spread to other parts, and finally respiratory failure occurs. 2. It begins with bulbar palsy: when the limbs are still in good motion, symptoms of swallowing and speech difficulties have appeared, and then they will soon progress to respiratory failure. Don't be discouraged, the success of active treatment is most likely to come from the so-called "cocktail" therapy, that is, comprehensive treatment of multiple possible causes. A variety of therapeutic combinations for different aspects of ALS diseases include: anti-glutamate drugs, neuroprotective agents, neurotrophic factors, symptomatic treatment and stem cell gene therapy. Only riluzole (rilutek) is approved for the treatment of ALS. Clinical trials have confirmed that riluzole can prolong the life of als patients for 3 to 6 months, and its main function is to delay the deterioration of the disease, rather than radically cure ALS. In addition, some experiments show that vitamin E can delay the deterioration of the disease, but it will not prolong the life of patients. Many other potential drugs, including epilepsy drugs, COX-2 selective inhibitors and adjuvant drugs, are in clinical trials. 1, and anti-glutamic drugs include 1) riluzole (daily 100mg), which is the only confirmed effective drug at present. Although the effect is limited, it is the beginning of effective drug treatment. ; 2) lamotrigine; 3) Branched amino acids, including L- leucine, L- isoleucine and L- valine, mainly enhance the oxidation of glutamic acid; 4) gabapentin; 5)D- methoxymethyl morphine. The latter four require more clinical trials to evaluate the efficacy. 2. Neuroprotective agent includes 1) vitamin E; (2) Si Laijilan; (3)N- acetylcysteine; (4)DHA dehydroepiandrosterone. The neuroprotective effect of neuroprotective agents has not been confirmed. 3. Nerve growth and nutritional factors: insulin-like growth factor-1. Symptomatic treatment includes noninvasive biphasic positive pressure ventilation (BIPAP), percutaneous endoscopic gastrostomy (PEG), mucolytic agent, antidepressant treatment, sleeping pills and daily life care. Physical therapy maintains good muscle strength and athletic ability, and maintains the independence of daily life function under the condition of physical and mental comfort, thus improving the quality of life and highlighting 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, through the tactile judgment of the therapist, all muscle, bone and joint pains caused by hypoxia, spasm and tension can be relieved immediately. 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 is a 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 it is not suitable for walking on land, it can easily move and walk in water, and induce limb movement with the help of buoyancy of water. For stronger muscles, you can use the resistance of water for proper exercise training, and for serious patients, you can use some floating tools for support and protection, so that you 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 method of this paragraph/nutrition nursing 1) olfactory stage: 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 patients with motor neuron disease are attacked by inspiratory muscles and expiratory muscles, so ventilation and cough will be affected. Therefore, if the patient catches a cold, it is not easy to cough up sputum, which is easy to cause lung atrophy and lead to pneumonia. Generally speaking, 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,

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