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Paralysis - the loss of muscle power
A guide for patients and carers
Recovery and treatment
The treatment of paralysis will depend on its cause; on whether it is improving, staying the same, or getting worse; and on whether it is accompanied by other difficulties. In many situations, paralysis is at its most severe in the early stages after injury or disease and recovery of movement occurs over time. For example, after a stroke almost three-quarters of those who are unable to walk in the early days and weeks will eventually regain this ability. However, in some situations the nature or extent of the damage to nerves is such that the loss of movement will persist in the longer term and in those cases where the disease is a progressive one, the paralysis will get worse.
At the present time there is no known cure for paralysis, nor is there a scientifically proven method of speeding up the recovery process. This does not mean, however, that nothing can be done but wait and hope. In the first place, we do know from experience how to create circumstances that give recovery a good chance and help prevent avoidable complications. Secondly, our understanding of the way the various parts of the body heal themselves is expanding rapidly all the time and it is likely that new effective treatments will be developed in time.
Treatment of spasticity
The first step in dealing with spasticity consists of avoiding factors that make it worse. When someone gets angry, worried or stressed they are sometimes described as being ‘uptight’. This is actually appropriate slang as the resting muscle tone does increase in these situations, and that applies even more when the tone is already increased by spasticity. No one can avoid stress or emotion, but relaxation or stress management techniques can help control their impact. Many complementary therapies and practices such as reflexology, aromatherapy and yoga include relaxation methods which some find helpful.
Certain sitting or standing positions, or particular postures of an affected limb can make spasticity more noticeable or bring on spasms. Making an effort to adopt the best positions and choosing an appropriate chair or armrest may be veryworthwhile.
If the temperature of the body is lowered the muscles tend to tighten up, so very cold weather is best avoided where possible, or else the affected limbs should be protected by warm clothing.
Irritations to the skin including tight clothing or footwear may also make spasticity worse. The presence of pain or discomfort from a full bladder or constipated bowel, urinary infections, pressure sores or ingrown toenails are other factors known to make it worse. Pain from fractures, abdominal or chest problems will do the same. Equipment such as catheters and urine drainage devices or badly-fitting splints or plasters can act as irritants and a source of increased spasticity. It is therefore important that these possibilities are considered if paralysis appears to be getting unexpectedly worse.
Physiotherapy
This form of treatment has much to offer in reducing the effects of spasticity. By advising on positioning, rest and relaxation and demonstrating exercises which help to compensate for the loss of power without making the spasticity worse, the therapist can assist the paralysed person to achieve their maximum potential in terms of movement. Physiotherapy does not offer a cure but, as already stated, neither do other forms of treatment.
Many people mistakenly assume that by exercising, strength will be increased in paralysed muscles and the power of movement will return. In most cases this is not the object of the exercise, the aim being rather to keep the paralysed muscles from wasting from lack of use while also strengthening the unaffected muscles. In addition to the above methods the physiotherapist may use techniques such as the application of heat, cold or electricity as part of their therapy programme. In some cases they will treat people in a heated pool - a technique called hydrotherapy. To make sure that the affected part(s) of the body are in the best possible position at rest or during activities the physiotherapist may recommend the temporary use of a plaster cast or splint to provide support around a joint.
Drugs to treat spasticity are available but are not always needed or desirable. They are mainly used to assist in positioning and physiotherapy to allow a greater range of movement and reduce the risk of contractures. They can also reduce the frequency of painful spasms in some cases. They do not increase the strength of spastic muscles. The drugs used to treat spasticity can have the side effect of causing some people to feel drowsy or nauseous, especially in higher doses. Sometimes they can actually work too well and make the muscles floppy. Many people with spasticity in the legs actually rely on the stiffness of the muscles for support, and if it is removed the legs give way. Even if this does not apply some people feel that their non-paralysed muscles are weaker on these drugs.
There has recently been considerable interest in some other techniques to alleviate spasticity. These methods are only appropriate in certain specific circumstances and some are still really at an experimental stage.
It is possible to give antispastic drugs into the fluid that surrounds the spinal cord so that they affect the nerves more directly than when drugs are taken by mouth. This may be done by injection or by an infusion, where a fine tube is inserted which is connected to an electrical pump to control the amount given.
Where spasticity is responsible for abnormal positioning of parts of the body, especially where this is causing pain or where it is likely to lead to contractures, injections are sometimes made into the nerves or muscles. This results in a flaccid type of paralysis which overcomes the spastic paralysis, allows better positioning and lets the unparalysed muscles work normally.
Occasionally surgical operations are done to release contractures in order to assist in positioning or reduce pain.
Finally, there has been considerable publicity in recent years concerning the use of electrical stimulation of paralysed muscles, particularly in people with spinal cord injuries. Advances in electronics have resulted in the possibility of stimulating paralysed muscles and so taking over the task from the damaged nerve pathways. The term Functional Electrical Stimulation (or FES) has been used to describe these procedures and the method has been used to control breathing in those with paralysis of the chest muscles and to enable those with paraplegia to stand or even walk. This form of treatment is still at an experimental stage, but it is a very exciting field of study that holds hope for the future.
Treatment of other forms of paralysis
The treatment of paralysis of lower motor neurones, i.e. flaccid, type is essentially similar to the above except in terms of the use of drugs. Again the underlying cause is important as in some cases recovery occurs over time and in others the loss of movement may persist or get worse. Good positioning and advice from physiotherapists and others are also important here. As the muscles tend to be limp there is perhaps a greater call for the use of splints, or ‘orthoses’ to give them their technical name, to support the joints.
Although some of the diseases which lead to this type of paralysis can be treated with drugs which can aid recovery, at present there are no drugs which act directly on this type of paralysis. While we hear about athletes and body builders abusing steroids to build up their muscles, these drugs do not work when the nerves to the muscles are damaged, as is the situation in paralysed muscles.
Surgeons are sometimes able to repair damage to the nerves or even transplant nerves to help overcome the paralysis. Our understanding about nerve repair and our knowledge and skill in these techniques is expanding rapidly and holds considerable promise for the future.
At the present time there is no known cure for paralysis, nor is there a scientifically proven method of speeding up the recovery process. This does not mean, however, that nothing can be done but wait and hope. In the first place, we do know from experience how to create circumstances that give recovery a good chance and help prevent avoidable complications. Secondly, our understanding of the way the various parts of the body heal themselves is expanding rapidly all the time and it is likely that new effective treatments will be developed in time.
Treatment of spasticity
The first step in dealing with spasticity consists of avoiding factors that make it worse. When someone gets angry, worried or stressed they are sometimes described as being ‘uptight’. This is actually appropriate slang as the resting muscle tone does increase in these situations, and that applies even more when the tone is already increased by spasticity. No one can avoid stress or emotion, but relaxation or stress management techniques can help control their impact. Many complementary therapies and practices such as reflexology, aromatherapy and yoga include relaxation methods which some find helpful.
Certain sitting or standing positions, or particular postures of an affected limb can make spasticity more noticeable or bring on spasms. Making an effort to adopt the best positions and choosing an appropriate chair or armrest may be veryworthwhile.
If the temperature of the body is lowered the muscles tend to tighten up, so very cold weather is best avoided where possible, or else the affected limbs should be protected by warm clothing.
Irritations to the skin including tight clothing or footwear may also make spasticity worse. The presence of pain or discomfort from a full bladder or constipated bowel, urinary infections, pressure sores or ingrown toenails are other factors known to make it worse. Pain from fractures, abdominal or chest problems will do the same. Equipment such as catheters and urine drainage devices or badly-fitting splints or plasters can act as irritants and a source of increased spasticity. It is therefore important that these possibilities are considered if paralysis appears to be getting unexpectedly worse.
Physiotherapy
This form of treatment has much to offer in reducing the effects of spasticity. By advising on positioning, rest and relaxation and demonstrating exercises which help to compensate for the loss of power without making the spasticity worse, the therapist can assist the paralysed person to achieve their maximum potential in terms of movement. Physiotherapy does not offer a cure but, as already stated, neither do other forms of treatment.
Many people mistakenly assume that by exercising, strength will be increased in paralysed muscles and the power of movement will return. In most cases this is not the object of the exercise, the aim being rather to keep the paralysed muscles from wasting from lack of use while also strengthening the unaffected muscles. In addition to the above methods the physiotherapist may use techniques such as the application of heat, cold or electricity as part of their therapy programme. In some cases they will treat people in a heated pool - a technique called hydrotherapy. To make sure that the affected part(s) of the body are in the best possible position at rest or during activities the physiotherapist may recommend the temporary use of a plaster cast or splint to provide support around a joint.
Drugs to treat spasticity are available but are not always needed or desirable. They are mainly used to assist in positioning and physiotherapy to allow a greater range of movement and reduce the risk of contractures. They can also reduce the frequency of painful spasms in some cases. They do not increase the strength of spastic muscles. The drugs used to treat spasticity can have the side effect of causing some people to feel drowsy or nauseous, especially in higher doses. Sometimes they can actually work too well and make the muscles floppy. Many people with spasticity in the legs actually rely on the stiffness of the muscles for support, and if it is removed the legs give way. Even if this does not apply some people feel that their non-paralysed muscles are weaker on these drugs.
There has recently been considerable interest in some other techniques to alleviate spasticity. These methods are only appropriate in certain specific circumstances and some are still really at an experimental stage.
It is possible to give antispastic drugs into the fluid that surrounds the spinal cord so that they affect the nerves more directly than when drugs are taken by mouth. This may be done by injection or by an infusion, where a fine tube is inserted which is connected to an electrical pump to control the amount given.
Where spasticity is responsible for abnormal positioning of parts of the body, especially where this is causing pain or where it is likely to lead to contractures, injections are sometimes made into the nerves or muscles. This results in a flaccid type of paralysis which overcomes the spastic paralysis, allows better positioning and lets the unparalysed muscles work normally.
Occasionally surgical operations are done to release contractures in order to assist in positioning or reduce pain.
Finally, there has been considerable publicity in recent years concerning the use of electrical stimulation of paralysed muscles, particularly in people with spinal cord injuries. Advances in electronics have resulted in the possibility of stimulating paralysed muscles and so taking over the task from the damaged nerve pathways. The term Functional Electrical Stimulation (or FES) has been used to describe these procedures and the method has been used to control breathing in those with paralysis of the chest muscles and to enable those with paraplegia to stand or even walk. This form of treatment is still at an experimental stage, but it is a very exciting field of study that holds hope for the future.
Treatment of other forms of paralysis
The treatment of paralysis of lower motor neurones, i.e. flaccid, type is essentially similar to the above except in terms of the use of drugs. Again the underlying cause is important as in some cases recovery occurs over time and in others the loss of movement may persist or get worse. Good positioning and advice from physiotherapists and others are also important here. As the muscles tend to be limp there is perhaps a greater call for the use of splints, or ‘orthoses’ to give them their technical name, to support the joints.
Although some of the diseases which lead to this type of paralysis can be treated with drugs which can aid recovery, at present there are no drugs which act directly on this type of paralysis. While we hear about athletes and body builders abusing steroids to build up their muscles, these drugs do not work when the nerves to the muscles are damaged, as is the situation in paralysed muscles.
Surgeons are sometimes able to repair damage to the nerves or even transplant nerves to help overcome the paralysis. Our understanding about nerve repair and our knowledge and skill in these techniques is expanding rapidly and holds considerable promise for the future.
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