Lecture-14

Brig (R) Ali Nasre Alam

Prevention for
Neuromuscular Conditions
 Prevention Practice for Stroke
 Prevention Practice for Spinal Cord Injury
 Prevention Practice for Parkinson’s disease
 Prevention practice for Multiple Sclerosis
 Stroke
•Strokes occur due blood supply to the brain either blocked

or a blood vessel within the brain ruptures.

Types
•Ischemic, Hemorrhagic and TIA.

Predisposing Factors
•Overweight, Age > 55, have family history

•Do not exercise, drink heavily or use illicit drugs.

Ischemic strokes

Ischemic strokes are the most common form of stroke with

around 85% of strokes being of this type.
Ischemia of brain arteries due to block or narrowing.

These blockages are often caused by blood clots, which can

form either in the arteries connecting to the brain, or further

away before being swept through the bloodstream and into
narrower arteries within the brain.
Clots can be caused by fatty deposits.
Hemorrhagic strokes
Hemorrhagic strokes are caused by arteries in the brain

either leaking blood or bursting open.

The hemorrhaged blood puts pressure on brain cells and

damages them.
Blood vessels can burst or spill blood in the middle of the

brain or near the surface of the brain, sending blood into the
space between the brain and the skull.
The ruptures can be caused by conditions such as

hypertension, trauma, blood-thinning medications and

aneurysms (weaknesses in blood vessel walls).
Transient ischemic attack (TIA)
 TIAs are different from the aforementioned kinds of

stroke because the flow of blood to the brain is only

disrupted temporarily for a short time.
 They are similar to ischemic strokes in that they are often

caused by blood clots or other debris.

 TIAs should be regarded as medical emergencies just like

the other kinds of stroke, even if the blockage of the

artery is temporary.
 They serve as warning signs for future strokes and

indicate that there is a partially blocked artery or clot

source in the heart.
Act FAST

A way to remember the signs of stroke

Face drooping: if the person tries to smile does one side of

the face droop?
Arm weakness: if the person tries to raise both their arms

does one arm drift downward?

Speech difficulty: if the person tries to repeat a simple

phrase is their speech slurred or strange?

Time to call for help
Rehabilitation
Strokes are life-changing events that can affect a person

both physically and emotionally.

Speech therapy

Physical therapy helps with relearning movement.

Occupational therapy helps to improve the carrying out of

routine daily activities, such as bathing, cooking, dressing,

eating, reading and writing
Support group can help with common mental health

problems such as depression that can occur after a stroke.

Many find it useful to share common experiences and

exchange information.
Support from friends and family
Preventing a stroke
The best way to prevent a stroke is to address the

underlying causes.
This is best done by living healthily.

Avoid drugs abuse, alcohol consumption, Quit smoking.

Diet rich in fruit and vegetables. Low in cholesterol / Fat

Exercise regularly

Keep blood pressure under control

Keep diabetes under control

Maintain a healthy weight

Treat obstructive sleep apnea (if present).

Use anti-coagulant and anti-platelet medication

 Spinal Cord Injuries
Result from damage to the vertebrae, ligaments or disks of

the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden,

traumatic blow to your spine that fractures, dislocates,

crushes, or compresses one or more of your vertebrae.
It also may result from a gunshot or knife wound that

penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks

because of bleeding, swelling, inflammation and fluid

accumulation in and around your spinal cord.
Non traumatic spinal cord injury may be caused by

arthritis, cancer, inflammation, infections or disk

degeneration of the spine.
Spinal cord injuries of any kind may result in one or more of
the following signs and symptoms:
Loss of movement

Loss of sensation, including heat, cold and touch.

Loss of bowel or bladder control

Exaggerated reflex activities or spasms.

Changes in sexual function, sexual sensitivity and fertility

Pain or an intense stinging sensation caused by damage to

the nerve fibers in spinal cord

Difficulty breathing, coughing or clearing secretions.
Common causes of spinal cord injury

Motor vehicle accidents.

Falls specially in old age

Violence often involving gunshot and knife wounds

Sports and recreation injuries.

Alcohol.

Diseases: Cancer, arthritis, osteoporosis and inflammation

of the spinal cord also can cause spinal cord injuries.

Risk Factors
Spinal cord injuries affect males

Traumatic spinal cord injury: age 16 – 30 years

Falls cause most injuries in older adults.

Engaging in risky behavior. Diving into too-shallow

water or playing sports without wearing the proper safety

gear or taking proper precautions
Motor vehicle crashes are the leading cause of spinal cord

injuries for people under 65.

A relatively minor injury can cause a spinal cord injury if

you have another disorder that affects your bones or joints,

such as arthritis or osteoporosis.
Prevention
Following this advice may reduce your risk of a spinal cord

injury:
Drive safely. Wear a seat belt.

Check water depth before diving and don't dive into any

water of which you don't know the depth.

Prevent falls.

Take precautions when playing sports.

Always wear recommended safety gear.

Don't drive while intoxicated by drugs / alcohol

Don't ride with a driver who's been drinking.

 Parkinson's Disease

PD usually occurs around age 60.

Small number of patients are younger than 40 years

PD develops when certain nerve cells in the brain die.

Neurons produce a chemical called dopamine.

When neurons die, low levels of dopamine are produced.

Dopamine helps relay messages between areas of the brain

that control body movement.

This makes it difficult to control muscle tension and

muscle movement.
Symptoms

It causes problems with body motions, including:

Tremor (shakiness)

Rigidity (muscle stiffness)

Slowed body movements

Unstable posture

Difficulty walking
Tremors

 PD usually begins as a slight tremor or stiffness.

It occurs in the arm or leg on one side of the body.

The tremor is most obvious at rest.

Usually worsens under stress

Improves when the arm or leg is moved voluntarily

May disappear entirely during sleep

They eventually affect limbs on both sides of body.

Handwriting may become small, shaky and eventually

illegible.
Rigidity and Bradykinesia
Stiffness or rigidity in the arms or legs.

Slowing of body movements called bradykinesia.

These are most disabling aspects of the disease.

They can impair the person's ability to walk.

They can make it difficult to perform daily activities.

These may include washing, dressing or using utensils.

Problems with unsteady balance and posture may make it

hard to sit down in a chair, or to rise from one.

Bradykinesia can affect the facial muscles, decreasing

spontaneous facial expressions and normal eye blinking.

Other symptoms of PD may include:
Depression

Anxiety

Disturbed sleep

Memory loss

Slurred or abnormally soft speech

Difficulty chewing or swallowing

Constipation

Impaired bladder control

Abnormal regulation of body temperature

Sexual dysfunction

Cramps, numbness, tingling or pain in the muscles

Prevention
There is no known way to prevent Parkinson's disease.

Research has shown that people who eat more fruits and

vegetables, high-fiber foods, fish, and omega-3 rich oils and

who eat less red meat and dairy may have some protection
against Parkinson's.
But the reason for this is still being studied.

Medications used to treat PD either:

Boost the levels of dopamine in the brain

Mimic the effects of dopamine

The most commonly used medication for PD is levodopa.

Levodopa is converted to dopamine in the brain.

 Multiple Sclerosis
Multiple sclerosis (MS) is a disease in which your immune

system attacks the protective sheath (myelin) that covers

your nerves.
No one knows what causes MS.

It may be an autoimmune disease, which happens when

your immune system attacks healthy cells in your body by

mistake.
Multiple sclerosis affects women more than men.

It often begins between the ages of 20 and 40.

Usually, the disease is mild, but some people lose the

ability to write, speak, or walk.

Myelin damage disrupts communication between your
brain and the rest of your body.
Ultimately, the nerves themselves may deteriorate, a

process that's currently irreversible.

There's no cure for multiple sclerosis.

However, treatments can help speed recovery from attacks,

modify the course of the disease and manage symptoms.

Your diet is an important tool in living well with these
symptoms but no single diet can treat or cure MS.
Because MS symptoms typically come and go, measuring

the effectiveness of a diet is difficult.

However, MS specialists suggest that a low-fat, high-fiber

diet can benefit people with MS.

Symptoms of MS
Signs and symptoms vary widely, depending on the

amount of damage and which nerves are affected.

Inability to walk independently or at all

Visual disturbances

Muscle weakness

Trouble with coordination and balance

Sensations such as numbness, prickling etc

Thinking and memory problems

Treatment
Steroids do not affect the course of MS, they can reduce

the duration and severity of attacks in some patients. 

Spasticity is treated with muscle relaxants / tranquilizers.

Avoiding excessive activity and avoiding heat are probably

the most important measures patients can take to counter

physiological fatigue. 
Antidepressant may help in depression or apathy.

Tertiary Prevention
Physical therapy and exercise can help preserve remaining

function, and patients may find that various aids -- such as

foot braces, canes, and walkers -- can help them remain
independent and mobile. 
Thank You