MND RCN Study Day. Limb Features

Transcription

1 MND RCN Study Day Limb Features L.I.M.B.s - An overview of function, maintaining independence, movement issues and helping to sustain the concept of being. Pam Bostock Consultant Occupational Therapist - Neurology Staffordshire and Stoke on Trent Partnership NHS Trust

2 Aims of the presentation - the brief: Demonstrate importance of collaborative working Provide an understanding of the OT/PT role and necessity to maintain function Explore issues of Quality of life Introduce current research Demonstrate the importance of palliative care/ care planning/ case management And show: Links to specialist nursing Triggers for referral Particular challenges for OT Outcome expectations of therapy And give practical tips to remember!

3 Red Flags Limb Features 70% of people present with limb symptoms, including: Focal weakness- painless with preserved sensation Distal weakness Muscle wasting hands and shoulders Muscle twitching and fasciculation's cramps

4 L.I.M.B. Limbs Independence Movement/Moving Being

5 Limb(s) Upper Limb Proximal Weakness shoulder weakness a particular issue *propensity for soft tissue damage, and functional difficulties lack of holding and placing for function:- hair/washing/teeth/computer/writing/ ironing/cooking/driving in fact most tasks! Also makes holding a walking aid more challenging.) top tip beware shoulder subluxation from manual handling Splints to splint or not to splint? Acpin/OT splinting guidelines Oct 13 A cross-sectional online web survey OPT/PT in neurology purposive sampling members of respective professional networks (+ve = reduce contractures, support swollen joints & reduce odema / reduce pain. ve reduce sensation/ proprioception, restricts automatic movements, denotes disability) Loss of dexterity importance of smaller equipment that can make a real difference adapted cutlery/crockery/pen grips/ button hooks/ elastic shoe laces. Use of low grade technology on screen key board with adapted mouse for computer access/ predictive text/use of sticky keys to control mouse

6 Limb(s) Lower Limb close liaison with physiotherapist Proximal weakness around pelvic girdle, and thoracic control interferes with gait balance and standing posture. Secondary soft tissue complications and pain from poor posture, especially neck and lower back pain Fatigue reduces ability to sustain walking Deterioration of dorsi- flexion (footdrop) causes significant issues leading to falls early referral to orthotics required Importance of retaining range of movement for overall health Physios teach carers passive range of movement ( should be carried out daily for effectiveness)

7 Neck Weakness Weak neck muscles difficulty sustaining head control = extremely distressing as reduces ability to walk and increases difficulties with function (arm control/moving/ sitting/ swallow) (MND Information sheet P1) Collars give support, but many find intrusive/ hot, some people acquire pressure areas, espc if drooling difficulties although some have removable stockinette inserts.

8 Neck Supports /Collars Hensinger Head Support Oxford head support A Philadelphia Halo and a Philadelphia Stabiliser

9 Static head supports Otto Bock Head & Neck Supports Lecky head and neck supports Oxford Lees Head Support (Sitting only or walking version careful measurement required)

10 Sheffield support snood for neurodegenerative conditions Under development Head-Up project is funded by the National Institute for Health Research (NIHR) Invention for Innovation (i4i) Collar developed by an MDT -Sheffield Teaching Hospitals NHS Foundation Trust, the University of Sheffield and Sheffield Hallam University functional tasks such as eating and speaking are easier as the collar contours neck muscles, and sits lower than usual collars Has a softer snood against the skin, with reinforcing bars placed where needed. Allows head to be supported, yet allow movement.

11 L.I.M.B.S - Independence Independence in What? In all daily OCCUPATIONS

12 The Canadian Model of Occupational Performance Social OCCUPATIONS = Leisure Physical Self Care SELF CARE PRODUCTIVITY LEISURE Physical Spirituality Cognitive Affective Cultural Productivity Institutional ENVIRONMENT OCCUPATION PERSON

13 L.I.M.B.S - Independence Enabling control and choice of occupations Encouraging aspirations Timeliness- Let interventions progress at the persons own speed Not every issue needs to be resolved with equipment try practical strategies first, then low tech then hitech solutions

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15 Practical strategies Analyse the activity and assess if there are other ways of doing the same task, eg: Sitting to wash at the sink Ensuring a good posture to eat to facilitate a swallow, maximise shoulder control Assess how someone stands up from a chair Don/Doff items of clothing over your head Pivoting hand to reach face/head supporting from opposite elbow

16 Low tech solutions Adapted cutlery/crockery Button hook Key extension/ cooker knob device Bath board and shower hose Transfer board Car door handle

17 High Tech solutions Reclining chair/ postural chair Wheelchairs Mobile arm supports Hoists (motolift/ stand aid/ fixed track hoist) Environmental Control Systems Stair lift/vertical lifts Home Adaptations

18 L.I.M.B. - Movement/Moving WALKING :Ankle foot orthosis/ environmental (falls) assessment (footwear and flooring surfaces)/ difficulty using walking aid/additional stair rail -often for carer MOVING IN BED: 4 section profiling bed/wendy lett type sheet with satin pyjamas / pain control? Pressure mattress TRANSFERS low tech (plastic bag for 90 car transfers ) -high tech (Fixed track hoist and slings). Ensure manual handling plan constantly updated

19 L.I.M.B. - Movement/Moving WHEELCHAIRS early prescription difficult discussions Attendant propelled. Powered self propelled variety of switching Specialist assessment of switching/pressure/ posture (respiration compromised) Environmental assessment - Rampage/ turning circles/access through doors etc (Scooters have a place whilst hand function/ sitting balance preserved) DRIVING / ADAPTED VEHICLES Notify DVLA and Insurance (COT 2012 Code of Conduct) Driving assessment centres can advise on safety of driving / equipment available Privately funded Advice from Motability Encourage trial with OT present to assess pitfalls Fixing systems TIP Remember that when transporting a person with MND they are more susceptible to whip lash type injuries with sudden braking if they have impaired head and trunk control

20 L.I.M.B. -Being (the person want to be) Person in driving seat regarding their decision's- HCP s need to be very respectful of their wishes professional role is to give advice and support with the decisions they make ADRT Writer Poet Memory box/life story Sleeping upstairs against advice safeguarding rules and mental capacity

21 Conclusion I hope I have given a brief insight of the role of Occupational Therapy with people with MND, and demonstrated some challenges for Health Care Professionals I have attempted to give an overview of function and maintenance of independence, examined movement issues and discussed the importance of the concept of being to quality of life I hope I have demonstrated the importance of an MDT approach for the person with MND and Given some practical tips to remember!

22 Thank You for Listening

23 References Canadian Association of Occupational Therapists. (1997). Enabling occupation; an occupational therapy perspective. CAOT. Canada. COT (Collage of Occupational Therapists) (2012) Guidance for Occupational Therapists regarding fitness to drive and driving cessation. Collage of Occupational Therapists/Chartered Society of Physiotherapy( Draft 2014). Splinting for the Prevention and Correction of Contractures in Adults with Neurological Dysfunction MNDA (2012)Head Supports professional information sheet P1 Whalley Hammell.K..(2004). Dimensions of meaning in the occupations of daily life. CAOT-Canadian Association of Occupational Therapists.