Physiotherapy for people with motor neurone disease (MND)

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Each person with MND is affected in a unique and unpredictable way. Your physiotherapist will be able to provide a detailed ongoing assessment of your physical needs while listening carefully to your views. They will have an ongoing supportive role and help you to be as independent and comfortable as possible, at any particular stage of the condition. How does MND affect muscles? As the motor neurones begin to stop carrying messages to your muscles, MND can impact in various ways. Muscle groups may become weak and unable to make joints move, which affects mobility. When it is difficult to move a part of the body, associated joints become stiff and muscles may tighten. Everyday activities such as washing, shaving and dressing can become increasingly difficult and sometimes painful. Once the motor neurones that control a particular muscle have degenerated, the muscle cannot be regenerated by exercise or anything else. However, muscle elasticity, range of movement for joints and prevention of muscle shortening can be helped by regular exercises. How can a physiotherapist help me? “One of the frustrations of a diagnosis of a disease like MND is the knowledge that there is currently no cure and that you are powerless to stop its advance. Physiotherapy has helped me feel proactive rather than a helpless victim.” Karen Walker, person with MND Physiotherapists help by: • giving advice on posture and positioning • developing an individual exercise programme suitable for your particular needs and abilities • providing diagrams of the exercises to help you remember the techniques • advising on different but positive ways to do things to compensate for any deterioration in movement • providing guidance on breathing management and how to conserve energy. Respiratory physiotherapy can also be benefical during a chest infection, providing techniques to help you clear your chest to aid breathing and speed up recovery • explaining what is happening to the body, as it changes with the progression of the disease (further guidance can be sought from the wider clinical health team, eg a respiratory consultant can advise on specific progression of any breathing issues) 2
• helping to advise on or arrange for specialist equipment, eg walking aids or orthoses, (a foot-supporting device or insole, which makes it easier to move your foot as you walk and gives stability) • showing your carer how they might help you, with active, assisted and passive exercises (see later heading What happens after assessment?) • advising your carer on safe movement and handling techniques or how to source appropriate training. “Physiotherapy should include emotional and psychological support, be patient focused, working with the individual and carer/family towards realistic goals.” Liza Robinson, physiotherapist What happens during assessment? It is important that any assessment is carried out by a qualified registered physiotherapist and that treatment is tailored to your needs. It is also important to note that any physiotherapy you receive may be different to someone else with MND, as: • each individual with MND is affected in different ways • you may be at a different stage of progression • you may have other conditions or injuries, unrelated to MND, which can influence the treatment given. As MND is progressive, treatment is likely to adapt to continue to meet your changing needs. An assessment usually includes an evaluation of: • muscle tone and muscle power • range of selective movement (that which you can do on your own) • range of passive movement (that which is controlled externally, eg by a helper) • balance and posture • quality and level of functional mobility (as in your ability to move around to accomplish daily activities or social interaction) • respiratory concerns and fatigue • any existing coping strategies and compensatory techniques that you have developed and to assess if there are better solutions to avoid secondary problems, such as pain • safe moving and handling techniques, if your carer is assisting you with mobility. 3
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Physiotherapy for people with motor neurone disease (MND)

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