Download Functional Disorders Essay 1 – Nervous System Conditions

Functional Disorders Essay 1 – Nervous System Conditions
Alzheimer disease
Definition – A progressive degenerative disorder of the brain causing memory loss,
personality changes and eventually death.
Origin/cause Sticky deposits of proteins called beta amyloid and tau, possibly genetics,
chronic inflammation, a history of head injury, exposure to environmental toxins, high
cholesterol levels, low estrogen levels (in women).
Conventional treatment options – treatment options address the deficit of neurotrasmitters
in the brain. Cholinesterase inhibitors or often prescribed to prevent reuptake of
acetylcholine and the use of some NSAIDs, antioxidants.
Clinical somatics cautions – sensitivity to communication with the client, depending on
the stage. I, personally, would prefer to have a close relative in the room, one who is in
frequent contact with the client, to help decipher as well as to help me in determining the
positive or negative effects of treatment.
Amyotrphic Lateral Sclerosis (ALS)
Definition – AKA Lou Gehrig disease in the US and motor neurone disease in GB. A
progressive condition that destroys motor neurons in the central and peripheral ns,
leading to the atrophy of voluntary muscles. The cells most at risk are the large motor
neurons in the lateral aspects of the spinal cord. These are replaced by fibrous astrocytes,
which make the spinal cord hard and scarlike.
Origin/cause – Cause is unknown. Several possible contributing factors have been
identified, some similar to Alzheimer – Tangled neural fibers and deposits of abnormal
proteins on clumps of cells; the accumulation of the neurotransmitter glutamate in the
synapses; genetic susceptibility to damage from free radicals; autoimmune disease;
mitochondrial dysfunction; and exposure to some environmental toxins.
Conventional treatment options – until recently, strictly palliative, including moderate
exercise and physical and occupational therapy to maintain muscle strength as long as
possible.
Clinical somatics cautions – any time dealing with the nervous system, caution is advised
However, helping to maintain functional movement, eliminating SMA will be helpful.
Multiple sclerosis
Definition – an idiopathic disease that involves the destruction of myelin sheaths around
both motor and sensory neurons in the CNS.
Origin/cause – the leading theories point to immune system attacks agains some
componenet of myelin sheaths in the CNS.
Conventional treatment options – symptomatic treatment with doses of steroidal antiinflammatories. Interferon betas, plasmapheresis which filters out overactive antibodies,
some chemotherapy drugs, careful exercise and physical or occupational therapy, diet,
sleep, stress management techniques.
Clinical somatics cautions – caution dealing with the nervous system is always
appropriate. I don’t see anything else other than prudent measures that would be
contraindicated.
Peripheral neuropathy
Definition – a symptom or complication of other underlying conditions. Peripheral
nerves, either singly or in groups, are damaged through lack of circulation, chemical
imbalance, trauma, exposure to pathogens or toxic substances.
Origin/cause – can be genetic, but is usually a consequence of some other injury,
infection or systemic disease.
Conventional treatment options – depends on the underlying pathology. Chronic pain is
often treated with tricyclic antidepressants or antiseizure medications. Topical ointments
with lidocaine or pepper sometimes offer some relief. TENS units, biofeedback,
acupuncture, relaxation techniques and massage to improve circulation in the affected
extremities.
Clinical somatics cautions – always use caution when dealing with ns. I can see how
somatics will be very helpful in freeing up SMA and bringing better function to the area.
Distonia
Definition – a movement disorder. It involves repetitive, involuntary, sometimes
sustained contractions of skeletal muscles. It often reaches a peak and then stabilizes or
sibsides in intensity, but may recur.
Origin/cause – it appears to be linked to problems with the basal ganglia. It involves an
inability to process certain neurotransmitters, including dopamine, GABA, serotonin,
acetylcholine.
Conventional treatment options – are attempts to modulate motor function in the affected
muscles with medications, botox, brain implant, surgery.
Clinical somatics cautions – the usual precautions when dealing with the ns, however it
seems as though somatics would be very helpful to individuals.
Parkinson Disease
Definition – a movement disorder involving the progressive degeneration of nerve tissue
and a reduction in neurotransmitter production in the CNS.
Origin/cause – environmental agents may be found to be one cause, exposure to some
pesticides, fertilizers and other industrial chemicals, the presence of Lewy bodies in the
basal ganglia may be one way to predict, some genetics as well.
Conventional treatment options – some drugs, deep brain stimulation, other surgery.
Clinical somatics cautions – it seems indicated to work with the client’s health care team.
Tremor
Definition – involuntary muscle movement. Can be a primary disorder or a symptom of
other neurological diseases.
Origin/cause – most appear to be related to dysfunction in the links between the
brainstem, the cerebellum and the thalamus.
Conventional treatment options – treated according to underlying causes, dopamine
precursors, beta blockers, tranquilizers, antiseizure medications, botulinum toxin, small
doses of alcohol. Some surgery.
Clinical somatics cautions – work in tandem with the client’s health care team.
Encephalitis
Definition an infection of the brain, usually caused by any of a variety of viruses. It
frequently occurs along with inflammation of the spinal cord (myelitis) and/or
inflammation of the meninges (meningitis)
Origin/cause – most cases are viral, although they can be bacterial or fungi. Viral is
spread either from person to person (enterovirus) or animal vector (arbovirus). Other
times it can be caused by causative agents such as herpes simplex, mumps, measles and
herpes zoster.
Conventional treatment options – viral types are treated with antiviral medications which
slow viral activity, along with steroids to limit inflammation; sedatives to moderate
convulsions.
Clinical somatics cautions – if client is exhibiting major signs of an infection, then the
client should not be treated. If the infection was a long time ago and the client has no
permanent damage, then Somatics work would be fine.
Herpes zoster
Definition - Aka – shingles – a viral infection of the nervous system and the target
tissues are the dendrites at the end of sensory neurons, which leads to painful, fluid-filled
blisters on all of the nerve endings of a specific dermatome.
Origin/cause – the chicken pox virus, which has become dormant vs the virus being fully
expelled from the body
Conventional treatment options – mainly palliatively. Acyclovir, lotion, steroids and
painkillers are used most often.
Clinical somatics cautions – it is painful, so most likely the client will not be seeking
Somatics work. If they do, I, personally, would wait until the lesions have completely
healed.
Meningitis
Definition - An inflammation of the meninges and the cerebrospinal fluid that surround
the brain and spinal cord
Origin/cause – usually caused by bacterial or viral infection
Conventional treatment options – if caused by bacteria, antibiotics are administered.
Steroids may also be used. Vial meningitis is supported by rest, fluids and good nutrition
while the patient fights back.
Clinical somatics cautions – because it is communicable, definitely not advised.
Polio and post polio syndrome
Definition - a viral disease which targes the intestinal mucosa first and anterior horn
nerve cells later. Post polio syndrome is a progressive muscular weakness that develops
10-40 years after an initial infection with the poliovirus.
Origin/cause – spread through oral-fecal contamination, usually through contaminated
water that is consumed
Conventional treatment options – moist heat applications, physical therapy and massage
have been used to treat polio survivors once the initial infection has subsided. PPS is
treated by reducing muscular and neurological stress: adjusted braces, a change in
activity levels and exercise programs that encourage the use of muscles not supplied by
the damaged nerves
Clinical somatics cautions – cautions are low, esp. because we are unlikely to encounter
someone with polio. With PPS, caution is advised because we are dealing with the ns. I
would be in contact with the client’s treatment team.
Anxiety Disorders
Definition - a collection of distinct psychiatric disorders that have to do with irrational
fears and extensive efforts to avoid or control them. They can range from mild to
completely debilitating.
Origin/cause – studies have investigated 2 major issues with anxiety disorders: problems
with the limbic system and the hypothalamic-pituitary-adrena (\HPA) axis, and
neurotransmitter imbalances.
Conventional treatment options – most are treated with a combination of medication and
psychotherapy.
Clinical somatics cautions – the most apparent caution I see is that the client feels safe in
the treatment environment and by being touched. Clear boundaries are indicated.
Perhaps having a trusted friend or family member in the room would be a good idea.
Attention deficit hyperactivity disorder
Definition - a neurobiochemical disorder resulting in difficulties with attention,
movement and impulse control.
Origin/cause – currently unknown, however some contributing factors have been
identified – genetics; altered brain function; maternal behaviors; exposure to toxins.
Conventional treatment options – currently psychostimulants, and other drugs;
counseling, training in coping skills; nutritional supplements, avoiding sugar, caffeine
and other stimulants.
Clinical somatics cautions – clients may need a shorter session. The quiet or slowness of
a session may be preferred by some and not others.
Autism spectrum disorders
Definition - a group of mental disorders characterized by problems connecting with other
people, including parents and family members; communication difficulties; specific and
predictable movement patterns and sensory problems.
Origin/cause – the most easily distinguishable factor behind some cases is a genetic
anomaly. Fragile X syndrome, tuberous sclerosis; mitochondrial dysfunction within
neurons, early exposure to some virus that stimulates an autoimmune response; exposure
to mercury, lead or other heavy metals; allergies.
Conventional treatment options – highly structured, specialized programs that reinforce
positive behaviors and work to reduce negative ones. Applied behavioral analysis,
dietary adjustments, medication for management of seizures, anxiety and depression.
Clinical somatics cautions – because the client may not want to be touched, working with
them by just teaching movements would be more appropriate.
Chemical dependency
Definition - the use of substances in methods or dosages that result in damage to the user
and people close to them. It can involve both legal and illegal substances.
Origin/cause – genetic predisposition, mental illness, environmental factors, types of drug
being used, age, medical reasons.
Conventional treatment options – recognizing that the problem exists, detoxification,
rehabilitation, aftercare, medications.
Clinical somatics cautions – depending on where the client is in their dependency –
active, in treatment or long term recovery, cautions will arise.
Depression
Definition - a group of disorders that involve negative changes in emotional state. It is a
CNS disorder involving a genetic predisposition, chemical changes and often triggering
events that results in a person losing the ability to enjoy life.
Origin/cause – genetics, environmental triggers, personality traits, chronic illness, other
problems.
Conventional treatment options – drugs, psychotherapy, other therapies such as light,
electoconvulsive, st. johns’s wort and other.
Clinical somatics cautions – clear boundaries have to be in place about the relationship
between the provider and client. There may be other issues that need to be addressed. If
the client’s doctor has referred them, I feel it would be beneficial with a few cautions.
Eating disorders
Definition - these include a variety of unhealthy habits that may begin slowly but over
time become difficult or even impossible to break. They often arise in response to
specific kinds of emotional or physical stressors, although these may be difficult to
identify. They often begin as a coping mechanism but become a serious impairment to
health.
 Anorexia nervosa – is the use of fasting, severely restricting eating and/or
compensatory activities to drastically reduce the # of calories that enter the
digestive system. It is essentially self-starvation.
 Bulimia nervosa – is a normal or higher than normal calorie consumption
followed by compensatory activities to prevent the absorption of those calories.
 Binge eating – patterns of overeating that are not followed by compensatory
behaviors. Although it is a common eating pattern, it has only recently been
recognized as a specific disorder.
Origin/cause – people with high expectations of themselves. These are eager-to-please
overachievers who do well in school and may be involved in athletics that emphasize
thinness (dancing or gymnastics for example). Adolescent girls in a culture that
bombards them with impossible standards to live up to. Seratonin levels are said to be
generally lower in eating sisorder patients than the general population.
Conventional treatment options – to focus on resolving the issues that led to the behaviors
in the first place.
Clinical somatics cautions – it seems that in many cases Somatics work would be
beneficial. Cautions arise when there is a concern of cardiovascular weakness. Working
with the clients health care team is advisable.
Bell palsy
Definition - he result of damage to or impairment of CN VII, the facial nerve. This
nerve is composed almost entirely of motor neurons and is responsible for providing
facial expression, blinking the eyes and providing some taste sensation. It travels a
complicated route from its origins to the face and exits the cranium through a small
foramen just behind the earlobe.
Origin/cause – linked to the herpes simplex virus that causes cold sores. This pathogen,
which lies dormant in the nervous system until it reactivates, stimulates the production of
antibodies and elicits and inflammatory response against the facial nerve.
Conventional treatment options – treatment is usually conservative because most cases
are self-limiting (they resolve without interference). A combo of steroidal antiinflammatories and acyclovir to slow down herpes activity is effective for most Bell
palsy patients. They may have to tape the affected eye closed at night and to protect it
from drying and dust during the day.
Clinical somatics cautions – if appropriately diagnosed, there should be no
contraindications. As always, appropriate cautions are advised.
Cerebral palsy
Definition - an umbrella term for many possible injuries to the brain during gestational
development, birth and early infancy. Several types of CP have been identified, each
involving damage to different parts of the brain at different moments in development.
Origin/cause – CP is the result of brain damage, usually to motor areas of the brain,
specifically the basal ganglia and the cerebrum. Intracranial hemorrhage, damage to the
white matter around the ventricles and toxicity due to extreme jaundice are leading
factors in CP. The causes of most cases are probably multifactorial events that often
occur early in pregnancy.
 Prenatal causes – can be traced to problems during pregnancy, often due to
maternal illness. Contributing factors include infections with rubella or
toxoplasmosis, hyperthyroidism, diabetes, Rh sensitization, toxic exposure or
abdominal trauma. Pregnancy-induced hypertension and infection of the
placental membrane can also increase the risk of CP.
 Birth trauma – can result if the child undergoes anoxia or asphyxia during birth.
Respiratory distress and head trauma from a difficult presentation or the use of
forceps in delivery may also increase the risk of brain damage.
 Acquired CP – is acquired in early infancy. Causes include very extreme jaundice
that can lead to brain damage and deafness, head trauma (car accidents or child
abuse) infection with meningitis or encephalitis, vascular problems (brain
hemorrhages) or neoplasms in the brain that may lead to brain damage.
Conventional treatment options – it is managed rather than treated. Could mean braces,
occupational, physical and speech therapy for many years. Medication to manage
seuzures and reduce muscle spasm. Some surgeries.
Clinical somatics cautions – from what I read in the book, it seems that there would be
many reasons TO DO clinical somatics. The one caution is that people with severe CP
may not be able to communicate their wants or concerns clearly. Having a care taker in
the room, who understands the communication signals, would be beneficial as well as
being part of the health care team.
Complex Regional Pain Syndrome
Definition - a collection of signs and symptoms including long-lasting pain and changes
to the skin, muscles, joints, nerves and blood vessels of the affected area. CRPS 1 is th
most current label for what used to be called reflex sympathetic dystrophy syndrome
(RSDS); this is abnormal pain and other signs related to soft tissue or other injuries
usually to a distal portion of the arm or leg. CRPS 2 (fna causalgia) is pain related to a
specific nerve injury that again outlives a normal process and often exceeds the
boundaries of the affected nerve.
Origin/cause – an initial trauma (often to a hand or foot, but anywhere on the body can be
affected) begins a pain sensation that is managed by the sympathetic nervous system.
Often associated with hight-velocity trauma such as a bullet or shrapnel would, but it has
also been seen with minor strains and sprains, as a postsurgical complication, with
fractures, at injction sites, following strokes as a consequence of disc disease and
sometimes with no identified causative trauma at all. Patients are usually diagnosed
when they are 40-60 yo. Women are diagnosed about 3xs more often than men.
Conventional treatment options – a long term process. Aggressive PT and OT are
recommend to preserve function and prevent or delay atrophy of the affected areas.
Psychotherapeutic intervention is suggested. Chemical nerve blocks are often used.
Intrathecal pumps allow patients to mange their own pain. Sympathectomy is sometimes
used as well.
Clinical somatics cautions – this sounds like something that would indicate extreme
caution as the client would be in so much pain that no amount of gentle movement would
be tolerable. On the other hand, as the aggressive PT and OT work can be unbearable for
this population, perhaps some gentle hands-off work may be beneficial. In any case, I
would want to be in touch with the client’s health care team.
Spina bifida
Definition - a neural tube defect resulting in an incompletely formed vertebral arch,
damage to the meninges and/or spinal cord and a igh risk of distal paralysis and infection.
Origin/cause – can be genetic, also a deficiency of folic acid at conception and in the
earliest weeks of fetal development.
Conventional treatment options – a baby born with cystic spinal bifida needs surgery with
a few ays to reduce the cyst and preserve as much spinal cord function as possible.
Rigorous PT and exercises to maintain function of the legs muscles as much as possible.
They may need crutches, braces, wheelchairs or other equipment as necessary.
Clinical somatics cautions – It appears extreme caution is recommended, as with most
CNS disorders.
Spinal Cord Injury
Definition - some or all of the fibers in the spinal cord have been damaged, usually by
trauma but occasionally by other problems such as tumors or bony growths in the spinal
canal.
Origin/cause – Motor vehicle accidents cause about 50%, gunshot wounds and other acts
of violence cause 11%, falls are responsible for 24% and sports injuries account for 9%.
Other causes can be from arthritis, bone spurs, tumors or other causes.
Conventional treatment options – surgery, limiting inflammation and other secondary
body reactions that may damage uninjured tissue – anti-inflammatories and other
medications that limit this kind of activity are usually administered as quickly as possible.
Implantation of electrodes in muscles, surgical transfer of healthy tendons can be helpful.
Treatment is targeted at providing them with the skills to lie as fully as possible. PT and
OT, mental emotional therapies are essential.
Clinical somatics cautions – there are many cautions and I would be very concerned
working with some with SCIs. Close communication with their health care team would
be my primary focus to see what is possible.
Stroke
Definition - damage to brain tissue caused either by a blockage in flood flow or by an
internal hemorrhage.
Origin/cause – high blood pressure, smoking, atherosclerosis, high cholesterol, C-reactive
protein, atrial fibrillation, high alcohol consumption, drug use, obesity and sedentary
lifestyle, diabetes, high-estrogen birth control pills, hormone replacement therapy,
depression, overall stress, age, gender, race, family history, previous stroke.
Conventional treatment options – prevention, acute care and postacute or chronic care.
Identifying those at risk and using preventative measures, including exercise and diet
changes.
Clinical somatics cautions – what is the client’s general cardiovascular health? Caution is
advised as stroke patients have other circulatory problems, which can affect easily
accessible blood vessels in the neck – Willis’s circle (is that what it was called?). We’ve
talked about it in class – that many times the afteraffect – paralysis, etc., is really just
SMA.
Traumatic brain injury
Definition - damage to the brain brought about by trauma rather than congenital or
chronic degenerative disease.
Origin/cause – MVAs, gunshot wounds, falls, sports injuries, physical violence are
leading causes.
Conventional treatment options – surgery when required, to remove pressure on the brain,
followed by intensive PT, RT, OT and speech therapy to preserve or recover function.
Clinical somatics cautions – caution is highly advised in the acute stages, however, when
a client is fully healed, such as a year post trauma, and their health care team is on board,
I feel it would be appropriate as traumas are a high cause of SMA.
Trigeminal neuralgia
Definition - nerve pain along one or more of the 3 brances of Cranial Nerve V, the
trigeminal nerve. It is also called tic douloureux, which is French for painful spasm or
unhappy twitch
Origin/cause – Women get it more often than men, average patient is 60-70 yo. The
trigeminal nerve is irritated and the result is brief, repeating episodes of sharp, electrical,
burning or stabbing pain on one side of the face. The myelin covering may be worn away
by an artery or vein that wraps around the nerve. Tumors, bone spurs, recent infection,
complications of dental surgery and MS are other causes.
Conventional treatment options – ruling out sinus and tooth infections, tmj and cervical
misalignment can be treated by the appropriate professionals. Acupuncture can be
effective. Anticonvulsant drugs, muscle relaxants and other more invasive treatments
such as destruction of part of the nerve with lasers, radiation and a heated probe or
injected chemicals..
Clinical somatics cautions – It looks like prone work would not be recommended,
although work on the back or side might be appropriate. Again caution is always advised
when working with the NS.
Other ns disorders
Guillain-barre syndrome
Definition - A condition involving acute inflammation and destruction of the myelin
layer of peripheral nerves.. It usually begins in the feet and moves proximally. Some
variants of this syndrome affect only cranial nerves or have other patterns.
Origin/cause – seems to be preceded by an infection of the respiratory or gi tract several
days before developing GBS symptoms. It is believed that this preceding infection
stimulates in immune system attack mistakenly directed against the myelin sheaths of
peripheral nerves.
Conventional treatment options- Because it is an idiopathic disease, no specific cure has
been developed. Two treatment options have been used to shorten recovery time:
plasmapheresis (blood cleansing) and injections of high concentrations of
immunoglobulin (donated antibodies)
Clinical somatics cautions- in the acute stages, I wouldn’t work with a person diagnosed
with this disorder. Once stable, I feel with the usual precautions, it would be beneficial.
Headaches
Definition - pain caused by any number of sources. Muscular tension, vascular spasm
and dialation, and chemical imbalances can all contribute to headache.
Origin/cause – there are a variety of reasons for headaches, including muscular tension,
vascular spasm and dilation and chemical imbalances, foods, allergies, alcohol.
Conventional treatment options – avoiding the triggers in the first pace, nsaids.
Clinical somatics cautions – during the headache, most likely the client will not even
want a session. If there is a serious underlying pathology or there is a bacterial or viral
infection, treatment would be inappropriate.
Meniere Disease
Definition - a group of signs and symptoms that center on inner ear dysfunction, leading
to vertigo, tinnitus and hearing loss.
Origin/cause – Not well know, however researchers believe that it has to do with the
accumulation of excess fluid in the endolymph inside the membranous labyrinth. When
no other cause can be found for this process, idiopathic endolympatic hydrops is
identified. Possible causes for this accumulation include rupture of the membranous
labyrinth that allow the perilymph and endolymph to mix, autoimmune activity, viral
infection, or pressure from a tiny blood vessel wrapping around the vestibulocohlear
nerve.
Conventional treatment options – treatment options focus on symptomatic control rather
than trying to correct an identified problem. Sometimes chemical or surgical options are
possible.
Clinical somatics cautions – There seem to be no contraindications. Caution must be
used when they may be experiencing vertigo or nausea.
Seizure disorders
Definition - any kind of problem that can cause seizures.
Origin/cause – Often related to some kind of neurological damage in the shape of tumors,
head injuries, or infection, although it may be impossible to delineate exactly what that
damage is. Definitely linked to a mechanical or chemical problem in the brain.,
infections, exposure to some toxins and extreme hypotension or hemorrhage.
Conventional treatment options – usually treated with anticonvulsant medication. Rarely
surgery
Clinical somatics cautions – never during a seizure, otherwise it is fine to work with
them.
Sleep disorders
Definition - any disorder that interfere with the ability to fall asleep, to stay asleep long
enough or to wake up feeling refreshed.
Origin/cause – there are several causes, depending on the sleep disorder. Included are the
air passage of a sleeping person temporarily shuts down; decreased respiratory drive/
sensation in the extremities, esp the legs, circadian rhythm disruptions.
Conventional treatment options – lifestyle changes including changes in diet and exercise
habits, quitting smoking, adjusting temperature or sound levels in the bedroom or other
simple interventions. Over the counter sleep aids, prescription sleep aids, surgery, nose
mask.
Clinical somatics cautions – none seem to be present.
Vestibular balance disorders
Definition - a grup of conditions that can cause the vestibular branch of Cranial Nerve
VIII to dysfunction, leading to debilitating vertigo that may last anywhere from a few
seconds to many hours.
Origin/cause – calcium stones, inflammation, head injury. Stroke, tumors, MS migraines,
allergies, some psychological disorders and their medications and some other drugs.
Conventional treatment options – sometimes learning head maneuvers, medication,
exercises.
Clinical somatics cautions – can be a problem if they are experiencing the vertigo during
the treatment – lying down, getting up.