FAQ

Disabilities (295)

Amputee (53)

Limb Loss (5)

Limb Loss

Q: What is involved in caring for people with Limb Loss and Limb Differences?
A:

Care for a person who has undergone amputation will depend greatly upon his or her overall health and strength.  Persons who are candidates for prosthesis use will make several visits to their prosthetic facility to obtain a correctly fitting device.  Physical/occupational therapy or gait training may be needed to facilitate successful use of prostheses and other assistive devices to regain independence.  Some new amputees may also need professional assistance with emotional adjustment to limb loss.  Amputees whose health does not permit prosthesis use may require more assistance with mobility and transfers.

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Q: Are there increased risks for other health problems?
A:

Limb Loss is more often the result of, rather than the cause of other health problems.  Since the loss of a limb can result in decreased activity, the risk of health problems associated with a sedentary lifestyle may be increased.  Residual limb and phantom pain, as well as skin problems associated with prosthesis use are also common.

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Q: How can I reduce the risk of amputation?
A:
  • Practice good foot hygiene and care, especially if you are diabetic
  • Stop smoking, or don't start
  • Practice good safety habits when operating machinery (lawnmowers, etc.)
  • Reduce the risk of limb deficiencies in your unborn child by taking medications only when absolutely necessary and under your doctor's supervision

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Q: What causes Limb Loss and Limb Differences?
A:

Limb Loss can occur due to trauma, infection, diabetes, vascular disease, cancer and other diseases.  The causes of congenital Limb Differences are frequently unknown.  In the past, many cases of Limb Difference were attributed to the use of drugs, such as thalidomide by the mother during pregnancy.

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Q: What are Limb Loss and Limb Differences?
A:

Limb Loss generally refers to the absence of any part of an extremity (arm or leg) due to surgical or traumatic amputation.  The term, Limb Differences, is used in reference to the congenital absence or malformation of limbs.

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Stump Care

Q: How to bandage your stumps?
A:

 
While you were in hospital, you might have had your stump bandaged. This is often done to hold a dressing in place. If you are advised to bandage your stump, the bandage must only:

  • Be used following advice from the doctor

  • Be used after you have been shown how to put it on

Never bandage your stump so that it feels tight or causes pain

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Q: How to check your stump for damage?
A:

Experiencing some changes in the size of your stump is normal, especially in the early days. But if you are worried, or think you have too much swelling or some damage, you should contact your rehab physician.

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Q: How to keep your stump clean and healthy?
A:

Because you will be wearing your limb for most of the day, you should keep your stump clean:

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Q: Important!
A:

Because the size of your stump can increase during the day, it is important to put your artificial limb on early in the morning.

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Amputee Rehabilitation

Q: What happens during community reintegration?
A:

 

  • Continuous assessment and follow-up

  • Prosthetic maintenance and upgrading

  • Vocational assessment and workplace visit

  • Driving assessment

  • Community reintegration with visit to public places and introduction to sports

 

Q: What does an amputee go through during rehabilitation?
A:
  1. Pre-amputation stage
  2. Post-amputation stage
  3. Pre-prosthetic stage
  4. Prosthetic stage
  5. Community reintegration

 

Q: What happens at the pre-prosthetic stage?
A:
  • Prosthetic assessment, casting and fitting
  • Gait assessment and training
  • Temporary prosthesis if necessary
Q: What happens at the post-amputation stage?
A:
  • Physical therapy which include strengthening, stretching, balance training and chest therapy
  • Stump care and pain relief
  • Activities of daily living training
  • Wheelchair training
  • Gait training using ambulatory aid
  • Home visit and modification as required
Q: Who are the members of the core amputee rehab team?
A:
  • Rehabilitation physician
  • Occupational therapist
  • Physiotherapist
  • Prosthetist and technician
  • the amputee

Consultations and collaboration from the other disciplines include:

 

Post Amputation Pain

Q: When does phantom limb pain usually start?
A:

Phantom limb pain can start anytime after the amputation. It has been said that it usually starts within the first 2 weeks post amputation.

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Q: How is phantom limb pain treated?
A:

Various methods have been used to treat phantom limb pain. Doctors may prescribe medications to reduce the pain. Some antidepressants or antiepileptic have been shown to have beneficial effect on reducing phantom limb pain.

Often physical modalities like using light massage, electrical stimulation, heat and cold therapy have also been used with variable satisfactory results.

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Q: What are the factors that may reduce phantom limb pain?
A:

Fortunately, there are many other factors that may make phantom limb pain feel less painful. Mental distractions, rest, emotional pleasure, massage, elevation of residual limb, electrical stimulation and a well fitted prosthesis are all known factors that may make phantom limb pain more bearable.

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Q: What are the factors that may worsen phantom limb pain?
A:

Many factors can modify phantom limb pain. Factors that may worsen phantom limb pain include yawning, passing urine, fatigue, sleeplessness, anxiety, weather changes, pain from other body sites, stimulation of other body parts, excessive heat/cold and even a poorly fitted prosthesis.

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Q: When does phantom limb pain start to disappear?
A:

This varies for different individuals. Some may experience phantom limb pain longer than others. However, it has been found that it usually disappears after 2 years. Some unfortunate individuals can even experience phantom limb pain forever although the frequency and the intensity of the pain may decrease.

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Q: What is phantom limb pain?
A:

Phantom limb pain is the feeling of pain in an absent limb or a portion of a limb.

There are many terms that have been used to describe the phantom pain. Some of the most commonly felt pain are burning and cramping pain. Other terms that have been used are slicing and squeezing pain. The pain sensation varies from individual to individual.

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Q: What is phantom limb sensation?
A:

Phantom limb sensation is the term given to any sensory phenomenon (except pain) which is felt at an absent limb or a portion of the limb. It has been known that at least 80-100% of amputees experience phantom sensations at some time of their lives.

There are various types of sensations that may be felt:

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Q: What can cause stump pain?
A:

There are many causes of stump pain that occurs at the amputated limb.

This could be due to internal causes or external causes.

Internal causes of stump pain include:

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Q: What is post amputation pain?
A:

Post amputation pain is the feeling of pain that is felt post amputation and may be due to various causes. The sensation of pain may affect the residual limb or can even affect the ?limb? which has been amputated - commonly referred to as a phantom limb.

Following an amputation, there are several types of sensations that should be discussed when referring to post-amputation pain. Post amputation pain can be broadly classified as stump pain or phantom pain.

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Residual Limb Contractures

Q: I'm a lower-limb below-knee amputee. How do I prevent hip and knee contractures from happening?
A:

First of all, avoid bad habits like listed below:

  • Do not lie on the bed with a pillow or cushion under the knee. This will cause the knee to bend in a fixed manner.
  • Do not put a cushion below the thigh as this encourages formation of hip contractures.
  • Do not allow the residual limb to be freely hanging from the edge of the bed or from the edge of a chair without any support.

Practice good habits like:

  • Continue doing stretching motions as taught by your physiotherapist.
  • Try to get used to lying on your stomach once in a while to force the hip and knee into a straightened position.
  • Use a stump board whenever you move around on a wheelchair, so that the residual limb is not hanging freely over the edge of the seat.
Q: What are the common contractures that happen to amputees?
A:

The types of contractures depend on the levels of amputation.

A lower limb amputee-above knee amputee may develop hip contracture, in which the hip is bent in a fixed manner. A below-knee amputee may develop hip and knee contractures.

This is not desirable as a fixed bent knee or hip will later interefere with movement and  prosthesis alignment.

Usually an upper-limb amputee does not develop contractures as compared to a lower-limb amputee.

Stump Bandage

Q: How long does it take for my limb to stop shrinking?
A:

This depends on many factors. The levels of your amputation and size of your limb are important factors. If your stump is fleshy, it will take longer for the stump to shrink as compared to a bony stump. For an upper limb amputation, it may take a shorter duration to shrink compared to a lower limb amputation.
As a general rule, it takes anywhere from 3-6 months for an upper limb and 6-12 months for a lower-limb stump to fully shrink.

FAQ Category:

Q: How long does it take for my limb to stop shrinking?
A:

This depends on many factors. The levels of your amputation and size of your limb are important factors. If your stump is fleshy, it will take longer for the stump to shrink as compared to a bony stump. For an upper limb amputation, it may take a shorter duration to shrink compared to a lower limb amputation.

As a general rule, it takes anywhere from 3-6 months for an upper limb and 6-12 months for a lower-limb stump to fully shrink.

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Q: Is there a situation when a stump bandage should not be applied?
A:

Yes. This occurs when there is poor blood circulation to the stump or there is abnormal skin reaction towards bandaging.

Stump bandage should not be applied when:

  • Stump feels excessively cold
  • Stump skin has a reddish, bluish discolouration indicating restricted venous flow
  • Stump skin is hypersensitive to bandage pressure
  • Stump skin shows blistering or breakdown, particularly over bony areas

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Q: What is the correct technique to do stump bandaging?
A:

There are actually various techniques for bandage applications.



The techniques differ from institution to institution and also for different stump amputation levels.

Example: Bandaging Technique for below- knee amputation

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Q: How much bandage tension is enough?
A:

It should be noted that it is difficult to achieve the same tension each time the bandage is applied. However, the final result should always feel snug and comfortable and does not cause any pain due to excessive tightness or feels too loose.

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Q: How often must I apply the stump bandaging?
A:

Stump bandaging is worn day and night.

Preferably, stump bandaging should be re?applied every 4 hours or when the bandage feels loose, whichever is earlier.

This is to allow for:

  • Surgical wound care
  • Stump inspection
  • Stump hygiene
  • Early detection of potential stump skin problems

Stump bandage should never be worn when prosthesis is worn.

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Q: How early should I bandage my stump?
A:
  • Stump bandaging starts immediately after the amputation (after removal of any post operative cast, if any). This is necessary as there will be quick development of edema during the post-operative  period.
  • Usually lightweight bandage is used first. Later, when the surgical scar starts to heal, a compression bandage may be used.

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Q: What are the materials that can be used for stump bandaging?
A:

Lightweight  bandage 
This is a net-like stretch bandage that allows for good ventilation.



It also provides gentle compression to the stump and because of the soft texture of the stump, it is comfortable.



The disadvantage is that it easily loses its elasticity after washing and if the finished end is cut, the bandage frays.

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Q: Why do I need to do frequent stump bandaging post amputation?
A:

Bandaging is important as it has many important advantages:

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Stump Skin Disorders

Q: What are the common skin disorders affecting amputees?
A:

 
Skin, as the first point of contact with the socket of an artificial limb, needs to be healthy to enable amputees to be as active as possible without experiencing pain or discomfort - so prevention of skin disorders is a very important consideration.

The following are some problems that may result from these factors:

  • Rashes and Abrasions - these are the most common skin disorder which may occur intermittently or even frequently thoughout the amputee's lifetime.

  • Edema - characterized by skin swelling, drying and roughening at the end of the stump, and a red-brown pigmentation, this can usually be prevented by gradual compression using an elastic bandage. Although this may seem like a minor affliction at first, it can develop into a serious complication - a doctor should always be consulted.

  • Contact Dermatitis - this is caused by an irritant, whether in the materials of the socket, or from an outside source, such as a cleaning agent, powder, lubricant or ointment used in amputee care. Once the cause is discovered and treated, the problem usually disappears.

  • Cysts - this usually occurs after a limb has been worn for months or even years. They start as small bumps, or nodules which vanish when the artificial limb is temporarily removed, but the constant rubbing of the artificial limb can make the problem worse as cysts become larger and more numerous. Cysts should always be treated by a doctor, as they can become infected and cause further damage.

  • Folliculitis - a bacterial infection of the hair follicle which produces small, itching, solid areas. If left untreated, these may later develop into boils in which deep-red, painful nodules rise to the surface of the skin. Anti-bacterial soaps may cut down on the bacteria which cause these conditions. Experienced amputees recommend not shaving the residual limb.

  • Fungal Infections - another product of the moist, warm conditions in the socket of an artificial limb. These require special creams or powders, which can eventually clear up the condition.

  • Eczema - this is found in dry, scaly skin which becomes moist for no discernable reason. A cause needs to be established or the condition will recur. Allergies, or secondary conditions following edema can contribute to the condition.

  • Adherent scars - when there has been repeated infection or ulceration damage to the skin, scar formation may be so intense that scar tissue may become attached to the underlying layers of skin. Surgical revision to free the scar is often necessary.

  • Ulcers - these sores come from bacterial infections, or from circulation problems. They may become chronic if not diagnosed and treated immediately.

 

FAQ Category:

Stump Socks

Q: What does ply mean?
A:

 
The "ply" refers to the number of strands used in the sock - if two strands are used the sock is "two-ply". The higher the number the thicker the sock. The "ply" can differ between materials - so if you are changing from a sock of one material to a new one of a different material you may need a different ply. Three-ply and five-ply are the most common thicknesses. 

FAQ Category:

Q: How do I wash the stump socks?
A:

Stump socks need to be washed every day - you may even need several different plys throughout the day if your stump changes in volume. Some can be machine-washed but others need to be washed by hand. Here are a few tips:

  • Make sure all soap is rinsed out to avoid irritation.
  • Do not subject socks to excessive heat.
  • To maintain the shape you can place a ball (same size as the sock) in the end of the sock.

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Q: What are stump socks made of?
A:

Socks are available in various materials:

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Q: What can stump socks do?
A:

Prosthetic socks can be used by amputees to provide a more comfortable prosthetic fit, reduce friction and absorb perspiration by "wicking" moisture away from the skin. Reducing perspiration on the skin will then reduce bacterial infections and common skin complaints. 

FAQ Category:

Driving And Riding Motorcycles For Amputees

Q: Driving for lower extremity amputees
A:

It will be possible for you to drive either with or without modifications to your car. In general, if you still have one healthy leg and an automatic transmission, you won't need modifications. If your right leg was amputated and you're not comfortable operating the accelerator with your left foot, an extension pedal can be installed so the accelerator can be operated from the left side. In general, most prosthesis users with below-knee amputations, even bilateral amputations, can operate a manual transmission without modifications.

For those who have bilateral amputations and are not prosthesis users or those who are simply uncomfortable operating the pedals with their prosthetic feet, a wide variety of hand controls are available.

The usual modifications made for a lower limb amputee are:

Right leg amputation

  • Left foot gas pedal
  • Automatic transmission
  • Power brake

Both leg amputation

  • Hand controls for brake and accelerator spinner knob
  • Automatic transmission
  • Hand operated dimmer switch
  • Emergency brake extension
Q: Driving for upper extremity amputees
A:

It will still be possible for you to drive, either with or without modifications to your car. In general, if you can reach and operate all your car's controls either with your "good" hand or with the help of your prosthesis, or with your "good" hand and residual limb, you will not need modifications. Indeed, many people with bilateral below-elbow amputations can drive as easily without prostheses or modifications as the rest of us can with both hands. However those with bilateral above-elbow amputations generally need vehicle modifications.

Q: Driving for amputees
A:

After a limb amputation, a person is sometimes unable to drive a vehicle in the normal manner. There are, however, several types of adaptive devices that will allow an individual with an amputation to safely resume driving. The site of amputation will determine the degree of difficulty an amputee will have with a standard equipped vehicle.

Q: Where to get more information?
A:

For more details, please contact:

Ibu Pejabat Jabatan Pengangkutan Jalan
Aras 1-5, Blok D4, Parcel D,
Pusat Pentadbiran Kerajaan Persekutuan,
62620 Putrajaya

Tel: 03-8886 6400
Fax: 03-8888 9645
Hotline: 03-8888 4244

Website: http://www.jpj.gov.my/

Email: [email protected]

 

Prosthesis

Q: Where can I get financial assistance to purchase a prosthesis?
A:

Please refer to the Do you know that... page of the Amputee section.

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Q: Where can I get a prosthesis (in Malaysia)?
A:

A listing of Malaysian companies that offer prosthetic and orthotic devices can be found here.

FAQ Category:

Q: How do I get a prosthesis?
A:

In most cases, purchasing a prosthesis involves the intended user, a rehabilitation physician or an orthopaedic surgeon, a prosthetist, the prosthetic company and a physical therapist.



The rehabilitation physician or the orthopaedic surgeon will prescribe the most suitable  prosthesis to suit the user's physical and medical condition, and also one's lifestyle.

FAQ Category:

Q: What are the parts of an upper limb prosthesis?
A:

Parts of upper limb prosthesis: 

Missing picture!!!

 

Source: WHO Manual for the Rehabilitation of People with Amputations 2004. All diagrams used below are from WHO Manual unless noted.

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Q: What should be considered when choosing a prosthesis?
A:

Several important factors should be considered when choosing a prosthesis:

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Q: What is a prosthesis used for?
A:

In general, prosthetic devices are used to replace  amputees' missing limbs so that they may perform regular daily tasks easier, helping them gain more independence and confidence as they carry on everyday life.

The availability of modern technology has made it possible for prosthetic devices to perform almost any task - from relatively simple artificial teeth used for dental implants to specially designed and manufactured artificial limbs for sports such as running/sprinting.

FAQ Category:

Q: What is a prosthesis?
A:

A prosthesis is an externally applied device designed to replace a missing part of the body or to make a part of the body work better. Diseased or missing eyes, arms, hands, and legs are commonly replaced by prosthetic devices. Generally, most people view prosthesis as an artificial limb.

FAQ Category:

Stump Shrinker

Q: Tips for initial shrinker application
A:

 

  • Complete wound healing is not required. You can apply it after dressing. A nylon stocking is applied to the stump after the dressing to prevent the shrinker from tugging on the dressing.

  • The shrinker is usually worn as you would wear a sock. For a beginner, the shrinker may be applied using an applicator.

 

FAQ Category:

Q: When to wear a stump shrinker?
A:
  • It is first worn after surgery (before a prosthesis is fitted) to control stump edema or swelling ? in other words to fasten the stump to shrink and reach maturity.
  • A shrinker should also be worn at nighttime, when not wearing a prosthesis.
  • When swelling makes prosthetic donning difficult.

 

FAQ Category:

Q: What is a stump shrinker?
A:
  • It is an elastic compression garment for an amputated limb.
  • It is used to control residual limb swelling and promote healing.
  • It is designed to fit snugly and to apply pressure to the soft tissues of the stump, usually as an alternative to the usual compression bandaging.

 

 

FAQ Category:

Cardiac Rehabilitation

Q: What does cardiac rehabilitation involve?
A:

 
Components of cardiac rehabilitation program vary by individual need and each program will be carefully constructed by his or her rehabilitation team.
Components of cardiac rehabilitation are:
i) Exercise 
Typically starts slow
Blood pressure and heart rate are monitored before and intermittently during exercise
High risk patient may need continuous ECG monitoring throughout the exercise session.
ii) Diet
Dietitian will work with you to develop an appropriate diet regime.
Depending on your need you may be prescribed with a low fat, low salt or diabetic diet.
Weight loss may be a goal for obese patients.
iii) Counseling
Psychologist can help patient to manage anxiety and stress.
You may be taught relaxation techniques.
iv) Education
For both the patient and the family.
Should be fully educated on the physical limitations of the patient, his recommended diet and exercise plan, his emotional status and the life style changes required.
Emphasized on life long behavioral modifications.
v) Smoking cessation.
An important part of cardiac rehabilitation.
Need strong willpower.
You may be referred to a specific centers to quit smoking.

Q: When does cardiac rehabilitation begin?
A:

 
Rehabilitation begins even while the patient is still in the ward and continues after discharge.
There are 4 recognized phases of cardiac rehabilitation.
Phase 1 (inpatient)
Inpatient education and mobilization should begin shortly after admission to hospital. A program should assist physical and psychological functioning and encourage lifestyle changes to prevent further coronary events specifically ,it can reduce anxiety associated with hospital admission,raise awareness about heart disease and increase patient's sense of control.
Phase 2
This phase consists of  the supervised exercise programme together with further  education on diet, stress management.
Phase 3 (long term maintenance)
This is the long term unsupervised exercise programme including the community - based  programme which  is hoped will be followed by the subject after graduation from phase 3. It also encompasses monitoring with the symptoms, lifestyle, risk factors modifications and medication.

Q: Contraindications of cardiac rehab
A:
  • Heart attack complicated by heart failure, cardiogenic shock or complicated ventricular arrythmias.
  • Chest pain or breathlessness at low level of exercise
  • ST segment depression > 1mm on resting ECG
  • If has undergone stress exercise testing, marked ST segment depression >2mm or angina at < 5 METS
Q: Goals of cardiac rehabilitation
A:
  • To minimize the risk of a future cardiac events
  • To provide optimal physical and emotional status
  • To promote self responsibility and use of health resources
Q: Who needs cardiac rehabilitation?
A:

Anyone who has had 

  • an acute heart events such as heart attack and  heart failure
  • cardiac surgery such as bypass surgery, valvuloplasty 
  • any other form of heart disease such as rheumatic heart disease, cardiomyopathy.
Q: What is cardiac rehabilitation?
A:

Cardiac rehabilitation is an integrated treatment of individuals after cardiac event or procedures with the goal of maximizing physical functions, promoting emotional adjustment, modifying cardiac risk factors and addressing return to previous social roles and responsibilities.

Autonomic Dysreflexia

Q: Reminder
A:

 
If you are unable to find the stimulus causing autonomic dysreflexia, or your attempts to remove the stimulus fail, you need to obtain emergency medical treatment. Since not all physicians are familiar with autonomic dysreflexia (hyperreflexia) and its treatment, you should carry a card that describes the condition and the treatment required.
The following is an example of a card you can cut out and carry in your wallet. Put your name on the card in the space after "The bearer of this card". Let people know you have this card and use it with the medical staff to instruct in emergency care. It may save your life!
 
 
 

Medical Alert Card for Autonomic Dysreflexia
The bearer of this card,
___________________________________,
is at risk for autonomic dysreflexia, a life-threatening complication of spinal cord injuries above the T7 level. It is caused by an exaggerated sympathetic nervous system response to a noxious stimulus below the level of injury. The usual etiologies of AD are inadequate emptying of the bladder, a full bowel, tight clothing, ingrown toenail, etc.
The symptoms can include elevated blood pressure, headache, nasal congestion, bradycardia, and flushing (above the level of injury). Please note the normal blood pressure for an SCI patient is 90/60. If the AD is unresolved, it may result in myocardial infarction, stroke, retinal hemorrhage, or death. It is essential that the source be identified and the elevated BP be resolved immediately. Please see reverse of this card for details of treatment.
 

Autonomic Dysreflexia Treatment

  1. Raise the head of the bed up to 90 degrees or sit the person upright.

  2. Check for the source of the AD: full bladder or bowel, tight clothing, ingrown toenail, pressure ulcer, or any other noxious stimulus. Removing the cause will usually eliminate or decrease the symptoms.

  3. Monitor the blood pressure and pulse every 5 minutes.

  4. Drain or irrigate the bladder, using a topical anesthetic jelly for catheterization.

  5. Check the rectum for stool, after first applying an anesthetic ointment to the rectal wall. If stool is present, begin digital stimulation to promote reflex defecation.

  6. If SBP is above 160, apply one inch of nitro paste to hairless skin, and cover with clear occlusive wrap.

  7. If elevated SBP continues, apply one additional inch of nitro paste, to equal two inches.

  8. Wipe off nitro paste when SBP decreases to 130.

  9. If SBP remains elevated despite two inches of nitro paste, give 10 mg of hydralazine. If SBP remains elevated after 10 minutes, give an additional 10 mg of hydralazine.

  10. If SBP remains refractory to the above treatments, give 10 mg of bite-and-swallow nifedipine. If nifedipine is given, the patient is at risk for hypotension once the AD is controlled and must be monitored closely for several hours after administration of nifedipine.

 
 

FAQ Category:

Q: How to Prevent AD?
A:

The following are precautions you can take which may prevent AD episodes:

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Q: How to treat AD?
A:

Treatment must be initiated quickly to prevent complications.

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Q: What are the causes of AD?
A:

There can be many stimuli that cause autonomic dysreflexia. Anything that would have been painful, uncomfortable, or physically irritating before the injury may cause autonomic dysreflexia after the injury.

The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder.

FAQ Category:

Q: What are the signs and symptoms of AD?
A:
  • Pounding headache (caused by the elevation in blood pressure)
  • Goose pimples
  • Sweating above the level of injury
  • Nasal congestion
  • Restlessness
  • Hypertension (blood pressure greater than 200/100)
  • Flushed (reddened) face

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Q: What levels of injury are at risk for AD?
A:

Persons at risk for this problem generally have injury levels above T7.

FAQ Category:

Q: What is Autonomic Dysreflexia?
A:

Autonomic dysreflexia (AD), also known as hyperreflexia, means an over-activity of the Autonomic Nervous System causing an abrupt onset of excessively high blood pressure. Autonomic dysreflexia can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.

FAQ Category:

General SCI

Q: What is the prognosis?
A:

 
The types of disability associated with SCI vary greatly depending on the severity of the injury, the segment of the spinal cord at which the injury occurs, and which nerve fibers are damaged. Most people with SCI regain some functions between a week and 6 months after injury, but the likelihood of spontaneous recovery diminishes after 6 months. Rehabilitation strategies can minimize long-term disability.

FAQ Category:

Spinal Cord Injury

Q: Is there any treatment?
A:

While recent advances in emergency care and rehabilitation allow many SCI patients to survive, methods for reducing the extent of injury and for restoring function are still limited. Immediate treatment for acute SCI includes techniques to relieve cord compression, prompt (within 8 hours of the injury) drug therapy with corticosteroids such as methylprednisolone to minimize cell damage, and stabilization of the vertebrae of the spine to prevent further injury.

FAQ Category:

Q: Is there a cure for Spinal Cord Injury?
A:

Damage to the spinal cord due to an injury can be permanent and currently there is no cure. However, new research proves that spinal cord repair and regeneration is possible. More and more researchers around the world are confident that a cure for paralysis could be as close as ten years away. New breakthroughs and discoveries leading to a cure are imminent.

FAQ Category:

Q: What is meant by the terms "complete" and "incomplete" injuries?
A:

Complete injuries result in total loss of sensation and function below the injury level. Incomplete injuries result in partial loss. "Complete" does not necessarily mean the cord has been severed. Each of the above categories can occur in paraplegia and quadriplegia.

FAQ Category:

Q: What is Paraplegia and Quadriplegia?
A:

Paraplegia is the loss of sensation and movement in the legs and in part or all of the trunk, usually resulting from an injury to the spinal cord below the neck. Quadriplegia (also Tetraplegia) is paralysis of all four limbs (from the neck down) resulting from injury to the neck.

Fractures or compression of the vertebrae, which cause permanent damage to the spinal cord may lead to loss of sensation, movement, pain management, bladder and bowel control, as well as affecting sexual function.

FAQ Category:

Q: What are the common causes of Spinal Cord Injury?
A:

The most common causes of spinal cord injury are car and other motor vehicle collisions, falls, and other medical conditions and sports injuries. The injury is usually caused by sudden impact, which crushes the spine and cord.

FAQ Category:

Diabetes (6)

Diabetes

Q: Where can I find out more information on diabetes?
A:

FAQ Category:

Q: Is there a cure for diabetes?
A:

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

FAQ Category:

Q: What are some of the complications associated with diabetes?
A:

Diabetes affects both the large and small blood vessels. Long-term damage to small blood vessels causes complications to the eyes, kidneys, legs and feet.



Damage to large blood vessels increases the risk of strokes and heart attacks.



For these reasons it is important to control your diabetes.

FAQ Category:

Q: What are the symptoms and signs of diabetes?
A:
  • Constant tiredness.
  • Excessive thirst.
  • Frequent urination, especially at night.
  • Unexplained weight loss.
  • Skin infections and itching in the genital areas.
  • Slow healing of cuts and wounds.
  • Numbness or burning sensations in the limbs.
  • If you have these symptoms or suspect that you may have diabetes, please see your doctor for a blood sugar test.

* You may not always experience all these symptoms

FAQ Category:

Q: What are the different types of diabetes?
A:

Types of Diabetes: missing information

FAQ Category:

Q: What is diabetes?
A:

Diabetes is a condition of abnormally high levels of sugar in the blood. It can develop from lack of insulin production by the pancreas or due to the body's resistance towards insulin, thus not allowing the uptake and action of insulin at its target sites.

FAQ Category:

Diabetic Foot Ulcers

Q: Self-care tips
A:

You can help prevent foot ulcers by practicing good foot care. This includes keeping your feet clean and dry each day; keeping your toenails cut straight across, preferably by a podiatrist; checking your feet daily for any cracks or sores; wearing well-fitting shoes; and following your doctor's treatment plan for controlling your blood sugar level.

FAQ Category:

Q: How is it treated ?
A:

missing info

FAQ Category:

Q: What if I develop an ulcer?
A:

If you suspect an ulcer has formed, tell your doctor or podiatrist STRAIGHT AWAY!



The goal of treatment is to dress and protect the ulcer, to prevent and treat any infection and to help the skin heal.



For an ulcer to heal, it is very important that your blood sugar levels are well controlled.

FAQ Category:

Q: What increases the risk of developing foot ulcers?
A:
  • reduced sensation to the feet. This risk increases:
    • the longer you have diabetes
    • with poorly controlled diabetes

If you have narrowed arteries. This risk increases:

missing info

FAQ Category:

Q: What is it?
A:

Missing photo

An area where the skin has broken down and you can see the underlying tissue.

In people with diabetes, the skin on the feet does not heal so well, and is prone to develop an ulcer, even after a mild injury, e.g. stepping on a small stone with your bare feet. 

FAQ Category:

Diabetic Footwear

Q: Removable Pneumatic Walkers
A:

A number of removable walking boots are available to help protect and heal foot wounds in patients with diabetes, including the DH Pressure Relief Walker, the Conformer Boot, and the AirCast Pneumatic Walker. Removable walking boots offer several advantages over TCCs*: they are relatively inexpensive, they have a protective inner sole that can be easily replaced if it shows signs of wear, they do not require special training for correct and safe application, and they can be easily removed to assess and debride the wound.

The DH Pressure Relief Walker has been shown to be identical to TCCs in pressure reduction at the site of ulcerations on the sole. The disadvantage of these boots is that patients can remove them, so the element of forced adherence that makes the TCC attractive is lost.

* TCC=total contact cast

FAQ Category:

Q: Diabetic Socks
A:

Diabetic socks are designed to reduce pressure on swollen feet, ankles, and sensitive legs by minimizing constriction. Socks that maintain their shape and ability to absorb moisture are preferable and are seen with materials with a blend of cotton and polyester. Manufactures will soon be coming out with cushioned and low-abrasion potential socks to use for patients with diabetic neuropathy.



Features that are seen in diabetic socks:

FAQ Category:

Q: Prescription Footwear
A:

MISSING PICTURE!!!

Many patients with diabetes need special footwear prescribed by a physician. Prescription footwear for diabetics includes:

FAQ Category:

Q: Diabetic Shoes
A:

Proper footwear is crucially important for people with diabetes, and especially so if there is any evidence of neuropathy, or lack of sensation.

MISSING PICTURE!!!

Diabetic footwear should:

FAQ Category:

Q: Insoles
A:

 

 

MISSING PICTURE!!!

 

 

Insoles are footwear inserts, that are designed to correct abnormal walking patterns, thus helping to relieve pain and soft tissue damage to the feet. This also helps to prevent diabetic foot complications such as calluses and corns, by evening out pressure distribution. Insoles are either custom made, or bought off the shelf.

FAQ Category:

Foot Conditions Caused By Diabetes

Q: Charcot Joints or Neuropathic Arthropathy
A:

This is a condition that affects some diabetic patients with peripheral neuropathy (loss of sensation) after eight to 10 years. Neuropathy affects the sensory nervous system especially at the farther points of the body (i.e. feet and hands) causing loss of feeling or numbness. Diabetic neuropathy also involves the autonomic (involuntary) nervous system which controls regulation of blood vessels and may result in increased blood flow to the limb, contributing to swelling and osteoporosis of the bones as the Charcot process occurs.

Arthropathy means a problem with a joint. It is thought that as the peripheral neuropathy progresses in chronic diabetes, the joints can no longer recognize the forces acting on them and the relative positions of the various joints. This leads to microtrauma or microfractures.

There are three stages to Charcot arthropathy. The first stage is the destruction stage. During this stage, the joint and surrounding bone is destroyed. The bone fragments, the joint becomes unstable and in some cases the bone is completely reabsorbed. There is swelling, redness, and warmth to the area. As the bones and joint are affected, fractures and instability develop and the joints can dislocate or shift the bones in relationship to each other. This can lead to severe deformity of the foot and ankle. Often the midfoot joints are affected and the result is a very flat foot which is wide where the normal foot narrows in the arch. Bony prominences often develop on the bottom surface of the foot. Diagnosis and early treatment at this stage is important to try to minimize the bone destruction and deformity. This process may last as long as six to 12 months.

During the second stage the acute destructive process slows down and the body begins to try and heal itself. The swelling and heat begin to disappear. Once the acute process is resolved and the healing on-going, the third stage begins. This is a reconstruction phase during which the bones and joints heal. Unfortunately, the foot is often deformed, and if there has been enough destruction, there may be residual instability. Fitting shoes may be very difficult, and prescription footwear and diabetic orthotics (shoe inserts) are important to help prevent ulcer formation over deformed areas.

Q: Foot Ulcers
A:

An ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. In some people with diabetes the skin on the feet does not heal so well and is prone to develop an ulcer, even after a mild injury.



About 1 in 10 people with diabetes develop a foot ulcer at some stage. A foot ulcer is prone to infection, which may become severe. Your risk of developing foot ulcers increases:

Q: Toenail Fungus
A:

Toenail fungus, also known as Onychomycosis. This occurs when microscopic fungi gain entry through a small trauma in the nail, then grow and spread in the warm, moist environment inside the patient?s socks and shoes.

Symptoms include swelling, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white.

Q: Mallet Toes
A:

MISSING IMAGE 

A mallet toe occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the mallet toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.

Q: Ingrown Toe Nails
A:

Ingrown toe nails are a common, painful condition that occur when skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. This can lead to infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection.



Ingrown toenails develop for many reasons. In some cases the condition is congenital. Often trauma, can cause a piece of the nail to be pushed into the skin.

Q: Corns
A:

MISSING IMAGE

Corns develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas. Unlike calluses they contain a cone-shaped core with a point that can press on a nerve below, causing pain. Corns usually form on the tops, sides and tips of the toes. Corns can become inflamed due to constant friction and pressure from footwear. Corns can lead to the development of an ulcer.

Q: Claw Toes
A:

MISSING IMAGE

Q: Calluses
A:

MISSING IMAGE

Q: Bunions
A:

MISSING IMAGE

Q: Athlete?s Foot
A:

Definition

Athlete?s foot is a fungal infection that causes red, dry, flaking skin, sometimes accompanied by pain or itching. The condition usually occurs between the toes or on the soles or sides of the feet. In the acute stage, there are blisters that itch or ?weep?. Athlete?s Foot can spread to the toenails, causing chronic fungal infections.



Cause

Fungal infections are often contracted in showers, gyms, dressing rooms, swimming pool lockers, or other warm, damp areas where fungus can thrive.

Q: Skin Changes
A:

Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.



After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products.



Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don't soak your feet - that can dry your skin

Total Contact Cast

Q: Is there anything else I should know?
A:

A few other tips may help you. You may have some itching under the cast. Don't slide anything down the cast to scratch the itch because you could very easily hurt the skin underneath. You might try gently rubbing the same area on your other foot. Sometimes that helps.

When you're sitting down, put your leg up on a chair or pillow whenever possible.

While you're sleeping, you might kick or rub your other leg with the cast. This could cause some skin damage. It is a good idea to put a thick, soft knee-high sock over your other leg before you go to bed, or put a pillow between your legs.

FAQ Category:

Q: When should I call my doctor?
A:

Call your doctor right away if any of the things listed below happen. Remember that you don't have good pain sensation (ability to feel pain) in your leg, so you might not be able to feel something going wrong. You must check your cast (or have someone else check it) every day. Watch for these things:

FAQ Category:

Q: Can I get my cast wet?
A:

No. You won't be able to take regular baths or showers because you have to keep the cast dry. Take sponge baths instead.



Try not to go outside when the weather is wet. If you must go outside when it's wet, wrap your cast in a plastic bag. Don't shovel snow or walk in the rain.

FAQ Category:

Q: How should I take care of my cast?
A:

Don't put any weight on the cast while it's drying. Depending on the type of cast you have, drying will take either 30 minutes or 24 hours. Your doctor will tell you what kind of cast you have.



There are 3 reasons you should do as little walking as possible after the cast dries:

FAQ Category:

Q: Why do I need a cast?
A:

The cast will help your foot sore heal. The sore goes from the surface of your skin down into the deeper tissues. Sores like these are caused by the pressure that is placed on bony points of your foot as you walk. You probably did not feel the injury when it started because of nerve damage (called neuropathy) caused by your diabetes. If you keep walking without the cast, your sore will not heal. The cast takes pressure off the ulcer and puts your weight on other areas of your foot and leg.

FAQ Category:

Q: What is a total contact cast?
A:

The total contact cast is a fiberglass shell with a walking bar on the bottom. The shell fits your leg and foot very closely. It touches, or is in contact with your whole foot--that is why it is called a total contact cast. The walking bar keeps weight off your foot when you are standing.

FAQ Category:

Treatment For Diabetic Foot Ulcer

Q: Guidelines for preventing foot ulcers from diabetes
A:
  1. General foot cleanliness

    • Wash feet daily with mild soap.

    • Do not use hot water or soak your feet.

    • Pat feet dry with soft towel, especially between the toes.

    • Apply moisturizer on feet, except in between toes, or on skin breaks and open sores.

    • Dust a non-medicated powder in between toes.Wear clean socks and sturdy shoes. Never go barefoot, not even indoors.

    • Do not use tongs.

  2. Daily foot examination
    Look for:

    • Swelling

    • Blisters

    • Callosities (thickened skin) on the sole of the feet

    • Changes in nail or nail colour and surrounding skin

    • Loss of feeling on the feet (compare hot water in the shower on feet and elbows, touch cotton to feet and to arms and look for differences in sensation)

    • Changes in skin colour (bluish, redness), skin break

      If vision is poor, get a family member to help you.

  3. Foot care

    • Cut toe nails straight across and gently file the edges

    • Avoid cutting nails to short

    • Do not cut the corner

    • Do not use sharp instruments to pick at the sides of the nails

    • If your feet are cold, you may be tempted to warm them. Unfortunately, if they cannot feel heat it is easy  to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks

    • Corns or calluses should be treated by a healthcare professional. Never cut them with a razor blade or use chemicals to remove them.

  4. Footwear

    • Wear properly fitted shoes with soft uppers and flexible soles, preferably with adjustable straps or laces.

    • Avoid walking barefoot or wearing open-toed or open-heeled shoes.

    • Break new shoes in gradually, by wearing them for a short time each day.

    • Check inside shoes daily for foreign objects, nail points, and torn linings. If the linings are torn or crumpled, the shoe should be discarded./div>

    • Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer.

    • Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes. Don't walk when you have open sores.

 

Q: How is Charcot arthropathy treated?
A:

First step  is to get the heat and swelling under control.

Q: What about surgical options?
A:

A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate.

 

Q: How can wounds and ulcers heal faster?
A:

Wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.



After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

Q: What are the key factors in the appropriate treatment of a diabetic foot ulcer?
A:

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

 

 

Arthritis (12)

Arthritis

Q: Are researchers studying arthritis and exercise?
A:

Researchers are looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis. They have found that people who do moderate, regular running have low, if any, risk of developing osteoarthritis. However, studies show that people who participate in sports with high-intensity, direct joint impact are at risk for the disease. Examples are football and soccer. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase osteoarthritis risk. Early diagnosis and effective treatment of sports injuries and complete rehabilitation should decrease the risk of osteoarthritis from these injuries.

Researchers are also looking at the effects of muscle strength on the development of osteoarthritis. Studies show, for example, that strengthening the quadriceps muscles can reduce knee pain and disability associated with osteoarthritis. One study shows that a relatively small increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of developing knee osteoarthritis. Other researchers continue to look for and find benefits from exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, and fibromyalgia. They are also studying the benefits of short- and long-term exercise in older populations.

FAQ Category:

Q: Should someone with rheumatoid arthritis continue to exercise during a general flare? How about during a local joint flare?
A:

It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares. Patients can talk to their doctor about how much rest is best during general or joint flares.

FAQ Category:

Q: How much exercise is too much?
A:

Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous. People with arthritis should work with their physical therapist or doctor to adjust their exercise program when they notice any of the following signs of strenuous exercise:

   1. Unusual or persistent fatigue
   2. Increased weakness
   3. Decreased range of motion
   4. Increased joint swelling
   5. Continuing pain (pain that lasts more than 1 hour after exercising)

FAQ Category:

Q: Are there different exercises for people with different types of arthritis?
A:

There are many types of arthritis. Experienced doctors, physical therapists, and occupational therapists can recommend exercises that are particularly helpful for a specific type of arthritis. Doctors and therapists also know specific exercises for particularly painful joints. There may be exercises that are off-limits for people with a particular type of arthritis or when joints are swollen and inflamed. People with arthritis should discuss their exercise plans with a doctor.

FAQ Category:

Q: What type of strengthening program is best?
A:

This varies depending on personal preference, the type of arthritis involved, and how active the inflammation is. Strengthening one's muscles can help take the burden off painful joints. Strength training can be done with small free weights, exercise machines, isometrics, elastic bands, and resistive water exercises. Correct positioning is critical, because if done incorrectly, strengthening exercises can cause muscle tears, more pain, and more joint swelling.

FAQ Category:

Q: How often should people with arthritis exercise?
A:

..........no answer

FAQ Category:

Q: What are some pain relief methods for people with arthritis?
A:

There are known methods to help stop pain for short periods of time. This temporary relief can make it easier for people who have arthritis to exercise. The doctor or physical therapist can suggest a method that is best for each patient. The following methods have worked for many people:
 

FAQ Category:

Q: Step up to exercise: How to get started
A:
  1. Discuss exercise plans with your doctor.
  2. Start with supervision from a physical therapist or qualified athletic trainer.
  3. Apply heat to sore joints (optional - many people with arthritis start their exercise program this way).
  4. Stretch and warm up with range-of-motion exercises.
  5. Start strengthening exercises slowly with small weights (a 1- or 2-pound weight can make a big difference).
  6. Progress slowly.

 

FAQ Category:

Q: How does a person with arthritis start an exercise program?
A:

People with arthritis should discuss exercise options with their doctors and other health care providers. Most doctors recommend exercise for their patients. Many people with arthritis begin with easy, range-of-motion exercises and low-impact aerobics. People with arthritis can participate in a variety of, but not all, sports and exercise programs. The doctor will know which, if any, sports are off-limits.

FAQ Category:

Q: What types of exercise are most suitable for someone with arthritis?
A:

Three types of exercise are best for people with arthritis:

    Range-of-motion exercises (eg dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.

    Strengthening exercises (eg weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.

FAQ Category:

Q: How does exercise fit into a treatment plan for people with arthritis?
A:

Exercise is one part of a comprehensive arthritis treatment plan. Treatment plans also may include rest and relaxation, proper diet, medication, and instruction about proper use of joints and ways to conserve energy (that is, not waste motion) as well as the use of pain relief methods.

FAQ Category:

Q: Should people with arthritis exercise?
A:

Yes. Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, cardiac fitness, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being.

FAQ Category:

Rheumatoid Arthritis

Q: Recovery and rehabilitation
A:

Your doctor will prescribe pain medication for your use after the surgery. Before you leave the hospital, you will be taught how to use crutches. It takes a long time to recover from foot surgery. Here are some things to consider as part of your recovery:

  • Ask friends or family for help in preparing meals and doing other activities of daily living.
  •  
  • For the first week or so after surgery, keep your foot elevated above the level of your heart as much as possible.
  •  
  • Be sure to do the prescribed physical therapy exercises. They will help you regain strength, motion, and the ability to walk.
  •  
  • You won't be able to put all your weight on your foot for several weeks, and you may need to wear a special shoe or a cast for several months.

You will probably be able to resume ordinary daily activities 3 to 4 months after surgery.

RA is a progressive disease that currently has no cure. However, medications, exercises, and surgery can help lessen the effects of the disease and may slow its progress.

FAQ Category:

Q: Surgical options
A:

Surgery can correct several of the conditions, such as bunions and hammer toes, associated with RA of the foot and ankle. In many cases, however, the most successful surgical option is fusion (arthrodesis). Fusion is often performed on the great toe, in the midfoot, in the heel, and in the ankle. In this procedure, the joint cartilage is removed; in some cases, some of the adjacent bone is also removed. The bones are held in place with screws, plates and screws or a rod through the bone. The surgeon may then implant a bone graft from the hip or leg.

FAQ Category:

Q: Treatment
A:

Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation.

FAQ Category:

Q: Diagnosis
A:

Sometimes, arthritis symptoms in the foot are the first indication that you have RA. Your doctor will ask you about your medical history, your occupation, and your recreational activities, as well as any other persistent or previous conditions in your feet and legs. The appearance of symptoms in the same joint on both feet or in several joints is an indication that RA might be involved. Your doctor will also request X-rays to see how much damage there is to the joints.

FAQ Category:

Q: Signs and symptoms
A:

"The most common symptoms of RA in the foot are pain, swelling, and stiffness. Symptoms usually appear in several joints on both feet. You may feel pain in the joint or in the sole or ball of your foot. The joint may be warm and the way you walk may be affected. You may d" - MISSING INFORMATION!!!

FAQ Category:

Juvenile Rheumatoid Arthritis

Q: Regular exercise
A:

When pain strikes, it's natural for your child to want to sit still. But it's important to maintain a regular exercise program, especially for those with arthritis. Muscles must be kept strong and healthy so they can help support and protect joints. Regular exercise also helps to maintain range of motion of joints.

At home and at school, your child should maintain regular exercise and physical fitness programs. Safe activities include walking, swimming, and bicycling (especially on indoor stationary bikes). Always be certain your child warms up the muscles through stretching before exercising. Making exercise a family activity can increase the level of fun and enthusiasm.

Consult your child's doctor, occupational therapist or physical therapist about sports restrictions. Some sports, especially impact sports, can be hazardous to weakened joints and bones. In addition, be certain your child eats a balanced diet that includes plenty of calcium to promote bone health.

Q: Physical therapy and occupational therapy
A:

An appropriate physical therapy and occupational therapy program is essential in the management of any type of arthritis. The therapist will explain the importance of certain activities and recommend exercises suited to your child's specific condition. The therapist may recommend range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to help build strength and endurance.

Q: Medications
A:

For inflammation and pain, your child's doctor or pediatric rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (such as Advil or Motrin). These drugs may help reduce inflammation and pain by limiting the release of harmful chemicals from white blood cells.

Q: Treating juvenile rheumatoid arthritis
A:

In many cases, JRA may be treated with a combination of medication, physical therapy, and exercise. In specific situations, your child may require injection of corticosteroids into the joint or surgery. Your child's health care providers, including the primary care physician, rheumatologist, and physical therapist, should work together to develop the best method of treatment for your child.

Q: Diagnosing juvenile rheumatoid arthritis
A:

Determining if your child has JRA starts with your child's doctor taking a detailed medical history and conducting a thorough physical examination. Your child's doctor may take X-rays or perform blood tests to exclude other conditions that can produce symptoms similar to those of JRA. In addition to X-rays, some tests the doctor may perform while evaluating your child's symptoms include:

Q: Signs and symptoms of juvenile rheumatoid arthritis
A:

The first signs of arthritis can be subtle or obvious. Signs may include limping or a sore wrist, finger, or knee. Joints may suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints can also occur. Rashes may suddenly appear and disappear, developing in one area and then another. High fevers that tend to spike in the evenings and suddenly disappear are characteristic of systemic juvenile rheumatoid arthritis.

Q: Types of juvenile rheumatoid arthritis
A:

Typically juvenile rheumatoid arthritis appears between the ages of 6 months and 16 years. The first signs are often joint pain or swelling and reddened or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.



There are 3 major types of juvenile rheumatoid arthritis: missing information

Q: What causes juvenile rheumatoid arthritis?
A:

The medical community doesn't know exactly what causes rheumatoid arthritis (also referred to as idiopathic arthritis) in children. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.

Scleroderma

Q: How can I play a role in my health care?
A:

Although your doctors direct your treatment, you are the one who must take your medicine regularly, follow your doctor's advice, and report any problems promptly. In other words, the relationship between you and your doctors is a partnership, and you are the most important partner. Here's what you can do to make the most of this important role:

  • Get educated: Knowledge is your best defense against this disease. Learn as much as you can about scleroderma, both for your own benefit and to educate the people in your support network (see below).

  • Seek support: Recruit family members, friends, and coworkers to build a support network. This network will help you get through difficult times - when you are in pain; when you feel angry, sad, or afraid; when you're depressed. If you can't find a support group, you might want to consider organizing one.

  • Assemble a health care team: You and your doctors will lead the team. Other members may include physical and occupational therapists, a psychologist or social worker, a dentist, and a pharmacist.

  • Be patient: Understand that a final diagnosis can be difficult and may take a long time. Find a doctor with experience treating people with systemic and localized scleroderma. Then, even if you don't yet have a diagnosis, you will get understanding and the right treatment for your symptoms.

  • Speak up: When you have problems or notice changes in your condition, don't feel too self-conscious to speak up during your appointment or even call your doctor or another member of your health care team. No problem is too small to inquire about, and early treatment for any problem can make the disease more manageable for you and your health care team.

  • Don't accept depression: While it's understandable that a person with a chronic illness like scleroderma would become depressed, don't accept depression as a normal consequence of your condition. If depression makes it hard for you to function well, don't hesitate to ask your health care team for help. You may benefit from speaking with a psychologist or social worker or from using one of the effective medications on the market.

  • Learn coping skills: Skills like meditation, calming exercises, and relaxation techniques may help you cope with emotional difficulties as well as help relieve pain and fatigue. Ask a member of your health care team to teach you these skills or to refer you to someone who can.

  • Ask the experts: If you have problems doing daily activities, from brushing your hair and teeth to driving your car, consult an occupational or physical therapist. They have more helpful hints and devices than you can probably imagine. Social workers can often help resolve financial and insurance matters.

 

FAQ Category:

Q: What other conditions can look like scleroderma?
A:

Symptoms similar to those seen in scleroderma can occur with a number of other diseases. Here are some of the most common scleroderma lookalikes:

FAQ Category:

Q: How is scleroderma diagnosed?
A:

Depending on your particular symptoms, a diagnosis of scleroderma may be made by a general internist, a dermatologist (a doctor who specializes in treating diseases of the skin, hair, and nails), an orthopaedist (a doctor who treats bone and joint disorders), a pulmonologist (lung specialist), or a rheumatologist (a doctor specializing in treatment of rheumatic diseases). A diagnosis of scleroderma is based largely on the medical history and findings from the physical exam.

FAQ Category:

Q: How can scleroderma affect my life?
A:

Having a chronic disease can affect almost every aspect of your life, from family relationships to holding a job. For people with scleroderma, there may be other concerns about appearance or even the ability to dress, bathe, or handle the most basic daily tasks. Here are some areas in which scleroderma could intrude.

FAQ Category:

Q: Who gets scleroderma?
A:

Although scleroderma is more common in women, the disease also occurs in men and children. It affects people of all races and ethnic groups. However, there are some patterns by disease type. For example:
 

  • Localized forms of scleroderma are more common in people of European descent than in African Americans.

 

  • Morphea usually appears between the ages of 20 and 40.

 

  • Linear scleroderma usually occurs in children or teenagers.

FAQ Category:

Q: What causes scleroderma?
A:

Although scientists don't know exactly what causes scleroderma, they are certain that people cannot catch it from or transmit it to others. Studies of twins suggest it is also not inherited. Scientists suspect that scleroderma comes from several factors that may include:

Abnormal immune or inflammatory activity: Like many other rheumatic disorders, scleroderma is believed to be an autoimmune disease. An autoimmune disease is one in which the immune system, for unknown reasons, turns against one's own body.

FAQ Category:

Osteoarthritis

Q: Relaxation and sleep
A:

Learning to relax is an important part of dealing with stress. Here are some techniques you can use to relax.
 

  • Deep Breathing. This is as simple as it sounds. Breathing deeply can help you calm down and unwind. And it feels great! Find a quiet place and find five to 15 minutes to practice this every day.

 

  • Progressive Relaxation. Progressive relaxation involves lying on your back and, starting with your feet and moving up your body to your face, consciously tensing and relaxing the muscles in your body. Combine with deep breathing for extra relaxation.

 

  • Creative or Guided Imagery. Use this with deep breathing and progressive relaxation. Either use a tape of someone speaking or just use your imagination to take your mind on a mini-vacation. Choose a place that you feel you can relax and go there mentally. See every detail and see yourself there refreshed and relaxed.

Other methods of relaxation, such as biofeedback or self-hypnosis, require instruction from a physician or psychologist.

The relaxation techniques above can also help you get to sleep and sleep better. There are other techniques to use to help you get a good night's sleep
 

  • Establish a nightly routine that includes things that relax you, such as reading, drinking hot milk or herbal tea or listening to soothing music.
  • Be conscious of your sleep environment. Use your bedroom only for sleep and sex. Don't keep work-related items in the bedroom.

 

  • Take a warm bath before bed to relax your muscles. Keep it quiet. Eliminate noise or cover unwanted noise with a neutral sound from a fan, air-conditioner or "white-noise" machine. Use earplugs and a mask if you need them.
  • Choose a good comfortable mattress, good quality sheets and blankets.

 

  • Exercise throughout the day.

 

  • Avoid stress.
  • Avoid beverages and foods that contain caffeine, alcohol and tobacco and big meals close to bedtime.

      If you still can't sleep, try taking over-the-counter sleep aids or talk to your doctor about getting a prescription to help you sleep.

Don't forget that regular exercise will also help by making your muscles and joints stronger.

FAQ Category:

Q: Self-management techniques
A:

Nondrug therapies are an important part of the treatment of osteoarthritis. Like your medication therapy, you will need to work with your healthcare team to develop a plan that works for you. Following are several elements you will need to consider when creating your plan.

FAQ Category:

Q: Physical and occupational therapy
A:

Your osteoarthritis (OA) may be treated by your primary care physician or you may be referred to a rheumatologist (an arthritis specialist) or an orthropaedic surgeon.



Sometimes OA can affect your ability to do everyday tasks such as bathing, dressing and walking. If you are having trouble with these types of tasks, your doctor may prescribe physical or occupational therapy. A physical or occupational therapist can give you more good recommendations on protecting your joints. Ask your doctor to refer you to one if you feel you need additional assistance.

FAQ Category:

Q: Treatment
A:

It is important that you get your osteoarthritis (OA) diagnosed and treated as early as possible. Early diagnosis and treatment is the first step in successful management of osteoarthritis. Your doctor may start you on a drug therapy regime, but ultimately you are the key factor in living successfully with OA. In addition to, and maybe more important than, medications you may take, making healthy lifestyle changes, managing stress and depression, avoiding joint damage, and balancing rest and activity will play a key role in battling the pain and limitations that can come with OA.

FAQ Category:

Q: Diagnosis
A:

Early diagnosis and treatment is the key to controlling osteoarthritis. Your doctor will take a medical history and perform a physical exam to assess your disease activity. He or she may use X-rays to confirm or strengthen a diagnosis, although most people over 60 reflect OA on X-ray while only 1/3 have actual symptoms.

FAQ Category:

Q: Causes
A:

While there isn't any single known cause of osteoarthritis (OA), there are several risk factors that should be considered. Knowing and controlling these risk factors can help you minimize your risk or even help you prevent getting OA altogether. Keep in mind that having risk factors for OA doesn't mean you will definitely get it. No single risk factor is enough to cause OA: it is more likely that a combination of risk factors works together to cause the disease.

FAQ Category:

Q: Who gets it?
A:

It most commonly affects middle-aged and older people, with most people getting it after age 45. Men under age 55 are more likely to have OA than women under 55. After age 55, women are more commonly affected; and, overall, more women have OA than men. It is thought that this is because the broader female hips put more long-term stress on the knees. However, age increases your risk for OA.

FAQ Category:

Q: Symptoms
A:

While each person is an individual and may be affected differently by osteoarthritis, we will discuss the general symptoms you want to look for if you suspect you have arthritis. Remember, it is crucial that you go to your doctor for a diagnosis before you treat your OA. Several other conditions seem similar to OA, but are treated in different ways.

FAQ Category:

Q: Stages of osteoarthritis
A:

There are several stages of osteoarthritis:

FAQ Category:

The Principles Of Joint Protection

Q: Remember
A:

Remember the four principles for energy conservation:

  • PACE yourself: activity-rest-activity. Work at a steady pace.
     
  • PRIORITISE: Set tasks in priority each day. Remember "the urgent" may not be "the necessary".
     
  • PLAN: Set priorities and pace yourself by planning - rest periods or light activities to follow heavier activities.
     
  • POSTURE: Poor posture will increase fatigue.

 

Q: The Principles of Joint Protection - Energy conservation
A:

The principle of reduction of effort can be used at work, home, and during leisure activities. Doing an activity the easiest way possible expends the least energy. Therefore, fatigue and pain can be prevented or reduced. Energy conservation involves taking an honest look at the methods, routines and habits you have developed and deciding how you can save energy.

Q: The Principles of Joint Protection - Strongest and Largest
A:

Use the strongest joints and largest muscles available for the activity.

Bend your hips and knees when lifting, use your shoulders and hips to open doors and your feet to close drawers. Use the heel of your hand to push yourself out of a chair and the muscles of your forearm to carry your handbag. Use palms rather than fingers.

Q: The Principles of Joint Protection - Hands
A:

The position of your hands at work and rest is very important.

  • Resting

    Position your hand with wrist supported in a slightly raised position and fingers slightly curled.

Q: The Principles of Joint Protection - Positioning
A:

Use each joint in the most stable position and practise good posture.

IMAGE MISSING

Q: The Principles of Joint Protection - Respect Pain
A:

Pain is your body's protective mechanism. If you feel pain during an activity, STOP and rest. If you experience pain for one hour after doing an activity, you know that you have done too much. Remember to do less and take rest breaks. The next time you attempt the activity ask yourself if there is some way you can modify the activity to make it less stressful.

How Occupational And Physical Therapy Can Help You

Q: What are some therapeutic methods?
A:

1. Rest - Bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints, and a soft collar can support the neck while you are sitting or standing.
 
2. Thermal modalities - Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, helps relieve pain locally. Heat also relaxes muscle spasms around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising might help you exercise more easily.
 
3. Exercise - This is an important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that might vary as your needs change.

  • Range of motion exercise
    Gentle movement of each joint through its normal range of motion will help relieve stiffness, improve and maintain joint movement, and increase flexibility.

  • Strengthening exercise
    Strengthening exercise helps preserve or increase muscle strength. Isometric exercises tighten and strengthen the muscle without moving the joint and are most useful when joints are painful. Isotonic exercises strengthen the muscle by using it to move a weight.

  • Water exercise
    Warm water helps relieve pain and relax muscles. Swimming is not necessary, as water exercises may be done while sitting in a shallow pool or standing in shoulder-high water. Support by the water decreases body weight applied to the joints of the spine, legs, and feet. Water support of the arms and legs also helps you move your joints through range of motion exercises more easily.

  • Recreational exercise
    Recreational exercise does not replace your therapeutic exercise program, but might enhance it with a variety of enjoyable activities. Some examples are games, sports, exercise classes, running, and swimming, all of which can benefit muscle strength and joint range of motion. Running and swimming are excellent aerobic activities and will help improve your endurance and lessen fatigue. Any exercise needs to be tailored to the patient's disease and limitations.

 
4. Therapy for joint surgery patients  - Preoperative programs of education and exercise, started before surgery in the outpatient therapy department, are continued at home. They might be changed in the hospital after surgery to fit new needs in the rehabilitation period. These exercises might be added to your usual exercise regimen, and you might find your ability to exercise has improved after surgery.
 
5. Joint protection techniques - There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these include:

  1. Control your weight to avoid putting extra stress on weight-bearing joints such as your back, hips, knees, and feet.

  2. Be aware of body position, using good posture to protect your back and the joints of your legs and feet. Sit down to do a job when you can instead of standing. Change position often since staying in one position for a long time tends to increase stiffness and pain.

  3. Conserve energy by allowing for rest periods, both during the day and during an activity.

  4. Respect pain. It is a body signal that is telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

A therapist can show you ways to do everyday tasks without worsening pain or producing joint damage. Some joint protection techniques include:

  1. Use proper body mechanics to get in and out of a car, chair or tub, as well as for lifting objects.

  2. Use your strongest joints and muscles to reduce the stress on smaller joints. For example, carry a purse or briefcase with a shoulder strap rather than in your hand.

  3. Distribute pressure to minimize stress on any one joint. Lift dishes with both palms rather than with your fingers, and carry heavy loads in your arms instead of with your hands.

  4. If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing, and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

 
6. Assistive devices -  Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist will suggest devices that will be helpful for tasks you might have found difficult at home or work.
A few examples of helpful devices include a bath stool in the shower or tub, grab bars around the toilet or tub, and long-handled shoehorns and sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices you may order.

Q: What are some benefits of occupational and physical therapy programs?
A:
  • Education about your kind of arthritis, so that you can be a well-informed member of your health care team
  •  
  • A dietary plan for overweight people to reduce the stress of excess weight on supporting joints of the back, legs, and feet (As yet, no specific diet, other than a diet designed for weight loss, has proven helpful for arthritis.)
  •  
  • Foot care advice, including choice of well-fitting shoes with shock-absorbing outer soles, and sculptured (orthotic) insoles molded exactly to the contour of each foot
Q: What are the goals of treatment?
A:

Therapists are important members of your health care team, and they will work closely with your doctor to tailor a program to your specific needs, whether your arthritic problems are widespread or confined to one joint or body area.



The goals of treatment are to:

Q: How can physical therapists help?
A:
Physical therapists teach you exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another. They can also teach you how to use walking aids such as crutches, a walker, or a cane when needed.
Q: How can occupational therapists help?
A:

Occupational therapists can teach you how to reduce strain on your joints during daily activities. They can show you how you can modify your home and workplace environments to reduce motions that might aggravate arthritis. Occupational therapists might also provide splints for your hands or wrists, and recommend assistive devices to aid in tasks such as driving, bathing, dressing, housekeeping, and certain work activities.

Q: How is arthritis treated?
A:

"Arthritis" means inflammation of the joints, and it might cause pain, swelling, and limited motion of one or many joints in the body. More than 100 different illnesses can cause arthritis.



Treatment begins after diagnosis by a physician, who might prescribe medication to reduce inflammation, pain, swelling, and loss of motion. As part of a comprehensive plan for arthritis treatment, your doctor might also prescribe occupational and physical therapy, which can provide additional help in your recovery.

Traveling With arthritis

Q: Select your transportation
A:

Planes, trains and automobiles ? as well as buses and ships ? can all be enjoyable ways to travel. Take these steps to further enhance your trip:

  • State your needs. When making your reservations, let the booking agent know about any special needs you have. Consider your diet and seating preferences. For example, you may have an easier time getting in and out of an aisle seat, and bulkhead seats may have more legroom. Make sure that your chosen mode of transportation is accessible for you and any assistive devices you may use. Also ask about storage capacity for medical equipment. Make your reservations as far in advance as you can when requesting special arrangements, as some services ? such as accessible sleeping accommodations ? may be in limited supply.

  • Ask for help. If getting around is difficult, request a wheelchair or other terminal transport, such as a shuttle at an airport. Protect your joints by asking others to help you with your baggage. Ask porters and taxicab drivers to carry your luggage whenever possible. At the airport, check your bags at the curb. Consider carrying small bills for tipping people who assist you. When possible, check your luggage through to your final destination so that you won't have to carry it as much.

  • Consider assistive devices. Traveling often involves waiting in long lines. If standing for long periods of time is difficult for you, try using a rolling walker or a cane that has a folding seat attached.

  • Plan your meals. Pack a light snack to save yourself a trip to the dining car when traveling by train or the need to get off the bus at food stops. Airlines and cruise ships may be able to accommodate special diets.

  • Travel during off-peak times. Consider scheduling trips during midweek, when fewer people travel. For airlines, peak travel times to avoid include morning and afternoon flights. Fewer passengers can result in more space and time for you to move about. Also avoid trips with multiple transfers.

  • Keep moving. Whatever mode of transportation you choose, prevent stiff joints by stretching and walking periodically throughout your journey.

Various modes of transportation have specific advantages and occasional challenges for travelers with disabilities. Explore your options to find the best mode for you.
Airplane
With the Air Carrier Access Act, airlines and terminals in the United States became far friendlier for people with arthritis. The rules offer benefits including terminal parking that's accessible to those with disabilities, restrooms that are accessible to those who use wheelchairs and other assistive devices, and more time to board. However, it's still a good idea to allow plenty of time to get through the airport. Other tips include:

  • Travel direct. Book nonstop direct flights to avoid having to transfer planes. If you have to take connecting flights, plan enough time to travel between gates.

  • Take your time. Request pre-boarding if you need extra time to get on the plane.

Since the terrorist attacks of Sept. 11, most U.S. airports have increased security measures. Changes such as parking restrictions and increased security searches may cause some additional challenges if you use a wheelchair or other assistive devices. The Federal Aviation Administration (FAA) can help to ensure that your trip proceeds smoothly.
Train
Trains provide another good transportation option. In the U.S., Amtrak offers special assistance and reduced fares for passengers with disabilities. Ask about complimentary porter (redcap) service at major stations. Porters can help you carry your bags, find the correct platform and assist you on and off the train. Tipping is up to you.
Bus
Bus travel has become easier. Some cities have modified their terminals to make them more accessible to people with disabilities. Changes include convenient restrooms, additional seats and handrails.
Most bus aisles aren't wide enough for wheelchairs. If you use a wheelchair or have trouble using stairs, make arrangements with customer service. Ask for help in getting on and off the bus.
Automobile
Car travel allows the most freedom. You can stop whenever you want. You have more room to stretch out. And you can bring anything that fits in, on or behind your vehicle. Remember these tips:

  • Park conveniently. Bring your handicapped parking permit, if you have one.

  • Be prepared. Keep medications, water, snacks, maps, an emergency kit and first-aid supplies in the vehicle.

  • Treat yourself. When renting, ask for amenities that make driving more comfortable and easier on your joints. These include power steering, power brakes and windows, cruise control, lift-up door handles, power side-view mirrors on both sides and an easily reachable ignition. To rent a car with special features, reserve your vehicle in advance.

Ship
You may find cruise travel particularly relaxing. Passageways, doorways and elevators are often wider than they used to be. Accessible staterooms for wheelchair travelers have been added. Additional tips include:

  • Look before you book. Before booking with a particular cruise line, ask plenty of questions about the ship's design and whether it's accessible for people with disabilities. Make sure the ship can meet your needs.

  • Plan to relax. If you anticipate difficulty in getting on and off the ship, book a cruise with fewer stops. Or plan to stay onboard and soak up the ship's ambience while others go ashore.

 

Q: Manage your medications
A:

Losing or running out of your medications can decrease your ability to control your symptoms and may increase the pain you experience. Follow these guidelines:

Q: Pack appropriately
A:

There's a fine line between bringing what you need to be comfortable and lugging around too many bags. Follow these guidelines as you decide what to pack:

Q: Consider professional services
A:

You don't need to have all of the answers when it comes to planning your trip. Travel professionals can help. Consider the services of:

Q: Plan your trip: Tips to get started
A:

As you prepare for your trip, keep the following points in mind:

Hearing Loss

Q: What are the different types of hearing loss?
A:

Conductive hearing loss is caused by interference with sound or transmission through the outer and/or middle ear. Sensorineural hearing loss is often called nerve loss and is caused by disorders of the inner ear or auditory nerve itself. One can also suffer from mixed hearing loss which involves both conductive and sensorineural hearing loss.

FAQ Category:

Q: How do I know if I suffer from hearing loss?
A:

To determine whether you suffer from hearing loss it is best to consult a licensed medical professional or audiologist who will properly assess your hearing ability. Often, people who suffer from hearing loss recognize that they have a reduced ability to communicate as they find speech or conversation more difficult to follow. This may result in frustration as one feels others are mumbling, needs to ask others to repeat themselves or may avoid social situations because of embarrassment. Some people find that others complain about how loud they listen to the television or stereo.

FAQ Category:

Q: Where can I find information on hearing loss?
A:

***Source***

 

 

 

The above information was obtained from Hearing Aids 101.

 

 

FAQ Category:

Hearing Aids

Q: Should I wear one or two hearing aids?
A:

Because every person has a different extent of hearing loss with a different type, this is difficult to answer. Some believe that there are benefits to wearing two aids. Obviously they provide for a more balanced hearing by better directing sound from different areas. Some believe that two aids provide more clarity and allow the user to hear better in noisy locations.
A licensed professional or audiologist will be best able to recommend whether one or two aids will work best for you.

FAQ Category:

Q: Choosing Hearing Aids
A:

The type of hearing aid device best suited to your needs will greatly depend on the nature and extent of your hearing loss and the size and shape of the outer ear and canal. Some conditions (i.e. ear drainage) may prevent a person from wearing hearing aids that block the ear or canal.

A few other factors to keep in mind as you choose your hearing aid:

FAQ Category:

Q: Types of Hearing Aids
A:

Hearing aids come in a wide variety of shapes, sizes and models. This consumer's guide consists of consolidated information to assist you in understanding all aspects of hearing aid devices to better make you an informed user and shopper.

Hearing aids today can be grouped under the following categories:

FAQ Category:

Q: How Hearing Aids Work
A:

Hearing aids are electronic devices that pick up and amplify sound. By amplifying sound, those that the wearer normally would not hear are increased in volume and therefore better communicated.

There are many different degrees of hearing loss and technology that have paved the way for many innovative products designed to improve a broad range of hearing.

Hearing Aid Components:

FAQ Category:

Q: ***Source***
A:

The above information was obtained from Hearing Aids 101.

FAQ Category:

Glossary Of Terms

Q: T-Switch or Telecoil
A:

Telecoils are optional on most hearing aids and assist in telephone conversations. The T-switch or telecoil is a small wire inserted into a hearing aid. It is used to improve telephone communication and it can be used with other assistive devices to enhance television and stereo enjoyment.
 

FAQ Category:

Q: Sensorineural Hearing loss
A:

This is often called nerve loss, and refers to hearing loss due to disorders of the inner ear or auditory nerve itself. This type of hearing loss can result from a variety of reasons including aging, noise, disease, infection or trauma. Often, hearing amplification is recommended.

FAQ Category:

Q: Programs (Memories)
A:

Hearing aid programs offer various sounds for a variety of listening environments. As an example, one program may be for conversations, another for the telephone and a third for noisy situations. An aid can come with numerous programs and the wearer may manually change back and forth between different programs, although some are able to switch automatically.

FAQ Category:

Q: Occlusion
A:

Hearing aid wearers often complain that their voice sounds odd and distorted as if they are speaking in a tunnel. This odd sound of hearing one's voice with a hearing aid is commonly referred to as occlusion and is caused when sounds cannot escape from the canal due to blockage.

FAQ Category:

Q: Mixed Hearing Loss
A:

This involves both conductive and sensorineural parts of the hearing system. Medical treatment, in conjunction with hearing amplification, may be recommended.

FAQ Category:

Q: Middle Ear Implants (MEI)
A:

A device is planted into the middle ear through surgery. The implant works in conjunction with an external casing that can be worn behind the ear or sometimes in the ear. The process works by vibrating the bones in the middle ear. MEI implants work well because they keep the ear canal and the ear unblocked. MEI candidates can have a mild to profound loss of sensorineural hearing.

FAQ Category:

Q: In the Canal (ITC) Hearing Aids
A:

ITC aids are placed inside the canal. They are often larger and slightly more visible than CIC devices. Some people, due to their canal shape or size, are unable to wear these types of devices.

FAQ Category:

Q: In the Ear (ITE) Hearing Aids
A:

These are placed in one's ear. They are often used by those who suffer moderate hearing loss. Some people who have extremely small ears may not find these models suitable.

FAQ Category:

Q: FM Systems
A:

An FM system comprises a small microphone and transmitter that sends sound directly to the hearing aid and receiver using a wireless FM transmission.  It can work well in a classroom, at a conference or while on a tour as it allows the person to hear the speaker's voice above disruptive background noise.

FAQ Category:

Q: Feedback
A:

Feedback is sometimes experienced by hearing aid wearers and is best described as a high-pitched screeching sound.

FAQ Category:

Q: Disposable Hearing Aids
A:

The disposable aid has a built-in battery and, after the allotted hour or time usage, the user simply replaces the entire aid.

FAQ Category:

Q: Digital
A:

Launched in the United States in 1996, many believe that the digital system has revolutionized hearing. Digital translates sound to digital code, changes it and re-transmits it back by using mathematical calculations. This relatively new technology has revolutionized hearing devices by duplicating sound transmission. Digital technology is praised for producing a quality sound that has increased accuracy.

FAQ Category:

Q: Decibels
A:

A unit of measurement that relates to sound.

FAQ Category:

Q: Conductive Hearing Loss
A:

This type of hearing impairment is caused by interference with sound or transmission through the outer and/or middle ear. The hearing loss can result from a variety of means including disease, infection and trauma.

FAQ Category:

Q: Completely in the Canal (CIC) Hearing Aids
A:

The whole hearing aid is placed completely inside the canal. CICs are extremely tiny in size and are almost invisible. Due to their canal shape or size, some people are unable to wear these types of devices.

 

FAQ Category:

Q: Cochlear Implants
A:

Cochlear implants are surgically implanted into a person's inner ear. External components are either body-worn or behind the ear. The external component sends signals to the implant through the skin, which are then instantaneously recognized as sound by the brain. The process sends sounds in the ear through nerve stimulation by avoiding damaged cells and by using an electrical signal.

Cochlear implant recipients must have severe or profound sensorineural hearing loss in both ears to receive cochlear implants.

 

 

FAQ Category:

Q: Cochlear
A:

A specific part of the internal ear.

FAQ Category:

Q: Body-Worn Hearing Aids
A:

Bone anchored hearing aids (BAHA) transfer sound through a bone in the skull directly into the cochlea through a 'bone-conduction' process. A small device is implanted surgically behind the ear in the skull of the recipient. A case is located externally which holds a microphone and a sound processor. This case transmits sound to the bone, which goes directly to the cochlea. One of the benefits of BAHAs is that the ear canal in the recipient remains unblocked.

FAQ Category:

Q: Behind-the-Ear (BTE) Hearing Aids
A:

These aids sit behind the ear and are connected to an ear mold placed inside the ear via tubing. BTE devices are fastened on the ear with an ear hook and the ear molds are custom made to fit the user's ear. BTE hearing aids are known for being robust and durable. They are practical in that they have the ability to produce a lot of power.

FAQ Category:

Q: Assistive Listening Devices
A:

These are a variety of instruments that assist in hearing. Phones for the hard of hearing, clocks, baby monitors, FM systems and amplifiers are just a few examples of ALDs.

FAQ Category:

Q: Analogue Aids (Programmable)
A:

If an analogue system is programmed it allows settings to be saved that the user can switch to depending on the listening environment. As an example, one program will work during a conversation, while the other may work best while in the theatre. Some hearing aids are equipped with many different programs to allow the user to adjust the aid, depending on the listening situation.

FAQ Category:

Q: Analogue
A:

Analogue is the conventional signal found in many hearing devices. Analogue aids can be conventional or programmable. Conventional analogue aids do not distinguish different sounds and therefore amplify all sounds equally, which means some sounds are too loud while others may be difficult to hear. This is rectified when the hearing aid user adjusts the volume.

FAQ Category:

Q: ***Source***
A:

The above information was obtained from Hearing Aids 101.

FAQ Category:

Stroke (45)

What Is stroke?

Q: What can you do to reduce your risk of stroke?
A:

To reduce your risk of stroke monitor your blood pressure, track your cholesterol level, stop smoking, exercise regularly and find out if you should be taking a drug to reduce blood clotting.

FAQ Category:

Q: What are the risk factors for stroke?
A:

There are things you can do to prevent stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition known as atrial fibrillation or AF, can double your risk of stroke. Your risk also increases if you smoke, have diabetes, sickle cell disease, high cholesterol, or a family history of stroke.

FAQ Category:

Q: Why is there a need to act fast?
A:

Ischemic strokes, the most common strokes, can be treated with a drug called t-PA which dissolves artery-obstructing clots. The window of opportunity to use t-PA to treat stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

FAQ Category:

Q: What should a bystander do?
A:

Bystanders should know the signs and act in time. If you believe someone is having a stroke, if they lose the ability to speak, or move an arm or leg on one side, or experience facial paralysis on one side, call 999 immediately. Stroke is a medical emergency. Immediate treatment may save someone's life and enhance his or her chances for successful rehabilitation and recovery.

FAQ Category:

Q: Why can't some victims identify stroke symptoms?
A:

Because stroke injures the brain, one is not able to perceive one's own problems correctly. To a bystander, the stroke patient may seem unaware or confused. A stroke victim's best chance is if someone around her recognizes the stroke and acts quickly.

FAQ Category:

Q: What are the symptoms of stroke?
A:

What make stroke symptoms distinct are their sudden onset:

FAQ Category:

Q: What are the types of strokes?
A:

A stroke can occur in two ways. In an ischemic stroke, a blood clot blocks or plugs a blood vessel or artery in the brain. About 80 percent of all strokes are ischemic. In an hemorrhagic stroke, a blood vessel in the brain breaks and bleeds into the brain. About 20 percent of strokes are hemorrhagic.

FAQ Category:

Q: What is a stroke?
A:

A stroke occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they no longer receive the oxygen and nutrients they need to function.

FAQ Category:

What Is Post-stroke Rehabilitation?

Q: Where Can A Stroke Patient Get Rehabilitation?
A:

Rehabilitation should begin as soon as a stroke patient is stable, often within 24 to 48 hours after a stroke. This first stage of rehabilitation usually occurs within an acute-care hospital. At the time of discharge from the hospital, the stroke patient and family coordinate with hospital social workers to locate a suitable living arrangement. Many stroke survivors return home, but some move into some type of medical facility.

Inpatient rehabilitation units
Inpatient facilities may be freestanding or part of larger hospital complexes. Patients stay in the facility, usually for 2 to 3 weeks, and engage in a coordinated, intensive program of rehabilitation. Such programs often involve at least 3 hours of active therapy a day, 5 or 6 days a week. Inpatient facilities offer a comprehensive range of medical services, including full-time physician supervision and access to the full range of therapists specializing in post-stroke rehabilitation.

Outpatient units
Outpatient facilities are often part of a larger hospital complex and provide access to physicians and the full range of therapists specializing in stroke rehabilitation. Patients typically spend several hours, often 3 days each week, at the facility taking part in coordinated therapy sessions and return home at night. Comprehensive outpatient facilities frequently offer treatment programs as intense as those of inpatient facilities, but they also can offer less demanding regimens, depending on the patient's physical capacity.

Nursing facilities
Rehabilitative services available at nursing facilities are more variable than are those at inpatient and outpatient units. Skilled nursing facilities usually place a greater emphasis on rehabilitation, whereas traditional nursing homes emphasize residential care. In addition, fewer hours of therapy are offered compared to outpatient and inpatient rehabilitation units.

Home-based rehabilitation programs
Home rehabilitation allows for great flexibility so that patients can tailor their program of rehabilitation and follow individual schedules. Stroke survivors may participate in an intensive level of therapy several hours per week or follow a less demanding regimen. These arrangements are often best suited for people who lack transportation or require treatment by only one type of rehabilitation therapist. The major disadvantage of home-based rehabilitation programs is the lack of specialized equipment. However, undergoing treatment at home gives people the advantage of practicing skills and developing compensatory strategies in the context of their own living environment.

 

Q: What Medical Professionals Specialize In Post-stroke Rehabilitation?
A:

Post-stroke rehabilitation involves physicians; rehabilitation nurses; physical, occupational, recreational, swallowing, speech-language, and vocational therapists; and mental health professionals.

Q: What Disabilities Can Result From A Stroke?
A:

The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged. Generally, stroke can cause five types of disabilities: paralysis or problems controlling movement; sensory disturbances including pain; problems using or understanding language; problems with thinking and memory; and emotional disturbances.

Q: What Is Post-stroke Rehabilitation?
A:

NO INFORMATION

What Special Risks Do Women Face?

Q: Are Children At Risk For Stroke?
A:

The young have several risk factors unique to them. Young people seem to suffer from hemorrhagic strokes more than ischemic strokes: a significant difference from older age groups where ischemic strokes make up the majority of stroke cases. Hemorrhagic strokes represent 20 percent of all strokes in the United States and young people account for many of these.
Clinicians often separate the "young" into two categories: those younger than 15 years of age, and those 15 to 44 years of age. People 15 to 44 years of age are generally considered young adults and have many of the risk factors mentioned above, such as drug use, alcohol abuse, pregnancy, head and neck injuries, heart disease or heart malformations, and infections. Some other causes of stroke in the young are linked to genetic diseases.
Medical complications that can lead to stroke in children include intracranial infection, brain injury, vascular malformations such as moyamoya syndrome, occlusive vascular disease, and genetic disorders such as sickle cell anemia, tuberous sclerosis, and Marfan's syndrome.
The symptoms of stroke in children are different from those in adults and young adults. A child experiencing a stroke may have seizures, a sudden loss of speech, a loss of expressive language (including body language and gestures), hemiparesis (weakness on one side of the body), hemiplegia (paralysis on one side of the body), dysarthria (impairment of speech), convulsions, headache, or fever. It is a medical emergency when a child shows any of these symptoms.
In children with stroke, the underlying conditions that led to the stroke should be determined and managed to prevent future strokes. For example, a recent clinical study found that giving blood transfusions to young children with sickle cell anemia greatly reduces the risk of stroke. The Institute even suggests attempting to prevent stroke in high-risk children by giving them blood transfusions before they experience a stroke.
Most children who experience a stroke will do better than most adults after treatment and rehabilitation. This is due in part to the immature brain's great plasticity, the ability to adapt to deficits and injury. Children who experience seizures along with stroke do not recover as well as children who do not have seizures. Some children may experience residual hemiplegia, though most will eventually learn how to walk.

 

Spasticity And Paralysis

Q: Lifestyle Can Affect Safe Movement
A:

Lifestyle modifications in relation to diet and exercise should be individualized to meet a person's specific environment and needs. Weak leg muscles, poor vision, dizziness and medications that may compromise balance may put people at risk for falls. Your health care provider should be aware of the symptoms and help provide guidance regarding dosage and side effects.
You can also prevent falls by:

  • Remaining active
  • Strengthening leg muscles and balance through weight training and/or Tai chi classes
  • Wearing flat, wide-toed shoes
  • Eating calcium-rich foods and taking calcium supplements, if necessary, to increase bone strength
  • Following your therapists' recommendations regarding limitations and walking needs
  • Not relying on furniture for support while walking. Use the assistive device prescribed by your therapist
  • Recognizing that certain medications may make you drowsy, and taking precautions
  • Limiting walking when distracted
  • Never walking without prescribed assistive aids such as braces

Be on the safe sides and don't take chances. Listen to the advice of healthcare professionals and experienced caregivers. Regaining independence requires patience.

 

Q: Safety At Home
A:

Stroke survivors and caregivers may be apprehensive about being on their own at home. With some simple modifications and education, fears can be overcome and recovery enhanced.

Assistive Devices
Modifying home environments with assistive devices, such as grab bars and ramps, may provide additional safety and easier movement around the home.

Other useful devices:

Q: Treatment Options
A:

Treatment for spasticity is often a combination of many therapies and medications. This approach is used to achieve the best function possible. It's important to remember that all therapies and drugs may have potential side effects which should be weighed against their benefits. Patients need to discuss appropriate options with their healthcare provider.

Q: What Are The Symptoms Or Effects Of Spasticity?
A:
  • Stiffness in the arms, fingers or legs
  • Painful muscle spasms
  • A series of involuntary rhythmic contractions and relaxations in a muscle or group of muscles that lead to uncontrollable movement or jerking, called clonus
  • Increased muscle "tone"
  • Abnormal posture
  • Hyperexcitable reflexes
Q: Understanding Paralysis And Spasticity
A:

Paralysis is the inability of a muscle or group of muscles to move voluntarily. When messages from the brain to the muscles don't work properly due to a stroke, a limb becomes paralyzed or develops a condition called spasticity.

Effects Of Stroke

Q: Brain Stem Stroke
A:

Strokes that occur in the brain stem are especially devastating. The brain stem is the area of the brain that controls all of our involuntary, "life-support" functions, such as breathing rate, blood pressure and heartbeat. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing. Since impulses generated in the brain's hemispheres must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis in one or both sides of the body.

FAQ Category:

Q: Cerebellar Stroke
A:

The cerebellum controls many of our reflexes and much of our balance and coordination. A stroke that takes place in the cerebellum can cause abnormal reflexes of the head and torso, coordination and balance problems, dizziness, nausea and vomiting.

FAQ Category:

Q: Left-Hemisphere Stroke
A:

The left hemisphere of the brain controls the movement of the right side of the body. It also controls speech and language abilities for most people. A left-hemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia.

FAQ Category:

Q: Right-Hemisphere Stroke
A:

The right hemisphere of the brain controls the movement of the left side of the body. It also controls analytical and perceptual tasks, such as judging distance, size, speed, or position and seeing how parts are connected to wholes.

FAQ Category:

Q: Effects Of Stroke
A:

The ability to define the world and our place in it distinguishes our humanity. Stroke or brain attack forever alters this world-making capacity. The stroke patient's world, once comprehensible and manageable, is transformed into a confusing, intimidating and hostile environment. The skills of intellect, sensation, perception and movement, which are honed over the course of a lifetime and which so characterize our humanity are the very abilities most compromised by stroke. Stroke can rob people of the most basic methods of interacting with the world.

FAQ Category:

How Stroke Affects People

Q: Disabilities After Stroke
A:

A "disability" is difficulty doing something that is a normal part of daily life. People who have had a stroke may have trouble with many activities that were easy before, such as walking, talking, and taking care of "activities of daily living" (ADLs). These include basic tasks such as bathing, dressing, eating, and using the toilet, as well as more complex tasks called "instrumental activities of daily living" (IADLs), such as housekeeping, using the telephone, driving, and writing checks. Some disabilities are obvious right after the stroke. Others may not be noticed until the person is back home and is trying to do something for the first time since the stroke.

Q: Depression After Stroke Effects On The Body, Mind, And Feelings
A:

Each stroke is different depending on the part of the brain injured, how bad the injury is, and the person's general health. Some of the effects of stroke are:

Deciding About Rehabilitation

Q: Rehabilitation Team
A:

In many programs, a special rehabilitation team with a team leader is organized for each patient. The patient, family, and rehabilitation professionals are all members. The team have regular meetings to discuss the progress of treatment. Using a team approach often helps everyone work together to meet goals.

Q: When Rehabilitation Is Not Recommended: Things To Consider When Choosing A Rehabilitation Program
A:
Does the program provide the services the patient needs?
Q: Choosing A Rehabilitation Program
A:

The doctor and other hospital staff will provide information and advice about rehabilitation programs, but the patient and family make the final choice. Hospital staff know the patient's disabilities and medical condition. They should also be familiar with the rehabilitation programs in the community and should be able to answer questions about them. The patient and family may have a preference about whether the patient lives at home or at a rehabilitation facility

Q: Individual Rehabilitation Services
A:

Many stroke survivors do not need a complete range of rehabilitation services. Instead, they may need an individual type of service, such as regular physical therapy or speech therapy. These services are available from outpatient and home-care programs.

Q: Types Of Rehabilitation Programs
A:

No Information 

What Happens During Rehabilitation

Q: Getting The Most Out Of Rehabilitation
A:

What the Patient Can Do
If you are a stroke survivor in rehabilitation, keep in mind that you are the most important person in your treatment. You should have a major say in decisions about your care. This is hard for many stroke patients. You may sometimes feel tempted to sit back and let the program staff take charge. If you need extra time to think or have trouble talking, you may find that others are going ahead and making decisions without waiting. Try not to let this happen.

  • Make sure others understand that you want to help make decisions about your care.
  • Bring your questions and concerns to program staff.
  • State your wishes and opinions on matters that affect you.
  • Speak up if you feel that anyone is "talking down" to you; or, if people start talking about you as if you are not there.
  • Remember that you have the right to see your medical records.

To be a partner in your care, you need to be well informed about your treatment and how well you are doing. It may help to record important information about your treatment and progress and write down any questions you have.
If you have speech problems, making your wishes known is hard. The speech-language pathologist can help you to communicate with other staff members, and family members may also help to communicate your ideas and needs.
Most patients find that rehabilitation is hard work. They need to maintain abilities at the same time they are working to regain abilities. It is normal to feel tired and discouraged at times because things that used to be easy before the stroke are now difficult. The important thing is to notice the progress you make and take pride in each achievement.
 
How the Family Can Help
If you are a family member of a stroke survivor, here are some things you can do:

  • Support the patient's efforts to participate in rehabilitation decisions.
  • Visit and talk with the patient. You can relax together while playing cards, watching television, listening to the radio, or playing a board game.
  • If the patient has trouble communicating (aphasia), ask the speech-language pathologist how you can help.
  • Participate in the education offered for stroke survivors and their families. Learn as much as you can and how you can help.
  • Ask to attend some of the rehabilitation sessions. This is a good way to learn how rehabilitation works and how to help.
  • Encourage and help the patient to practice skills learned in rehabilitation.
  • Make sure that the program staff suggests activities that fit the patient's needs and interests.
  • Find out what the patient can do alone, what the patient can do with help, and what the patient can't do. Then avoid doing things for the patient that the patient is able to do. Each time the patient does them, his or her ability and confidence will grow.
  • Take care of yourself by eating well, getting enough rest, and taking time to do things that you enjoy.

To gain more control over the rehabilitation process, keep important information where you can find it. One suggestion is to keep a notebook with the patient. Some things to include are provided in the sample that follows.

 

Q: Rehabilitation Goals
A:

Being able to walk, at least with a walker or cane, is a realistic goal for most stroke survivors.

Q: Setting Rehabilitation Goals
A:

The goals of rehabilitation depend on the effects of the stroke, what the patient was able to do before the stroke, and the patient's wishes. Working together, goals are set by the patient, family, and rehabilitation program staff. Sometimes, a person may need to repeat steps in striving to reach goals.

Q: Rehabilitation
A:

In hospital or nursing facility rehabilitation programs, the patient may spend several hours a day in activities such as physical therapy, occupational therapy, speech therapy, recreational therapy, group activities, and patient and family education. It is important to maintain skills that help recovery. Part of the time is spent relearning skills (such as walking and speaking) that the person had before the stroke.

Discharge Planning

Q: Follow-up Appointments
A:

After a stroke survivor returns to the community, regular follow-up appointments are usually scheduled with the doctor and sometimes with rehabilitation professionals. The purpose of follow-up is to check on the stroke survivor's medical condition and ability to use the skills learned in rehabilitation. It is also important to check on how well the stroke survivor and family are adjusting. The stroke survivor and caregiver can be prepared for these visits with a list of questions or concerns.

FAQ Category:

Q: Tips For Reducing Stress
A:

The following tips for reducing stress are for both caregivers and stroke survivors.

FAQ Category:

Q: Going Home
Q: Deciding About Special Equipment
A:
Deciding About Special Equipment

Even after rehabilitation, some stroke survivors have trouble walking, balancing, or performing certain activities of daily living. Special equipment can sometimes help. Here are some examples:

Preparing A Living Place
 
Discharge

 

FAQ Category:

Q: Preparing Caregivers
A:

missing info

FAQ Category:

Home Adaptation After A Stroke

Q: Safety And Mobility
A:

Below are suggestions about considerations that you should make throughout your home before you return following your stroke. Especially if you are in a wheelchair, you may need to make modifications that require professional installation. Other pieces of advice apply to homeowners in any situation.
 
 Doorways

Entryways and hallways should have a 32-inch clearance to accommodate people in wheelchairs. When doors do not open as wide as hinges were designed, application of a lubricant allows the hinges to work as they were designed. This extra space can allow a person using a wheelchair or walker to fit through the doorway. The edges of a swelled door may need to be shaved to allow for extra space as well.
   
Stroke survivors who are unable to grasp with their fingers or twist their wrists to open doors can use a downward movement of their fist to open lever door handles more easily than regular doorknobs. The location of the knob may need to be moved as well.
   
Swing away hinges, folding doors, or pocket doors can make passage through doors less difficult. To provide more space or clearance in doorways, doors between rooms can be removed.
   
Uneven threshold should be fixed or changed to prevent tripping and allow easier wheelchair access. A portable ramp is often an affordable solution.

It may be necessary or helpful to place blue pads on chairs that the stroke survivor sits in for long periods of time. Blue pads are pads, often washable and reusable, with a cloth and waterproof side to prevent staining on furniture. They can be covered with a blanket or cloth to be made unnoticeable.
To allow for movement in a wheelchair, furniture may need to be moved and thick rugs may need to be replaced. Rugs should be moved unless they are sufficiently secured to the floor with some sort of non-skid tape. Electrical cords should be free from pathways as well.
 
resource: http://www.strokecenter.org

Q: Cleaning
A:

After a stroke, when the survivor has less energy and endurance, everyday cleaning tasks such as sweeping, mopping, washing counters, walls and other surfaces, garbage disposal, and general tidying may need to be done while seated. Working in small areas and taking frequent breaks can make these tasks more manageable.

Q: Laundry Room
A:

Household tasks such as cleaning and doing laundry may be impossible or difficult for stroke survivors with severe disabilities. However, some modifications may make these or some of these tasks possible or less difficult.

Q: The Kitchen The Dining Room
A:

Being unable to enjoy activities that you once did because of recent disabilities can be extremely frustrating. For many stroke survivors, dining is one such activity. Using utensils, sitting up at the table, and swallowing are often difficult following a stroke.

Q: The Bedroom
A:

Of all the rooms in the house, it seems most important that your bedroom be a place where you can feel comfortable and safe. Because this is a private area of the home for you, it should be catered to meet your needs.

Q: Introduction
A:

The changes following a stroke can impact one's ability to perform typical daily activities. When a stroke patient returns home, the home environment itself can also impact a person's performance. While the home environment includes physical features such as the housing materials, structures, and special equipment, it also includes the social and cultural environment such as the people who live there, as well as the customs and preferences of individuals.

Autism (4)

Autism

Q: What causes ASDs? Can they be treated?
A:

No one knows exactly what causes ASDs, but scientists think that both genetic and environmental factors might play a role. We do know that parental actions do not cause children to have ASDs.
There is no known cure for ASDs. However, early and intensive education can help children grow and learn new skills. The goal of these efforts is to help with the difficult symptoms of an ASD in a child and to improve the child?s skills that help him or her talk, interact, play, learn, and care for his or her needs. Medicines can relieve symptoms and be helpful for some people, but structured teaching of skills (often called behavioral intervention) is currently the most effective treatment.
 

FAQ Category:

Q: How common are ASDs?
A:

What is the prevalence of Autism Spectrum Disorders (ASDs)?
Data from several studies that used the current criteria for diagnosing autism and autism spectrum disorders (ASD), such as Asperger?s disorder and pervasive developmental disabilities (PDD-NOS), found prevalence rates for ASDs between 2 and 6 per 1,000 individuals. Therefore, it can be summarized that between 1 in 500 (2/1,000) to 1 in 166 children (6/1,000) have an ASD.

FAQ Category:

Q: What conditions are included in ASDs?
A:

ASDs include autistic disorder, pervasive developmental disorder - not otherwise specified (PDD-NOS, including atypical autism), and Asperger disorder. These three conditions all have some of the same symptoms, but they differ in terms of when the symptoms start, how fast they appear, how severe they are, and their exact nature. These three conditions, along with Rett syndrome and childhood disintegrative disorder, make up the broad diagnosis category of pervasive developmental disorders.

FAQ Category:

Q: What are some of the symptoms of ASDs?
A:

As the name "autism spectrum disorders" says, ASDs cover a wide range of behaviors and abilities. People who have ASDs, like all people, differ greatly in the way they act and what they can do. No two people with ASDs will have the same symptoms. A symptom might be mild in one person and severe in another person. Some examples of the types of problems and behaviors a child or adult with  ASDs might have the following:

FAQ Category:

  1. How is Mosaicism diagnosed?
  2. Is it possible to predict a child?s IQ based on the number of normal cells present in the study?
  3. How does it effect her development?
  4. How does mosaic Down Syndrome happen?
  5. My baby has mosaic Down Syndrome. What does that mean?
  6. Is iron dangerous for children with DS? Is craniosacral therapy (cranial therapy) useful for children with Down Syndrome?
  7. What is the life expectancy for people with Down Syndrome?
  8. Are atropine eye drops dangerous for children with DS?
  9. I have read on the internet about treating DS with a type of Indian medicine called Ayurvedic therapy. Is there any evidence that this can help children with DS?
  10. How likely is a person to have a child with Down Syndrome if he/she has a sibling with DS?
  11. If maternal age over 35 years is a risk factor for having babies with DS, why are more than half of all babies with DS born to women under 35 years?
  12. Does fluoride intake increase the risk of having a child with DS?
  13. Is fluoride safe to give to children with Down Syndrome?
  14. Are adults with Down Syndrome sterile?
  15. Does the use of drugs or alcohol in a parent before or during pregnancy cause children to have Down Syndrome?
  16. Is Down Syndrome inherited?
  17. Are there medical treatments for Down Syndrome?
  18. Can Down Syndrome be cured or outgrown?
  19. How prevalent is Alzheimer Disease (pre-senile dementia) in adults with Down Syndrome?
  20. Are people with Down Syndrome at high risk of developing Alzheimer's Disease later in life?
  21. Do people with Down Syndrome have normal life expectancies?
  22. Are children with Down Syndrome born only to older mothers?
  23. What tests are used for prenatal diagnosis? When is prenatal diagnosis recommended?
  24. Can people with Down Syndrome have babies?
  25. What are a couple's chances of having a child with Down Syndrome?
  26. What is the incidence of Down Syndrome?

Down's Syndrome

Q: How is Mosaicism diagnosed?
A:

The usual way in which mosaic Down Syndrome is discovered is through genetic testing of the baby's blood. Typically, 20 to 25 cells are examined. If some of the cells have trisomy 21 and some don't, then the diagnosis of mosaicism is made. However, this blood test can only determine the level of mosaicism in the blood cell line. While mosaicism can occur in just one cell line (some blood cells have trisomy 21 and the rest don't), it can also occur across cell lines (skin cells may have trisomy 21 while other cell lines don't). In the latter case, it may be more difficult to diagnose mosaicism. When mosaicism is suspected but not confirmed through the blood test, other cell types may be tested: skin and bone marrow are most commonly the next cells checked. Because skin cells and brain cells arise from the same type of cell at the beginning of fetal development (ectoderm), many doctors believe that skin cell tests reflect the chromosomal makeup of the brain cells as well.

FAQ Category:

Q: Is it possible to predict a child?s IQ based on the number of normal cells present in the study?
A:

In most cases chromosome studies are done using white blood cells. The number of blood cells containing 46 chromosomes may not accurately reflect the number of skin cells, heart cells, or brain cells with 46 chromosomes. Therefore, it is impossible to predict what affect, if any, the presence of these chromosomally normal cells will have on a child?s development. The parents of children with mosaic Down Syndrome are like the parents of any other child. Your child?s strengths and weaknesses will only be revealed over time.

FAQ Category:

Q: How does it effect her development?
A:

Every child is born with a unique set of talents and abilities. However, it is impossible to predict what these talents and abilities will be. This is true for a child who inherits 46 chromosomes. This is true for a child with trisomy 21 (Down Syndrome), and this is true for a child with mosaic Down Syndrome. While it is impossible to tell you what the future holds for your daughter, I can share with you information about other children with mosaic Down Syndrome.

FAQ Category:

Q: How does mosaic Down Syndrome happen?
A:

Ordinarily, when an egg and a sperm are joined at conception, a single cell is created with a total of 46 chromosomes. These chromosomes are copied, the copies are separated, and the cell then divides to create two identical ?daughter? cells. The chromosomes in these two cells are copied, the copies divide and four cells are created. These four cells become eight cells. Eight cells become 16 cells, and so on. If nothing disrupts the chromosome replication and separation process, each cell in the body should have the same number of chromosomes that were present in the fertilized egg.

FAQ Category:

Q: My baby has mosaic Down Syndrome. What does that mean?
A:

Children with mosaic Down Syndrome have two distinct cell groupings. In some cells there is a total of 46 chromosomes, which is the ?typical? group. In other cells there is an extra copy of the chromosome #21, making 47 cells total for this group.

FAQ Category:

Q: Is iron dangerous for children with DS? Is craniosacral therapy (cranial therapy) useful for children with Down Syndrome?
A:

Proponents of cranial therapy claim that skull bones can be manipulated to relieve many disorders. To quote the website of the Craniosacral Therapy Assoc. of the UK: "Dr William Sutherland, an American osteopath, discovered intrinsic movements of the bones of the skull around the turn of the century. His further research revealed different rhythmic tidal motions in the body. These movements, which can be measured with delicate scientific instruments, are a direct expression of the health of the system.

FAQ Category:

Q: What is the life expectancy for people with Down Syndrome?
A:

This is a more complicated question than it seems, because how you answer it depends on how you look at the statistics. First, looking at how long adults with DS live: the last major published article to look at this was in California in 1991, and the results in that study may not be the same for any other place in the world. But that study looked at over 12,000 people with DS and found that major medical problems were not a consistent predictor of mortality, which was a common belief. Instead, self-help skills were the best predictor of life expectancy.

FAQ Category:

Q: Are atropine eye drops dangerous for children with DS?
A:

No. Atropine eye drops are used to dilate the pupil during eye exams, and also to treat the conditions amblyopia, esotropia and strabismus. Children with DS seem to have a greater dilation in response to atropine, and the dilation appears to last longer as well. However, there is no evidence that atropine eye drops has any effect on the body beyond the eyes. (North RV, Ophthal Physiol Opt, 7(2): 109-114, 1987)

FAQ Category:

Q: I have read on the internet about treating DS with a type of Indian medicine called Ayurvedic therapy. Is there any evidence that this can help children with DS?
A:

Not at the present time. To quote Drs. Lodha and Bragga of the Dept of Pediatrics, All India Institute of Medical Sciences in New Delhi: "Evidence-based studies on the efficacy and safety of traditional Indian medicines are limited. The essential ingredient in most formulations is not precisely defined. High quality studies are necessary to evaluate and compare the value of traditional Indian drugs to modern medicine." (Ann Acad Med Singapore 29(1):37-41, 2000)

FAQ Category:

Q: How likely is a person to have a child with Down Syndrome if he/she has a sibling with DS?
A:

For the vast majority of people, having a sibling with DS does not increase one's risk of having a child with DS. That's because 95% of all cases of DS are not inherited. The chromosomal test on the person with DS will show how likely it is to be an inherited case.

FAQ Category:

Q: If maternal age over 35 years is a risk factor for having babies with DS, why are more than half of all babies with DS born to women under 35 years?
A:

While it is much more common for babies with DS to be born to women over 35 years of age (see my risk page), women under 35 have a higher birth rate. No risk factors have been found yet for women under 35 years of age, but several research groups are looking at this question.

FAQ Category:

Q: Does fluoride intake increase the risk of having a child with DS?
A:

No. A study in 1980 of births in 44 US cities proved conclusively that there was no difference in the rate of births of children with DS in cities with and without fluoridated water supply (Erickson JD, Teratology 21:177-80,1980).

FAQ Category:

Q: Is fluoride safe to give to children with Down Syndrome?
A:

There is no evidence that fluoride, used correctly, is harmful to children with DS than any other child. Fluoride in the proper amounts is not toxic.

FAQ Category:

Q: Are adults with Down Syndrome sterile?
A:

Women with DS are fertile. Men with DS have traditionally been considered sterile; however, there have been two documented cases of adult men with DS fathering children.

FAQ Category:

Q: Does the use of drugs or alcohol in a parent before or during pregnancy cause children to have Down Syndrome?
A:

No. Down Syndrome occurs at conception. So nothing in the pregnancy can cause Down Syndrome to occur. As for prior to conception, the research all shows that drug or alcohol use does not increase the risk of having a child with DS.

 

FAQ Category:

Q: Is Down Syndrome inherited?
A:

Only 3 to 5% of cases are inherited; the rest arise as an accident of chromosome arrangement during meiosis. For details, see my essay on the origin of trisomy 21 or Dr. Paul Benke's essay on the types of DS, and the risk and recurrence risk of DS.

FAQ Category:

Q: Are there medical treatments for Down Syndrome?
A:

Although there have been proposed medical treatments for Down Syndrome, none of them have been proven effective. These treatments have included thyroid hormone, pituitary extract, glutamic acid, dimthyl sulfoxide, Sicca cell therapy, five-hydroxytryptophan, various vitamin and mineral therapies and lately, nootropic drugs such as piracetam. Sicca cell therapy has been shown by several reports to be dangerous. Careful studies looking at the use of vitamin supplementation showed no benefit.

FAQ Category:

Q: Can Down Syndrome be cured or outgrown?
A:

No. Just as we cannot change your genetic make-up, we cannot change the genetic make-up of a person with Down Syndrome. The effects of Down Syndrome, however, can be modified by providing good medical care, good education and good parental support.

FAQ Category:

Q: How prevalent is Alzheimer Disease (pre-senile dementia) in adults with Down Syndrome?
A:

In the 1960's, autopsies of adults with DS showed that after about age 30 years, they all have the characteristic plaques and neurofibrillary tangles associated with Alzheimer disease. From that finding, it was assumed that all adults with DS would eventually get Alzheimer dementia if they lived long enough. However, population studies in the 1980s and '90s showed that the percentage of adults with DS who actually get dementia range from 16% to 50%, depending on the criteria used to diagnose dementia.

FAQ Category:

Q: Are people with Down Syndrome at high risk of developing Alzheimer's Disease later in life?
A:

Possibly, although the final answer on this is not available. Although it is true that some of the Alzheimer-like changes in the physical brain occur in most, if not all, people with Down Syndrome as they age, the clinical appearance of dementia does not always occur. The latest thinking is that because of premature aging, Alzheimer's dementia that does develop comes on at an earlier age but that the incidence of dementia may or may not be increased. It would be wrong to assume that an adult with Down Syndrome who appears to have developed dementia does in fact have Alzheimer's dementia.

FAQ Category:

Q: Do people with Down Syndrome have normal life expectancies?
A:

No. Generally, life expectancy is reduced by 10-20 years. Some people with Down Syndrome, however, have been known to live into their 80's.

FAQ Category:

Q: Are children with Down Syndrome born only to older mothers?
A:

No. Although the risk of Down Syndrome increases with age, a child with Down Syndrome can be born to a mother at any age. Although only 5-8% of pregnancies occur in women over the age of 35, they account for 20% of Down Syndrome births. Therefore, 80% of children with Down Syndrome are born to women who are less than 35 years of age.

FAQ Category:

Q: What tests are used for prenatal diagnosis? When is prenatal diagnosis recommended?
A:

Until recently, the answer was to offer amniocentesis to all pregnant women age 35 or older and to those women who had a previous child with Down Syndrome. Now some doctors reccommend screening tests for all pregnancies.

FAQ Category:

Q: Can people with Down Syndrome have babies?
A:

The chance of a woman with Down Syndrome having a baby with Down Syndrome is theoretically 50%. There is one documented instance of fertility in a male with Down Syndrome; the mother also had Down Syndrome. The pregnancy miscarried about half-way through.

FAQ Category:

Q: What are a couple's chances of having a child with Down Syndrome?
A:

In the usual circumstance, the chances depend upon the age of the mother. The odds of having a child with Down Syndrome at age 35 are approximately 1 in 350. Under age 25, the odds are about 1 in 1400 and at age 40 the odds are about 1 in 100. (Thompson, et al., 1991) The chances of a parent of a child with Trisomy 21 having another child with Down Syndrome is approximately 1 in 100. If the child has a translocation, the recurrence risk can be as high as 100% or as low as 2%.

FAQ Category:

Q: What is the incidence of Down Syndrome?
A:

The incidence of Down Syndrome has been variously reported as 1 in 800 live births to 1 in 1,100 live births. A recent estimate in the United States puts the incidence at about 1 in 1,000. There is no association between Down Syndrome and any given culture, ethnic group, socioeconomic status or geographic region. (CDC, 1994) (Thompson, McInnes, & Willard, 1991)

FAQ Category:

Cerebral Palsy

Q: What medical problems are associated with cerebral palsy?
A:

Children with cerebral palsy have many problems, not all of them related to the brain injury. Most of these complications are nevertheless neurological. They include epilepsy, mental retardation, learning disabilities, and attention deficit-hyperactivity disorder. Children with cerebral palsy may also develop hip subluxation or have problems with the gait.

FAQ Category:

Q: How can realistic goals be designed for the child with cerebral palsy?
A:

When it comes to expectations and questions of what the future holds for the child with CP, it is important to maintain a combination of optimism and realism, just as one would with any child. Suppose, for example, that the parent of a non-disabled three year old has hopes and expectations that the child will go to college and law school, enter politics, and eventually become President of the United States. Some of these expectations are realistic and are likely to be met, while others are extremely unlikely to occur to the point of being clearly unrealistic.

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Q: How aggressive should treatment be given a sick newborn?
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Many times when a child is a few years old and severely disabled, parents begin to wonder whether treatment should have been less aggressive than it was. Given the tremendous uncertainties in outcome, physicians and parents usually choose to treat newborns and preserve life with the hope that the outcome will be a good one.

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Q: Does Cerebral Palsy get worse?
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No. Cerebral palsy is a nonprogressive disorder. This means that whatever damage was done to the brain will not get any worse. The problem that many parents face is that, generally, it is impossible to diagnose cerebral palsy with any certainty in infancy. Many cases are not diagnosed until somewhere around age two. It only appears that the disorder is progressive because the symptoms may not appear until the child's lack of motor skills, or other developmental delays begin to emerge.

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Q: Is there any treatment?
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There is no standard therapy that works for all patients. Drugs can be used to control seizures and muscle spasms, special braces can compensate for muscle imbalance. Surgery, mechanical aids to help overcome impairments, counseling for emotional and psychological needs, and physical, occupational, speech, and behavioral therapy may be employed.

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Q: What causes repeated fractures in children with cerebral palsy?
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We build up the strength of our bones during childhood, usually until approximately age 20 to 25. During these first years of life, calcium and phosphorus are being formed into a crystal structure that gives the bone its strength. Things that can result in weaker than normal bones include poor intake of calcium, phosphorus, magnesium or vitamin D, all of which are needed to help build strong bones.

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Q: What can the physician tell the parents early on?
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Parents are naturally concerned when their newborn child has problems, and physicians need to evaluate the child's condition and prognosis as well as they can. For example, evidence of a bleed in the child's brain should be discussed with parents, although the outcome of such a bleed cannot be predicted.

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Q: What causes nutritional problems in children with cerebral palsy?
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Children with cerebral palsy often have the muscles of their mouth and throat affected by their condition. They may have difficulty speaking or forming words clearly, and/or they may have trouble chewing and swallowing food and liquids. This difficulty can lead to poor nutrition if they are unable to eat sufficient amounts of food to grow at a normal rate. It also may take such children much longer to eat a meal than it would a child without cerebral palsy, thus using up a lot of energy simply to eat.

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Q: What is the prognosis for the child with cerebral palsy?
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The first questions usually asked by parents after they are told their child has cerebral palsy are "What will my child be like?" and "Will he walk?". Predicting what a young child with cerebral palsy will be like or what he will or will not do (called the prognosis) is very difficult. Any predictions for an infant under six months of age are little better than guesses, and even for children younger than one year it is often very difficult to predict the pattern of involvement.

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Q: What is the best type of school for a child with cerebral palsy?
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This is a complex issue but very important to the child with cerebral palsy. While having cerebral palsy means that the child has a physical disability, many children with cerebral palsy also have learning difficulties and/or attention deficit disorder. Their learning styles may require special help, and specific weakness in particular academic areas may also need special help. For these reasons, a child approaching school age should have a good assessment of his or her learning strengths and weaknesses, something that is usually done by a pediatric psychologist.

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Q: What are the right words to use when referring to children with cerebral palsy?
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Cerebral palsy is the term used to describe the motor impairment resulting from brain damage in the young child regardless of the cause of the damage or its effect on the child. Impairment is the correct term to use to define a deviation from the normal, such as not being able to make a muscle move or not being able to control an unwanted movement.

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Q: How common is cerebral palsy?
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Cerebral palsy usually is not diagnosed until a child is about 2 to 3 years of age. About 2 to 3 children in 1,000 over the age of three have cerebral palsy. About 500,000 children and adults of all ages in this country have cerebral palsy.

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Q: How is a diagnosis of cerebral palsy made?
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Many of the normal developmental milestones, such as reaching for toys (3 to 4 months), sitting (6 to 7 months), and walking (10 to 14 months), are based on motor function. When a child's motor skills do not develop on a normal timetable, a physician may begin to suspect cerebral palsy. In making a diagnosis of cerebral palsy, the physician takes into account the delay in developmental milestones as well as physical findings that might include abnormal muscle tone, abnormal movements, abnormal reflexes, and persistent infantile reflexes.

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Q: Do x-rays or other tests help in the diagnosis of cerebral palsy? What are some disorders which are not cerebral palsy but resemble cerebral palsy?
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Children with disabilities have many problems in common, especially problems involving interactions with family members and society at large. The physical and medical problems of children with disabilities vary widely, however. Some of the problems caused by various disorders resemble those affecting children with cerebral palsy, but on closer inspection the medical issues turn out to be quite distinct.

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Q: What causes cerebral palsy?
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Most cases of congenital cerebral palsy (cerebral palsy that is present at birth, not acquired during the birthing process or after it) are of unknown origin. However, certain characteristics are associated with a higher than normal incidence of cerebral palsy. For example, many infants having cerebral palsy often have a congenital malformation of the brain. This is like a birth defect of the brain, and the cause is not known.

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Q: Is cerebral palsy contagious?
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Cerebral palsy is not contagious. It is not a disease and should not be considered as such. Cerebral palsy is caused by injury suffered near the time of birth. There is nothing to be feared by being near someone with cerebral palsy.

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Q: Can Cerebral Palsy be cured?
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There is no treatment, as such, that will cure cerebral palsy. The main goal of professionals who work with individuals affected by cerebral palsy is to foster as much independence for the individual as his or her impairment will allow. Individuals with seizure disorders may be effectively controlled with anticonvulsive medications. Physical therapy, speech therapy, and occupational therapy are frequently utilized to maximize participation and independence.

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Q: What happens when the child matures?
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When thinking of the future for a child with cerebral palsy, it is important that parents keep a positive attitude, just as one would with any child. It is equally important to understand the child's abilities. A parent's hopes are likely a mix of realistic and unrealistic dreams for the child; professional help can enable the parent to adopt realistic goals. Often, a communication breakdown can occur when parents and health care experts discuss living with cerebral palsy.

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Q: Is cerebral palsy progressive?
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Cerebral palsy itself is not a progressive disease. The conditions and disabilities that can arise from cerebral palsy may improve, worsen, or remain unchanged with time.

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Q: Can cerebral palsy be prevented?
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Cerebral palsy may be prevented. Pregnant women that test Rh negative may be immunized to avoid bad effects of blood incompatibility with the child. Exchange transfusion can also prevent blood incompatibility with the newborn. If a child has jaundice, phototherapy (medical use of ultraviolet light) can prevent brain damage. Preventing viral infections, radiation exposure, drug abuse, anemia, and malnutrition in pregnant women is important. Equally important is protecting children from brain trauma after birth.

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Q: How many people have cerebral palsy?
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Approximately 500,000 people in the U.S. have cerebral palsy. About 5,000 children are diagnosed with cerebral palsy each year and about 1,500 young children acquire cerebral palsy each year.

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Q: Can cerebral palsy be acquired later in life?
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You cannot acquire true cerebral palsy later in life. There is a form of palsy similar to cerebral palsy that can be sustained by traumatic brain injuries. Typical causes of this similar form of palsy are motor vehicle accidents, falls, child abuse, and brain infection.

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How To Be A Good Listener?

Q: When you just can't understand what the other person is saying
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Do not pretend to have understood if you haven?t. Let the person using AAC know how much you have understood. Say to the person that you have not understood everything and ask them to repeat what they have just said or to say it again using different words. Ask them to show you what they mean, either by miming or using a gesture to show you, or to take you to the thing they are meaning ? if this is realistic! If the person can spell, it can sometimes be helpful if they spell out the word you are not able to understand. Sometimes someone else will be able to understand ? ask the person using AAC if there is someone else who could interpret.
 
Sometimes the problem is caused by background noise! If you are having difficulty understanding what the person using AAC is saying, it can help to move to a quieter spot or to reduce the volume of the sound on the TV or hi-fi.

How To Start Communication?

Q: Signs, Objects, Photographs and Symbols in the Environment
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It is important that the person with multiple disabilities has access to their means of communication at all times. It can be useful to have their communication method visible, for instance:

  • a timetable of the day displayed three dimensionally using objects of reference
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  • appropriate photographs or symbols on the wall in the canteen
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  • appropriate pictures up round the sand pit or water tray
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  • pictures/objects available or pinned to the wall above the bathroom sink