REHABILITATION OF PATIENTS WITH MOTOR NEURON DISEASE
Joel A. DeLisa, M.D. (UMDNJ-New Jersey Medical School, Newark, New Jersey, USA)
Motor neuron diseases present a challenge to the field of medicine. Most start in the "prime of life", are progressive, devastating and intractable, finally culminating in death. These patients begin as independently functional individuals who can rapidly progress to a state of complete dependency, often with their mental facilities entirely intact. The etiology of MND is unknown and the only treatment is symptomatic. The disease not only affects the patient but often disrupts the family structure as well. Treatment applied early in the course of the disease can significantly enhance the quality of life by preventing disuse weakness, maintaining range of motion and facilitating transfers and ambulation. Adaptive equipment is useful to aid in self-care. Dysphagia and sialorrhea can be improved using supportive measures. Dysarthria or the loss of speech can be aided by multiple methods including electronic communications. Respiratory management including ventilatory support should be considered. One must give patients the opportunity to express their feelings, concerns and frustrations. Attention must be given to personal care on a 24-hour basis.
PREVENTION OF DISABILITIES
Gunnar Schioler, MD, DPH (National Board of Health, Copenhagen, Denmark)
Prevention of diabilities is an important activity for the medical profession as well as for the society in general. This concept took a major step forward in 1996, when Rehabilitation International at its world congress adopted an international Declaration on Prevention of Disabilities.
Prevention of disabilities is not only a challenges for the medical profession, but the whole society However, the medical profession have special possibilities and obligations to promote prevention in general - and prevention of disabilities This can be done directly as well as indirectly The method are various and are concentrated around the following items:
-quality in medical and surgical treatment
-research in better techniques and technology
-epidemiological and statistical research
-influencing decision makers
Examples and viewpoints are discussed.