Special Adult Patient Populations

Multiple Sclerosis is a neurological disorder in which demyelination of nerves in the brain or spinal cord occurs. This causes plaque development and slower nerve conduction rates. Patients often present with spasticity. They may complain of trouble seeing, numbness or tingling, sensory changes, clumsiness, weakness, gait difficulty, frequent loss of balance, and tiredness. Factors that worsen these symptoms include sickness, trauma, stress, infection, pregnancy, and heat (Giles, 2020).

It is important to keep heat intolerance in mind when treating this population. This may vary individually. A temperature-controlled room with minimal distractions would be ideal to decrease the risk of symptom exacerbation. Intervention strategies vary depending on the person's functional status and needs. For a person that lives independently, educating the person on energy conservation techniques is extremely important. This would include things such as the importance of taking rest breaks often, doing difficult tasks earlier in the day, and exercising in the morning. Core stability and strengthening is important, as it improves a person's overall balance and reduces the amount of energy used by the extremities. Using PNF strategies, such as contract relax, helps improve range of motion and decrease spasticity (Martin & Kessler, 2016). Other interventions may include balance, gait, and functional training. 

A Traumatic Brain Injury occurs due to severe head trauma (primary) or underlying conditions that result in one (secondary). An open injury occurs due to a skull fracture, puncture wound, or anything else that exposes the brain to the air. A closed head injury happens when the brain hits the skull with sudden impact, but no penetration of the skull occurs. The resulting injury may be in one area or widespread. Clinical signs and symptoms can vary, depending on what parts of the brain are affected and the extent of damage. Typical symptoms may include some loss of consciousness, behavioral impairments, trouble with speech or swallowing, motor impairments, and changes in muscle tone (Giles, 2020). The Glasgow coma and Ranchos Los Amigos Cognitive Function scale assess a person's level of consciousness and helps determine treatment. Attached is a link to charts that show how to use the scale. 

Treatment depends on the severity and location of the injury. Those who are bedridden and unstable need to be repositioned every 2 hours to prevent contracture formation and skin breakdown. Once the patient is stable, getting a person used to sitting upright for longer periods of time is important before learning to propel a wheelchair. Functional mobility and ADL training, i.e. eating, brushing hair, should be initiated at this point with assistance as needed. Transfer training, i.e. slide board, sit-pivot, is also appropriate (Kessler & Martin, 2016). 

The amount of progress made is different for every patient. Some may never walk again and others may return close to where they were. Treatment should be tailored to the individual. Core stability and strength, sitting balance, and range of motion exercises are appropriate for those who are wheelchair bound. Those who are able to stand can do any of these things and also do standing balance and strengthening/stretching. The goal is to maximize function as much as possible. 

PTAs should remember that recent TBI patients usually have short attention spans and may have difficulty with motor learning. They may also have frequent mood swings due to environmental stressors, i.e. loud noises (Martin & Kessler, 2016). Being in a quiet environment with minimal distractions, repetition of tasks and patience are keys to success.