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Lecture for Year 2 Semester 2 PPSD session on Wednesday 30th January 2008 by Professor Omar Hasan Kasule Sr.
PATIENTS WITH LIMB WEAKNESS
Motor deficits can affect muscles in various ways causing weakness (decreased power), wasting, fasciculation, increased/decreased tone, increased/decreased reflexes, and incordination.
The clinical manifestations depend on the site of the lesion which could be upper motor (pyramidal), lower motor, extrapyramidal, or cerebellar.
Careful clinical assessment has to be carried out before advising the patient about how they can pray and what forms of physical work or physical activity they can undertake. There are no general rules. Each case should be treated on its own merits.
PATIENTS WITH GAIT DISORDERS
Gait disorders also affect patients’ abilities to fulfill their obligations. The causes (neurological, or musculo-skeletal) should be established and treated as much as possible and where treatment is not possible rehabilitation is carried out.
Patients should be advised to avoid activities during which their handicap can lead to accidents. Failure of the physician to explain and provide the information necessary in such cases will lead to legal liability if the patient is harmed.
PATIENTS WITH INVOLUNTARY MOVEMENTS
There are several types of involuntary movements that can affect social and religious obligations.
Tremors are rhythmic oscillating involuntary movements of a limb of the head that may occur at rest or during activity.
Choreas are jerky and purposeless involuntary movements. Ballisms are big ballistic movements of the limbs.
Athestoses are slow writhing movements of the limbs.
In dystonia the limb takes up and involuntary abnormal posture.
Involuntary movements could be a cause of accidents that injure the patient or others. Care should be taken in allowing patients with these conditions to work in occupations involving moving machinery or to drive motorized vehicles. Care is also needed in other physical activities including activities of daily living. Physicians are liable for failure to warn their patients about potential dangers.
TREATMENT OF PARKINSON’S DISEASE USING STEM CELLS
Geraerts et al. CONCISE REVIEW: THERAPEUTIC STRATEGIES FOR PARKONSON DISEASE BASED ON THE MODULATION OF ADULT NEUROGENESIS. Stem Cells 2007 Feb(2):263-270.
Parkinson disease (PD) is a progressive neurodegenerative disorder affecting millions of people worldwide. To date, treatment strategies are mainly symptomatic and aimed at increasing dopamine levels in the degenerating nigrostriatal system. Hope rests upon the development of effective neurorestorative or neuroregenerative therapies based on gene and stem cell therapy or a combination of both. The results of experimental therapies based on transplanting exogenous dopamine-rich fetal cells or glial cell line-derived neurotrophic factor overexpression into the brain of Parkinson disease patients encourage future cell- and gene-based strategies. The endogenous neural stem cells of the adult brain provide an alternative and attractive cell source for neuroregeneration. Prior to designing endogenous stem cell therapies, the possible impact of PD on adult neuronal stem cell pools and their neurogenic potential must be investigated. We review the experimental data obtained in animal models or based on analysis of patients' brains prior to describing different treatment strategies. Strategies aimed at enhancing neuronal stem cell proliferation and/or differentiation in the striatum or the substantia nigra will have to be compared in animal models and selected prior to clinical studies.