"Neurological Conditions" is a rather broad category that includes many different diagnoses that affect the central or peripheral nervous system. Information about some of the specific conditions is presented below:
Multiple Sclerosis (MS) is a progressive neuromuscular disease in which the central nervous system loses its protective coating, causing progressive paralysis, sensory loss and visual impairment. The disease is characterized by periods of exacerbation, when symptoms are worse followed by periods of remission, when little or no changes are experienced. For some patients, the onset of MS is sudden and severe, while others experience a very gradual decline. Inpatient rehabilitation is often medically necessary during initial onsets or episodically during periods of significant exacerbation. Due to the progressive nature of the disease, these individuals typically require intermittent specialty services such as seating and positioning, brief physical, occupational or speech therapy that is targeted at a specific issue, and/or training in use of assistive technology.
Parkinsons Disease is a chronic, progressive disorder of the central nervous system that belongs to a group of conditions called motor system disorders. The body's ability to produce a chemical called dopamine, responsible for transmitting signals, is affected. This loss of dopamine causes critical nerve cells in the brain, or neurons, to fire out of control, leaving patients unable to direct or control their movement in a normal manner. Parkinsons Disease is also a progressive condition, with symptoms that often appear gradually and worsen over time. Specific symptoms may include tremors, balance and coordination impairments affecting gait and mobility, rigidity and difficulty initiating movement, and oral motor difficulties.
Guillain-Barre' (ghee-yan bah-ray) syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness and/or abnormal sensation in the legs, which often spreads to the arms and upper body. These symptoms often increase in intensity until the muscles cannot be used at all and the patient is almost totally paralyzed. In these cases, the patient may be put on a ventilator to assist with breathing. Most patients recover from even the most severe cases although some continue to have some degree of weakness. Intense coordinated rehabilitation has been proven to improve strength and functioning for individuals with this syndrome.
Neuromuscular Disorders refers to several different conditions, of which the largest group is referred to as motor neuron diseases. According to the National Institute of Neurological Disorders and Stroke, motor neuron diseases (MNDs) are a group of progressive neurological disorders that destroy cells that control essential muscle activity such as speaking, walking, breathing, and swallowing. Common MNDs include amyotrophic lateral sclerosis (ALS), progressive bulbar palsy, primary lateral sclerosis, and progressive muscular atrophy. Other MNDs include the many inherited forms of spinal muscular atrophy and post-polio syndrome, a condition that can strike polio survivors decades after their recovery from poliomyelitis. In addition to the Motor Neuron Diseases, this category also includes muscular dystrophies, which are a group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement. Some forms of Muscular Dystrophy are seen in infancy or childhood, while others may not appear until middle age or later. The disorders differ in terms of the distribution and extent of muscle weakness (some forms of Muscular Dystrophy also affect cardiac muscle), age of onset, rate of progression, and pattern of inheritance. Myasthenia Gravis, a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body, is also included in this grouping. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Muscles that control eye and eyelid movements, facial expression, chewing, talking, and swallowing are often, but not always, involved.
Other Neurologic includes conditions such as extrapyramidal disease and movement disorders (for example, Dystonia) that affect a person's coordination, Spinocerebellar disease (for example, Friedrick's Ataxia) that affect balance and coordination, autonomic nervous system disorders (for example, Reflex Sympathetic Dystrophy) that are typically treated on an outpatient basis, and other demylinating diseases of the central nervous system (for example, transverse myelitis) that are a result of an inflammatory process often resulting in muscle weakness, abnormal sensation and bowel/bladder dysfunction.
The Neurological Conditions Program at Madonna Rehabilitation Hospital serves individuals with those types of diagnoses on multiples levels of care, including:
- Long Term Acute Care Hospital (LTACH)for those patients who have higher medical needs and/or are unable to tolerate intense therapy
- Acute Rehabilitation Unit (AR)for those who are able to tolerate and benefit from intense inpatient rehabilitation of at least 3 hours per day
- Transitional Care Unit (TCU)for patients who have medical and/or rehabilitation needs that are less intensive.
- Rehabilitation Day Program (RDP)for patients immediately after inpatient rehabilitation or for those who do not require overnight hospitalization but would benefit from an intensive, coordinated rehab program focused on community re-entry and independent living.
- Outpatientfor patients who need single service therapy, multiple service with lower intensity, or a specialized service such as assistive technology, wheelchair seating, or vision services.
During the fiscal year ending June 30, 2009 Madonna served 23 inpatients with neurological conditions. The majority of patients (20) were served on acute rehabilitation, 2 on LTACH and 1 on Subacute rehab. Patients had the following diagnoses:
Multiple Sclerosis 7
Parkinsons Disease 5
Other Neurological 3
Guillian Barre' 3
Polyneuropathy 3
Neuromuscular Dis. 1
Cerebral Palsy 1
The average age of persons served in this program was 60 years old. Most were admitteed from Lincoln or greater Nebraska, with two patients from out of state.
Madonna served 65 new outpatients with neurological conditions during the same period. Ten of those patients were served in the Rehabilitation Day Program.
