Incoordination

A lack of normal adjustment of muscular action so that the intended movement of the limb or other part is not made smoothly and harmoniously, and does not accurately achieve its objective. If the abnormality is hypermetric, the condition is referred to as ataxia. If it is inclined to weakness, e.g. knuckling at the turn, stumbling, failure to flex limbs properly, or to misdirection as in a proprioceptive deficit, it is called incoordination. The judgment is best made with the animal going at a good pace, preferably unrestrained, and on level going. A number of sophisticated techniques are available for the examination of the gaits of racing horses. As affecting sphincters, especially of the alimentary tract, the term is used alternatively to achalasia.

Causes

Some of the common causes of Incoordination may include:

  • Transient ischemic attack (TIA)
  • Stroke
  • Multiple sclerosis
  • Post-infectious condition
  • Congenital cerebellar ataxia

treatment

Adaptive robot training for the treatment of incoordination in Multiple Sclerosis. BACKGROUND: Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects. METHODS: Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects’ impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes. RESULTS: Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions. CONCLUSIONS: The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

 

 

Common Neurological Disorders are :

 

  1. Infections of the brain and spinal cord:( MENINGITIS, ENCEPHALITIS, BRAIN ABSCESS, MYELITIS, ARACHNOIDITIS, POTTS SPINE etc)

An infection of the membranes surrounding the brain is called meningitis, while an infection involving the brain tissue itself is called encephalitis. Infections may be caused by bacteria, viruses, fungi or parasites. Organized pockets of infection within the brain are called abscesses. Most infections are treated with a combination of antibiotics. Some abscesses require surgical drainage. Patients with heart infections such as endocarditis are at particular risk for infection spreading to the brain. Infection of spinal cord is Myelitis.

  1. ISCHEMIC STROKE :

If Diagnosed in time and presenting before 4.5 Hours to ED then Patients of Ischemic Stroke can benefit from life saving Thrombolysis- tPA and remarkable recovery can be made.

  1. Subarachnoid Hemorrhage (SAH) :

This type of bleeding in the brain occurs in the membranes that surround the brain and is typically due to trauma or the rupture of an aneurysm. An aneurysm is an abnormal ballooning of an artery that most patients are born with. Smoking, high blood pressure and cocaine use can contribute to the formation and growth of aneurysms. Most aneurysms rupture when patients reach age 40-60. Aneurysms should be repaired as soon as possible either with surgery or endovascular coiling. The next 3-14 days after aneurysm rupture represents the vasospasm period. During this time, other brain vessels can become irritable and spasm or clench up. Spasm limits the amount of blood that can pass through that vessel to supply nourishment to the brain. In the worst case scenario, stroke can occur due to vasospasm. Neurointensivists carefully watch patients for the development of vasospasm so they can intervene with medical or endovascular treatments to prevent stroke. Most subarachnoid hemorrhage patients will spend at least 1 week in the ICU. Outcome after SAH depends primarily on the patient’s age, his or her clinical status at presentation (depth of coma etc) and the size of the aneurysm that ruptured

  1. Intracerebral Hemorrhage (ICH):

ICH is another type of bleed in the brain that occurs within the brain tissue itself. ICH is usually due to high blood pressure, vascular malformations (abnormal tangle of blood vessels) in the brain tissue, brain tumors that bleed, blood thinners, or amyloid angiopathy which implies vessel abnormality that occurs in older patients. Some types of ICH are treated with surgery, though most are not. Intracerebral hemorrhages can rupture into the fluid filled spaces within the brain called the ventricles. When this occurs patients often need drainage of this fluid and blood through a tube placed through the skull and into the ventricle. Prognosis after ICH depends on the size of the bleed, the presence of intraventricular blood, the clinical condition of the patient at presentation, the age of the patient and the location of the blood.

  1. Traumatic Brain Injury (TBI) :

TBI can result from blunt trauma (falls, motor vehicle accidents etc), or penetrating trauma (such as gun shot wounds, stab wounds etc). There are many types of brain injury following head trauma including bleeds around the brain such as subdural or epidural hemorrhage and injury to the brain tissue itself such as contusions or bruising of the brain. Rapid acceleration- deceleration injury (as in motor vehicle accidents) can cause shearing of the brain tissue which is called diffuse axonal injury. Elevated pressure in the skull is a serious consequence of TBI and must be treated rapidly and aggressively. Many types of TBI are treated by surgically removing the blood (subdural, epidural hemorrhage) or part of the skull to treat the pressure in the brain. Special medications can also be given to lower brain pressure
Stroke: Ischemic stroke occurs when arteries that feed nutrients and oxygen to the brain and clogged preventing blood flow. Clots may travel to the brain from the heart or other blood vessels or may form at an atherosclerotic plaque in a vessel. High blood pressure may contribute to abnormalities in small blood vessels leading to strokes. It is important to recognize the warning signs of stroke (sudden weakness, difficulty speaking, drooping mouth, vision abnormalities, difficulty walking etc.) because special clot-busting medications can be delivered to treat stroke if given within a narrow time window. Clot busters can either be given through the veins or directly into the arteries via an angiogram at special facilities. Large strokes may require surgery.

Brain Tumors: There are many different types of brain tumors including primary brain tumors (glioblastoma multiforme, astrocytoma, oligodendroglioma, meningioma, pituitary adenoma etc.) and metastatic brain tumors which are tumors that have spread to the brain from other parts of the body (lung, breast, kidney etc.). Depending on the location of the brain tumor, patients will have different neurologic deficits such as speech difficulty, weakness, numbness or difficulty walking. Most brain tumors are treated with a combination of surgical resection, chemotherapy and radiation therapy. Seizures are abnormal electrical discharges that propagate through the brain. Seizures can occur in patients with epilepsy, but also can be provoked by brain injury from trauma, strokes, tumors, infection, alcohol abuse, metabolic imbalance or certain drugs. Status epilepticus is defined as uncontrolled and persistent seizures. Status epilepticus can lead to brain injury and must be treated without delay. Patients typically require brain monitoring called electroencephalogram (EEG) to help treat status epilepticus. A variety of different medications are available to treat status epilepticus.

Neuromuscular disorders: Certain diseases of the muscle (myopathy) and nerves (Guillain Barre Syndrome etc) and the junction between the muscles and nerves (Myasthenia Gravis) can cause profound weakness. Some patients require the mechanical respiratory support of a ventilator. Some of these neuromuscular disorders can be treated with intravenous gammaglobulin or plasmapheresis and many patients recover their strength over a period of days to weeks. Spinal cord injury: Spinal cord damage can occur from trauma, metabolic deficiencies infection, inflammation, tumors, strokes of the spinal cord or injury to the bones or discs that surround the cord. Some types of spinal cord injuries require surgical decompression, while others require treatment with steroids, intravenous gamaglobulin or plasmapheresis.

Peripheral Neuropathy : Peripheral neuropathy is disorders of peripheral nerves. The peripheral nervous system is made up of the nerves that branch out of the spinal cord to all parts of the body.Peripheral neuropathy can be caused by poor nutrition, a number of diseases including diabetes, pressure and trauma. In some cases patients suffers from the disorder without ever identifying the cause. There are many possible causes of peripheral neuropathy, including:Diabetes ,Vitamin deficiency,Alcohol, Rheumatoid arthritis,Guillain-Barre syndrome(GB Syndrome),Kidney failure,AIDS HaNSEN’S dISEASEetc. Diabetes and post herpetic neuralgia are the most common causes of peripheral neuropathy. Diabetic neuropathy is a nerve disorder caused by diabetes. Common symptoms of neuropathy include numbness and pain in the arms and legs. Myopathy Is muscle weakness, wasting, and histologic changes within muscle tissue, as seen in any of the muscular dystrophies. The first symptom is muscle weakness due to dysfunction of muscle fiber and Other symptoms of myopathy are muscle stiffness and spasm. Myopathies can be inherited or acquired. A myopathy can be caused by nerve dysfunction. The specific diagnosis is made by using tests of electromyogram(EMG Test),

Parkinson’s Disease Parkinson’s Disease is a neurological illness is a disorder caused by the gradual loss of cells in a small part of the brain. The loss /death of these cells produces a reduction in a vital chemical called dopamine which causes symptoms, as trembling of the limbs and head while at rest, slowing down of movements, stiffness, and loss of balance, loss of facial expression, reduction in speech volume and clarity, difficulty swallowing, change in size of handwriting, dry skin, constipation, urinary difficulties, and depression. Because Parkinson’s disease is a progressive disorder, these symptoms worsen with time. Patient may feel difficulties to walk, talk, and complete simple tasks. These vary in severity, and not every individual will experience all of them. Some of the secondary symptoms include:

  • Anxiety, insecurity, and stress
  • Confusion, memory loss, and dementia
  • Depression
  • Difficulty swallowing and excessive salivation
  • Diminished sense of smell
  • increased sweating
  • skin problems
  • slowed, quieter speech, and monotone voice
  • urinary frequency/urgency

 

Risk factor :

  • Age is the largest risk factor for the development and progression of Parkinson’s disease. Most people who develop Parkinson’s disease in their old age.
  • If there is a family history of Parkinson’s Disease
  • Head trauma

Dementia /Alzheimer Disease: Dementia is a progressive and degenerative disorder of the brain caused by multiple cognitive deficits that include impairment in memory. The beginning of the disease it seems as an absentmindedness or forgetfulness. The patient may forget names, belongings etc. Most people occasionally forget things, these early symptoms may go unnoticed, but when these will become more frequent and more severe, eventually developing into other symptoms of dementia. As the disease increase patients will slowly become unable to care for themselves. At first they may need only occasional attention and supervision, but eventually they will need to be cared for and supervised at all times. Early indications:

  • Difficulty with regular activities.
  • Forgetfulness at work, having negative consequences, such as frequently forgetting appointments, daily work schedule etc.
  • Becoming apathetic, losing the desire to take initiative on tasks, take part in daily activities.
  • Difficulties in remembering familiar locations, such as own address, what year it is etc.
  • Difficulties handling money.
  • Trouble remembering simple words; often dementia sufferers will substitute inappropriate words without realizing, making them difficult to understand.
  • Sudden mood swings with no obvious causes. Changes in personality and increased irritability are also possible.
  • Dementia patients may experience diminished judgment, often behave completely inappropriate.
  • Losing things and blaming others for “stealing” from them Moderate Dementia In this phase symptoms of dementia likely to be more obvious such as:
  • Forgetting recent events, becoming confused about times and places, remembering events from the past as though they are the present.
  • Forgetting names and faces, confusing family members with each other.
  • Becoming lost, wandering outdoors, often at inappropriate times or in inappropriate clothing.
  • Forgetting to eat, or maintain proper hygiene/ Auditory and visual hallucinations
  • Getting frustrated and becoming upset or angry. Severe Dementia Is known as final stage of dementia, patients will likely be unable to care for themselves and need round the clock attention: Symptoms are:
  • Uncontrollable movements
  • Incontinence
  • Failure to recognize even objects that we use every day
  • Restlessness, inability to sleep
  • Symptoms worsen at night
  • No longer recognize family member and friends
  • Need help using the toilet, washing or getting dressed.
  • Difficulty walking and getting around
  • Become aggressive and easily threatened

 

Subarachnoid Hemorrhage (SAH):

This type of bleeding in the brain occurs in the membranes that surround the brain and is typically due to trauma or the rupture of an aneurysm. An aneurysm is an abnormal ballooning of an artery that most patients are born with. Smoking, high blood pressure and cocaine use can contribute to the formation and growth of aneurysms. Most aneurysms rupture when patients reach age 40-60. Aneurysms should be repaired as soon as possible either with surgery or endovascular coiling. The next 3-14 days after aneurysm rupture represents the vasospasm period. During this time, other brain vessels can become irritable and spasm or clench up. Spasm limits the amount of blood that can pass through that vessel to supply nourishment to the brain. In the worst case scenario, stroke can occur due to vasospasm. Neurointensivists carefully watch patients for the development of vasospasm so they can intervene with medical or endovascular treatments to prevent stroke. Most subarachnoid hemorrhage patients will spend at least 1 week in the ICU. Outcome after SAH depends primarily on the patient’s age, his or her clinical status at presentation (depth of coma etc) and the size of the aneurysm that ruptured. Intracerebral Hemorrhage (ICH):

ICH is another type of bleed in the brain that occurs within the brain tissue itself. ICH is usually due to high blood pressure, vascular malformations (abnormal tangle of blood vessels) in the brain tissue, brain tumors that bleed, blood thinners, or amyloid angiopathy which implies vessel abnormality that occurs in older patients. Some types of ICH are treated with surgery, though most are not. Intracerebral hemorrhages can rupture into the fluid filled spaces within the brain called the ventricles. When this occurs patients often need drainage of this fluid and blood through a tube placed through the skull and into the ventricle. Prognosis after ICH depends on the size of the bleed, the presence of intraventricular blood, the clinical condition of the patient at presentation, the age of the patient and the location of the blood.

ITraumatic Brain Injury (TBI): TBI can result from blunt trauma (falls, motor vehicle accidents etc), or penetrating trauma (such as gun shot wounds, stab wounds etc). There are many types of brain injury following head trauma including bleeds around the brain such as subdural or epidural hemorrhage and injury to the brain tissue itself such as contusions or bruising of the brain. Rapid acceleration- deceleration injury (as in motor vehicle accidents) can cause shearing of the brain tissue which is called diffuse axonal injury. Elevated pressure in the skull is a serious consequence of TBI and must be treated rapidly and aggressively. Many types of TBI are treated by surgically removing the blood (subdural, epidural hemorrhage) or part of the skull to treat the pressure in the brain. Special medications can also be given to lower brain pressure.

IStroke: Ischemic stroke occurs when arteries that feed nutrients and oxygen to the brain and clogged preventing blood flow. Clots may travel to the brain from the heart or other blood vessels or may form at an atherosclerotic plaque in a vessel. High blood pressure may contribute to abnormalities in small blood vessels leading to strokes. It is important to recognize the warning signs of stroke (sudden weakness, difficulty speaking, drooping mouth, vision abnormalities, difficulty walking etc.) because special clot-busting medications can be delivered to treat stroke if given within a narrow time window. Clot busters can either be given through the veins or directly into the arteries via an angiogram at special facilities. Large strokes may require surgery.

IBrain Tumors: There are many different types of brain tumors including primary brain tumors (glioblastoma multiforme, astrocytoma, oligodendroglioma, meningioma, pituitary adenoma etc.) and metastatic brain tumors which are tumors that have spread to the brain from other parts of the body (lung, breast, kidney etc.). Depending on the location of the brain tumor, patients will have different neurologic deficits such as speech difficulty, weakness, numbness or difficulty walking. Most brain tumors are treated with a combination of surgical resection, chemotherapy and radiation therapy. Seizures are abnormal electrical discharges that propagate through the brain. Seizures can occur in patients with epilepsy, but also can be provoked by brain injury from trauma, strokes, tumors, infection, alcohol abuse, metabolic imbalance or certain drugs. Status epilepticus is defined as uncontrolled and persistent seizures. Status epilepticus can lead to brain injury and must be treated without delay. Patients typically require brain monitoring called electroencephalogram (EEG) to help treat status epilepticus. A variety of different medications are available to treat status epilepticus.

INeuromuscular disorders: Certain diseases of the muscle (myopathy) and nerves (Guillain Barre Syndrome etc) and the junction between the muscles and nerves (Myasthenia Gravis) can cause profound weakness. Some patients require the mechanical respiratory support of a ventilator. Some of these neuromuscular disorders can be treated with intravenous gammaglobulin or plasmapheresis and many patients recover their strength over a period of days to weeks. Infections of the brain and spinal cord: An infection of the membranes surrounding the brain is called meningitis, while an infection involving the brain tissue itself is called encephalitis. Infections may be caused by bacteria, viruses, fungi or parasites. Organized pockets of infection within the brain are called abscesses. Most infections are treated with a combination of antibiotics. Some abscesses require surgical drainage. Patients with heart infections such as endocarditis are at particular risk for infection spreading to the brain.

ISpinal cord injury: Spinal cord damage can occur from trauma, metabolic deficiencies infection, inflammation, tumors, strokes of the spinal cord or injury to the bones or discs that surround the cord. Some types of spinal cord injuries require surgical decompression, while others require treatment with steroids, intravenous gamaglobulin or plasmapheresis.