Multiple System Atrophy
Multiple system atrophy, MSA, is a disease affecting many parts of your body. Much like Parkinson’s disease or cerebellar disease depending on the sub type representing most symptoms.
Symptoms closely related to Parkinson’s are tremor, slow movement, rigidity, and impaired balance and posture. While the cerebellar type is associated with loss of coordination, slurred, slow and or soft voice, difficulty with swallowing, visual disturbances; such a blurred vision or problems focusing. A prominent sign is postural hypotension which involves low blood pressure resulting in dizziness or lightheadedness when changing position from lying or sitting. In some cases there can be a rise in blood pressure when going to a lying position. Patient may also have difficulty controlling their emotions. There are many other symptoms one might experience with MSA.
This blog will discuss treatments with patients on opposite sides of the country.
The first one is today. I recently had the chance to see two individuals with MSA; one in North Carolina and the other in Calaifornia. Both individuals were in their 50’s and had professional careers but were retired due to their illness. Lucky for them they both had wonderful supportive spouses. They were at different stages of MSA.
One gentleman was wheelchair bound, required maximal transfers and could not stand or walk anymore. His wife reported that he was hardly able to read due to blurred and double vision and runs into things with the electric wheelchair. I wasn’t the treating therapist as we had several patients in the treatment room while I was teaching. I did help with his treatment however. He was a rather large individual. In the wheelchair during pretest he was unable to maneuver around cones without running over them. He had emotional outbursts of uncontrollable laughing while driving the electric wheelchair, testing his vision and especially during perturbations (Nudges to see where you fall off balance). His vision was positive for nystagmus (jerkiness of the eyes) and decreased convergence (decreased ability to bring eyes close to center when an object is getting closer to your nose). He held his eyes almost closed like slits. It was maximal effort to transfer him from electric wheelchair to the mat. He could sit with slight posterior loss of balance requiring him to hold his arms closely in front of him. He exhibited uncontrolled laugh.
After testing we placed the weights on him. This actually took the most weight I have ever used, five pounds strategically placed. We got him standing with stand by assist. His wife transferred him with minimal assist. His eyes opened more and were no longer slits. His uncontrolled laughing ceased and he looked relaxed. We repeated the vision tests and they showed some improvement. When we repeated the driving in the electric wheelchair he did not hit the cones. In addition his trunk and arms became relaxed. He watched the next treatment and did not have any outbursts of laughing. Can some of the outburts be associated with uneasiness? Hmm???
His wife stated that giving patients a little more ability is so gratifying to them. To the spouse also. This treatment was going to have the potential to decrease her work in tranfering him from the wheelchair to the chair or other surfaces. This was a double win for this family. Also improving the ability to steer his wheelchair will make everything safer.
I have not worked with many people who have been wheelchair bound but this treatment gives me hope that we can help make a difference for them with BalanceWear!
Stay tuned for the report on the next patient with MSA.