The Role of Physiatry in the Management of Neuromuscular Disease

Aging with muscular dystrophy: pathophysiology and clinical management

Major advances in the fields of medical science and physiology, molecular genetics, biomedical engineering, and computer science have provided individuals with muscular dystrophy (MD) with more functional equipment, allowing better strategies for improvement of quality of life. These advances have also allowed a significant number of these patients to live much longer. As progress continues to change management, it also changes patients' expectations. A comprehensive medical and rehabilitative approach to management of aging MD patients can often fulfill expectations and help them enjoy an enhanced quality of life.

The reliability and validity of a self-report version of the FIM instrument in persons with neuromuscular disease and chronic pain

OBJECTIVE

To evaluate the reliability and validity of a self-report version of the FIM instrument (FIM-SR).

DESIGN

Survey study.

SETTING

Rehabilitation research program.

PARTICIPANTS

Adults with neuromuscular disorders (NMD) and chronic pain (N=141).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The FIM-SR and Medical Outcomes 36-Item Short-Form Health Survey (SF-36).

RESULTS

The internal consistency coefficients of the FIM-SR scales were all adequate to excellent (Cronbach alpha range, .73-.98; median, .96). Correlations between the FIM-SR scales and SF-36 scales supported the concurrent validity of the former. Also, the FIM-SR scales associated with motor function discriminated between those subjects who reported being ambulatory and those who reported requiring use of a wheelchair or other assistive device for getting around. Finally, FIM-SR scales discriminated between different types of NMDs, with patients with amyotrophic lateral sclerosis showing significantly lower scores on the FIM-SR self-care, motor, and total scores than all other NMD diagnostic groups, and showing significantly lower scores on the FIM-SR sphincter control, mobility, and locomotion scales than most of the other diagnostic groups.

CONCLUSIONS

The FIM-SR scales appear to be reliable and valid measures of independence in 6 specific (self-care, sphincter control, mobility, locomotion, communication, social cognition), and 3 global (motor, cognition, total) areas of functioning in persons with NMD.

Marijuana in the management of amyotrophic lateral sclerosis

Marijuana has been proposed as treatment for a widening spectrum of medical conditions. Marijuana is a substance with many properties that may be applicable to the management of amyotrophic lateral sclerosis (ALS). These include analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction. In addition, marijuana has now been shown to have strong antioxidative and neuroprotective effects, which may prolong neuronal cell survival. In areas where it is legal to do so, marijuana should be considered in the pharmacological management of ALS. Further investigation into the usefulness of marijuana in this setting is warranted.

Expanding the role of hospice care in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive, ultimately fatal, motor neuron disease that poses a myriad of clinical and end-of-life problems. The needs of advanced ALS patients are well suited to the interdisciplinary, multi-modality setting of hospice, where comprehensive palliative strategies may ease suffering and allow the patient to die with dignity in the home. Unfortunately, hospice services are far underutilized in this setting. There is a great need to increase awareness of both patients and clinicians regarding the effectiveness of hospice in the care of advanced ALS patients.