1,721,013 research outputs found

    Parkinson's disease, nutrition, and surgery in context of critical care

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    Parkinson’s disease is a common neurodegenerative disorder with a higher risk of hospitalization than the general population. Therefore, there is a high likelihood of encountering a person with Parkinson’s disease in acute or critical care. Most people with Parkinson’s disease are over the age of 60 years and are likely to have other concurrent medical conditions. Parkinson’s disease is more likely to be the secondary diagnosis during hospital admission. The primary diagnosis may be due to other medical conditions or as a result of complications from Parkinson’s disease symptoms. Symptoms include motor symptoms, such as slowness of movement and tremor, and non-motor symptoms, such as depression, dysphagia, and constipation. There is a large degree of variation in the presence and degree of symptoms as well as in the rate of progression. There is a range of medications that can be used to manage the motor or non-motor symptoms, and side effects can occur. Improper administration of medications can result in deterioration of the patient’s condition and potentially a life-threatening condition called neuroleptic malignant-like syndrome. Nutrients and delayed gastric emptying may also interfere with intestinal absorption of levodopa, the primary medication used for motor symptom management. Rates of protein-energy malnutrition can be up to 15 % in people with Parkinson’s disease in the community, and this is likely to be higher in the acute or critical care setting. Nutrition-related care in this setting should utilize the Nutrition Care Process and take into account each individual’s Parkinson’s disease motor and non-motor symptoms, the severity of disease, limitations due to the disease, medical management regimen, and nutritional status when planning nutrition interventions. Special considerations may need to be taken into account in relation to meal and medication times and the administration of enteral feeding. Nutrition screening, assessment, and monitoring should occur during admission to minimize the effects of Parkinson's disease symptoms and to optimise nutrition-related outcomes

    Features and Physiology of Spinal Stretch Reflex Pathways in People with Chronic Spinal Cord Injury

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    In spastic individuals with chronic spinal cord injury (SCI), the stretch reflex gain and reflex stiffness are high at rest and do not decrease with muscle activation. The soleus H-reflex is also large during voluntary muscle contraction, and the soleus stretch and H-reflexes are abnormally modulated during walking. Hyperexcitable stretch reflexes are most problematic in mid-late swing through early stance as they can trigger clonus and negatively affect locomotion. These observations of stretch reflex behaviors in SCI do not appear to match what has been found in hemiparetic stroke or cerebral palsy. Different from pharmacologically or surgically disabling a reflex pathway, changing a reflex behavior through neurobehavioral training such as locomotor training and reflex operant conditioning could provide new means to enhance motor function recovery in people with SCI
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