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OT for Chiari Malformation (CM)

Published : Friday, 14 September, 2018 at 12:00 AM Count : 638

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Chiari malformation is a problem with the structures at the back of the brain. An area of the brain called the cerebellum normally sits inside the back of the skull. In Chiari malformation, the cerebellum sits partially or fully below the skull. This position can put pressure on the cerebellum, nearby brainstem, and upper spinal cord. It can also block the flow of cerebrospinal fluid (CSF) around the brain and spinal cord. CSF normally cushions the brain and spine but when it becomes blocked it can cause a buildup of pressure in the brain and spinal cord.
There are 4 types of Chiari malformations. The types are based on the severity of the disorder and the parts of the brain that protrude into the spinal canal.

Causes
Chiari malformation is most often caused by a problem in the formation of the skull before birth. It is not clear why the skull does not develop normally, but it may be due to genetics or the health of the mother during pregnancy. The back of the skull normally has a curved area for the cerebellum and brainstem to sit in. In some babies, the space is too small for the brain to properly sit in and the cerebellum and brain stem are pushed downward into the spinal canal.
Type I Chiari malformation, the most common type, usually presents in older children, adolescents, and sometimes adults.
Type II is present at birth and is usually associated with spina bifida and occasionally with hydrocephalus.
Type III is usually present at birth and is usually associated with hydrocephalus.
 
Rabeya Ferdous Occupational Therapist National Institute of Neurosciences & Hospital

Rabeya Ferdous Occupational Therapist National Institute of Neurosciences & Hospital

Symptoms
In general, the more brain tissue that pushes into the spine, the more severe the symptoms. For example, someone with type 1 may not have any symptoms, while someone with type 3 may have severe symptoms. People with CM can have a variety of symptoms, depending on the type, buildup of fluid, and pressure on tissues or nerves.
Since CM affects the cerebellum, symptoms typically involve balance, coordination, vision, and speech. The most common symptom is a headache at the back of the head. It's often brought on by activities like exercising, straining, bending over, and more.

Other symptoms include:
v    Dizziness
v    Neck pain
v    Numbness or tingling in hands and feet
v    Trouble swallowing
v    Weakness in the upper body
v    Hearing loss
v    loss of pain or temperature sensation in the upper body
v    balance trouble or difficulty walking
v    Cognitive problem
v    Difficulty in motor skills
v    Abnormal reflexes

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Rehabilitation:
A group of rehabilitation team works for CM patients. These include:
l    Specialized doctor
l    Occupational therapist
l    Physiotherapist
l    Speech and language therapist
l    Psychologist
l    Social worker
l    Nurses
Rehabilitation through Occupational Therapy
Firstly occupational therapist assesses the patient and according to assessment therapist provide treatment. This occupational therapy includes:
m    Engage the patient in different activities in different sitting and standing positions for improving balance.
m    Practice different gross motor activities for improving gross motor skills e.g. basket ball throwing.
m    Engage the patient in different fine motor activities such as manipulation board, buttoning etc.
m    Sensory re-education for sensory related problem.
m    Educate the patient and their caregiver about proper positioning of neck during activity. It will reduce neck pain.
m    Functional gait retraining.
m    Cognitive retraining for improving memory loss
m    Provide different type of splint according to patients need
Rehabilitation is done by many professionals where occupational therapy is one of unique profession which has great role to independent the person's life into their daily activities. In Bangladesh, people think only doctor can provide treatment and only doctor can cure the disease. This perception is totally wrong. Besides doctor other rehabilitation professionals like therapists (Occupational therapist, Physiotherapist, Speech and Language Therapist), Psychologist and social worker are working for these patients according to their view. Their treatment view is totally different from each other. So, rehabilitation must be need in any condition. Patient may get a good qualitiful service from a multidisciplinary team. So, we have to more aware about rehabilitation services.



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