El impacto de la discapacidad en la vida sexual de los individuos con enfermedades neurológicas

Individuals with acquired neurological diseases (such as stroke, head trauma, spinal cord injury, etc.) suddenly see their lives limited by alterations and functional, motor, sensory, and cognitive problems, among others. In addition to these limitations that on their own lead to a disability, there are other affected areas such as family, work, social life and even sexuality.
The motor, sensory, emotional and cognitive disability of patients with neurological disorders interrupts the sexual life of those affected and their respective partners and spouses.
The therapists of the rehabilitation team of the Neurorehabilitation Clinic of Sant Cugat del Vallés (Barcelona) recommend that patients overcome the tabu, shyness, shame and talk about this issue with a doctor, neurologist, psychologist, physiotherapist and even social worker. Different professionals can help in the search of strategies and therapeutic options (pharmacological and non-pharmacological) to face problems related to sexual life (erection, ejaculation, fertility, orgasm, reproduction, etc.).
Neurological patients, whether due to brain or spinal cord disease, may experience different symptoms or alterations that affect sexual activity. For example, the sensitive alteration can affect aspects related to the excitement or pleasure sensation, the motor alteration can affect the aspects related to the erection or ejaculation and even emotional alterations can influence the sexual libido and behavior.
Communication can also be a limiting factor to address the issue. Patients with aphasia (comprehension, expression, mixed, others) may have difficulty expressing their concern about the sexual issue, either with rehabilitation professionals, or at home with their partners. In a similar way it happens at an emotional level. Patients usually see their life changed completely, their body is not the same, they feel useless, unwanted, insecure of their family role and their position as a couple. Thus, we must assume that any type of disability can lead to an interruption and limitation in your sex life.
Nowadays you can find several therapeutic strategies apart from the help and impulse that is received by the professionals (psychologist, occupational therapist, physiotherapist). Some of the best known options are sensory and sensory stimulation, neuroprosthetic implantation, sensitive substitution therapy, transcranial electrostimulation, vibro-stimulation among others.
There are strategies for men and women equalizing the importance of sexual life in both genders, at different ages and for people and couples with different needs.
With this, in the Neurorehabilitation Clinic, we do not forget that a patient is a person with needs and demands in different areas. One of the objectives as a therapeutic team is to help the individual and his family achieve a better quality of life.

OCCUPATIONAL THERAPY AT HOME

Occupational therapy is a socio-sanitary discipline that focuses on the treatment of people who have a deficit in the performance of their daily activities and occupations, from the most basic such as grooming or clothing, to more complex tasks such as money management or the care of the home. Its purpose is to improve the autonomy of the person, and improve the quality of life.

An intervention from occupational therapy at home allows us to transfer to daily life all the objectives that are worked on in physiotherapy, neuropsychology and speech therapy sessions. In each person’s own environment it will be possible to adapt to the individual and personal needs of each one.

At home we analyze the activities that are carried out in order to detect difficulties or abilities and skills. We also analyze the current role that each one develops in their environment. Many times after suffering a brain damage the person changes the roles of home and happens to depend on a third person to perform their daily activities. These roles, instead of adapting to advances in rehabilitation, tend to become chronic and family members adopt the role of caregiver and the patient has a more passive role in the basic activities of cleanliness and self-care and in household chores.

 


For this reason, in the Neurorehabilitation Clinic we believe that it is very important to be able to make a TO intervention to encourage, help and train the different tasks and daily activities, to improve the autonomy and to change the role of the affected person to be more active and participative. Advice and recommendations are given on changes and adaptations that facilitate accessibility and mobility within the home. An example of a TO session at home could be participating in the kitchen. From choosing the dinner looking at what is in the fridge, prepare the food (clean, cut food and cook) all training the use and management of devices that facilitate the realization of the activity (as would be a kitchen table for hemiplegia) . Throughout this process the person works on motor, neuropsychological aspects (such as remembering the steps to be taken, preventing what we need to cook, being alert to unexpected events or organizing time and space), aspects of speech therapy (oral language, reading, comprehension) of language) and emotional aspects. Other examples would be to put and empty the dishwasher or the washing machine and even leave home alone and be able to move around the neighborhood (on foot or in a wheelchair) autonomously and safely.

WHAT DO VIDEOCONSOLES BRING US IN THE FIELD OF NEUROREHABILITATION?

Current video games have developed a technological evolution that allows their use, not only in the field of leisure, but also for therapeutic purposes.

Thanks to the capture of movements by the Kinect system allows users to control and interact with the console without having to have physical contact with a traditional video game controller, through a natural user interface that recognizes gestures, voice commands and objects and images. The video game offers a virtual reality that allows you to create an avatar of the person who introduces you to the game and stimulates it physically, cognitively and sensorially.

In the field of motor rehabilitation, several studies have been carried out that show favorable results in neurological affectations.

The latest-generation video consoles (Nintendo Wii ®, Kinect for Microsoft Xbox ®) allow you to work on balance, gait, functionality and upper-extremity activity and tolerance to effort. These mechanisms allow us to perform objective assessments of equilibrium, postural control, and upper extremity mobility.

The advantages of these systems is that combined with the conventional rehabilitation allows to base the therapy in the principles of motor learning: active participation of the patient physically and cognitively, repetitions of functional movements, to give a feedback visual, auditory and constant proprioceptive of the movements performed and maintain an interest and motivation while performing the tasks.

One drawback of the game consoles is the level of difficulty that often involves the neurological patient, by implementing specific software for cognitive or motor neurorehabilitation. Several examples of these software are: Neuroathome®, Biotrak®, VirtualRehab®, SONRIE®, Neurorehabilitation Training Toolkit® o Rehabcity.

LSVT exercise program for Parkinson treatment

Recently, we have made an interesting discovery for the treatment of patients with Parkinson’s. It is an exercise program called LSVT (Lee Silverman Voice Treatment). Created initially with the aim of improving motor disorders related to speech (LSVT LOUD), recently it has been extended to address the treatment of limbs (LSVT BIG) of patients with Parkinson’s.

The objectives of the therapy are:

  • Increase the range of movement: volume at the level of speech and wider movements at the level of the extremities (arms and legs).
  • Sensory Recalibration: to help patients recognize movements with greater amplitude as normal.
  • Exercises can be performed autonomously and allow attention to action to be trained, which facilitates the long-term maintenance of the treatment results.
  • The intensity in which this therapy is performed drives the mechanisms of neuroplasticity and motor learning.

 

In the following link you can see an example of LSGT BIG exercises.

 

Whether you are therapists or patients, if you are interested in receiving training in LSVT therapy for the treatment of motor symptoms of Parkinson’s do not hesitate to contact the Neurorehabilitation Clinic.

Virtual Reality in Neurorehabilitation

Virtual reality is a technological system that has gained ground in neurological rehabilitation in recent years, although it has begun to develop in the 60s. Virtual Reality is used to artificially create sensory information from an interactive virtual environment being perceived as real and thus favoring exploration, commitment, curiosity and motivation.

In the neurological clinic of physiotherapy in Sant Cugat del Valles, we integrate Virtual Reality systems in neurorehabilitation of patients with stroke, spinal cord injury, multiple sclerosis and other neurological diseases. The objective of their integration is to increase the effectiveness of the treatment according to the scientific evidence, to increase the adherence of the treatment by the users and to provide opportunities and sensations not achieved by conventional methods.

In the field of the rehabilitation of diseases and especially of the deficits caused by the injuries of the nervous system, an important development of different systems and tools is observed. Many of these tools are focused on the treatment of the cognitive system (example: alteration of memory), motor system (example: leg movement) and sensory system (example: neuropathic pain).

An example of the application of Virtual Reality systems in the rehabilitation of patients in this neurological center is in alteration of balance. The alteration of balance can lead to a reduction in the practice of physical and ambulatory activity, limiting participation in activities of daily life and deterioration of the quality of life. With a virtual reality system, the therapist can provide the patient with the right environment for the work of balance without exposing him to risks. In this case activating the visuo-vestibular system involved in the maintenance of balance, gait etc.

There are several published studies that conclude that interventions based on Virtual Reality are effective in the treatment of balance and gait deficit after the Cerebral Vascular Accident or Stroke. However, intervention protocols can not be constructed since the therapist has the fundamental role of assessing and developing the most appropriate therapeutic plan for each patient.

Dos ejercicios que debes realizar si tienes un pie equino

If you have an equine foot due to your neurological injury, here are some tips so you can prevent capsular retractions, joint stiffness and muscle shortening. In the case that you already have them, it will be a matter of spending more time, but following these recommendations you could improve the contact of your foot with the ground and get better mobility for your foot.

As you should know, due to your joint misalignment, when you support the foot while standing or walking, there is a large part of the weight of the body that falls on the tip and the lateral part of the foot. Therefore what you should work is the support of the heel and the internal part of it.

You must do the exercises barefoot to allow the foot contact with a flat surface and control the supports well.

  • First exercise: place the flat foot on the floor and bend the knees keeping the heel in contact with the ground. Direct the knees inward if you notice that you lack support on the inside of the foot.
  • Second exercise: get yourself a wedge with a slight inclination and stand on top. A good idea is to place it in a place in your house where you spend a few minutes a day, in the basin sink, for example. In this way you will ensure you perform the exercise daily.

If you have difficulties to perform these exercises do not hesitate to contact the physiotherapists of the Nerorehabilitación Clinic to make an assessment and we can help you in the realization of them.

Formación profesional

The Neurorehabilitation Clinic of Sant Cugat del Vallés, Barcelona, ​​apart from being specialized in the treatment of patients with neurological diseases, is also a Training Center for Healthcare Professionals.
As a training center for professionals in the area of ​​neurological rehabilitation (physiotherapy, occupational therapy, speech therapy and psychology), the Neurorehabilitation Clinic ensures quality training accredited and controlled by the Commission for Continuing Education of the Health System of the Ministry of Health.
Controlled and well-planned training favors scientific progress in the field of neurorehabilitation, providing not only scientific knowledge but also new technical skills to the professionals in question, be they physiotherapists, occupational therapists, speech therapists or psychologists.
With the training service, courses, seminars and workshops for therapists, the Neurorehabilitation Clinic aims to provide conditions to update the knowledge of professionals, improve the qualifications of the staff of health institutions that receive patients with neurological diseases or pathologies (Stroke, Sclerosis Multiple, Parkinson’s disease, etc.). Apart from taking into account the theoretical knowledge and application of techniques and treatment approaches, the organization of the Neurorehabilitation Clinic seeks to provide professionals with skills for the correct recognition and assessment of patients and the development of clinical reasoning.

The Neurorehabilitation Clinic looks for specialized training and for that it organizes courses of special interest to the rehabilitation professions such as:

  • Training courses in the Bobath Concept for physiotherapists and occupational therapists
  • Scapular motor control course for physiotherapists and occupational therapists
  • Upper limb rehabilitation training course in neurological patients
  • Neuropsychology workshop for physiotherapists, occupational therapists and speech therapists
  • Mirror therapy workshop in the neurological patient
  • Course of postural control and balance in the neurological patient
  • Course of manual therapy for neurological patients addressed to physiotherapists
  • Workshop on the use of accessible technology in neurorehabilitation
  • Among others

If you are active in neurological rehabilitation or have special interest in this area, consult our training programs or contact us.

Rehabilitación de la marcha sobre tapiz rodante

It consists in the accomplishment of the march on a treadmill with the possibility of diminishing the corporal weight with a harness. The march can be assisted manually or robotic. The intense repetition of the cycle of the march is the main sensational impulse to promote motor activity. For someone who has difficulty maintaining the equalizer and therefore performing a steady pace, the tape allows you to maintain a rhythm and speed and thanks to the holders or the suspension system do not worry about the balance. The therapist, while the patient walks, can: Maintain trunk stability and pelvic alignment. Guide the displacement of weight. Control the foot in the support phase and in the oscillation phase. Control the knee during the loading phase. It is very important to practice an activity to improve the execution of the activity. That is why it is important that the march is carried out daily and at different times of the day. In the neurorehabilitation clinic we focus on improving the functional capacity of the walk, working the necessary skills to be able to walk safely and with the best possible quality. And from there practice the march as much as we can and in different situations (interior by land, by treadmill, by outside in different types of terrain …) The treadmill allows us to do a more complete practice of the cycle of the march. We have the opportunity to increase the speed and the resistance and optimize the aerobic capacity. Thanks to the maintenance of a constant activity, the nervous system activates the postural musculature that will help us improve stability, increases the tone of the weakened muscles and reduces that of the muscular spasticity. At the neurophysiological level it is proven that repeating a constant activity on the tape allows the activation of a neuronal group that we have innately in the spinal cord (lumbar region) responsible for activating autonomously the muscles needed to make the movements of the step during the march. These are named Central Power Generators (Central Power Generators) The treadmill can be made with body weight supported or without:

If we analyze the pros and cons of its use we can say that the harness facilitates the load on the affected bed, the straight and aligned position of the trunk, allows us to do an early training of the march, increases the person’s safety at the time. It’s time to start walking, discharge body weight to the legs and allow more time to walk as it reduces fatigue.

On the contrary, the harness can cause a diminution of the work of balance of trunk, and the situation of disastrous suspension that moves away of the march in the daily life.

To conclude, we can say that we believe that it is very important to have a treadmill in neurorehabilitation centers in order to increase the practice of walking, perform aerobic work difficult to achieve in daily life and improve the functional capacity of patients.

 

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