Movement disorders

How does movement work?

Even a simple action such as picking up a pencil engages several different parts of the brain. The conscious thought areas of the brain trigger the motor area to send signals to the muscles of the arm.
As the movement begins, sensors in the arm are activated, sending signals back into different areas of the brain that interpret them and then send further messages to the motor area to fine tune power, speed, coordination and balance.

Who's affected?

Given such complexity, problems with the control of movement are understandably widespread. Essential tremor - the most common movement disorder - affects one in 20 people under the age of 40 and one in five people over 65. Up to one in ten people has restless legs syndrome.
Other conditions such as Parkinson's disease (which affects one in 500 people) are less common, but can severely impair quality of life because they reduce the independence of those affected.

Dyskinesia

Dyskinesia simply means abnormal ('dys') movement ('kinesia'). Tics, spasm, athetosis (slow, writhing motions), chorea (rapid, randomly irregular jerky movements) and dystonia are all different types of dyskinesia.
The term 'paroxysmal' is also often used, to indicate the abnormal movements are sudden and unpredictable, with a fairly rapid return to normal.
Dyskinesia is often used to describe the movement difficulties of Parkinson's disease and similar disorders. They're also a common side-effect of certain drugs, such as L-dopa and antipsychotic medication.

Dystonia

In dystonia there are sustained or persistent contractions of one or more muscles. This leads to abnormal postures or writhing, twisting movements of part of the body. There are many different types, with various muscles involved. Writer's cramp is an example of focal dystonia (limited to one group of muscles), causing bizarre postures in one arm when writing or typing and disappearing at rest.
Blepharospas is a focal dystonia involving muscles that control closure of the eyelids. This leads to increased blinking and involuntary closing of the eyes.
Dystonias tend to be aggravated by tiredness, stress, anxiety and emotion.

Tics

Tics are involuntary rapid and repeated contractions of a group of muscles. This may cause movement, such as blinking, shrugging or grimacing, or the production of a sound.

Tremor

A tremor is an involuntary, rhythmic oscillation of a body part due to contractions of opposing muscles. There may be many causes. Everybody has a physiological tremor - that is, a very faint tremor in response to signals from the part of the brain called the cerebellum. Certain factors, such as exercise, emotional stress, or an overactive thyroid gland, can make this 'normal' tremor more prominent.
Essential tremor is as common as angina or stroke. It usually causes a tremor of the hands and feet, but the head and voice may also be affected. Very little is known about what goes on in the brain to cause essential tremor. It's often dismissed as insignificant, especially in elderly people, or misdiagnosed as Parkinson's disease.
But although it isn't fatal, it can cause severe disability. Essential tremor can be treated with drugs, including beta-blockers, or brain surgery in severe cases.

Dysphonia

Spasmodic dysphonia is a disorder of the voice caused by abnormal contraction of the muscles controlling the vocal cords. This results in a quivery, jerky or strained voice. There may be times when no sound can be made at all, while at other times the voice is fairly normal.

Ataxia

Ataxia is unsteady or poorly controlled movement due to problems with the control of coordination and balance. There are many different types. Ataxia may be a symptom of conditions such as multiple sclerosis or cerebral palsy, or it may be due to diseases of the cerebellum (a part of the brain). One simple and familiar cause of ataxia is alcohol consumption

Restless legs syndrome

Restless legs syndrome is an intensely uncomfortable sensation in the legs (and sometimes arms), which typically occurs with inactivity, especially around bedtime. The sensation, which has been described as tingling, creeping or 'bugs tunneling', is temporarily relieved by moving the limbs.
Other problems include disrupted sleep, insomnia and daytime fatigue. In most cases the cause isn't clear although it may be related to other conditions such as iron deficiency.
Relaxing bedtime routines can help, as can avoiding caffeine, nicotine and alcohol. The condition may be related to a disruption of brain chemical transmitters and medicines, for example those that increase the transmitter dopamine (such as those used to treat Parkinson's disease), can be effective in treating the syndrome.
There are many other movement disorders, including myoclonus, Huntington's disease, gait disorders, spasticity and progressive supranuclear palsy (PSP).
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Change in taste in older people

What is change in taste?

It’s caused by a variety of factors and like most of our senses, the sense of taste tends to decline with age as the taste buds degenerate. This means problems that would cause a bit of a loss of taste in younger people can wipe out what little remains in an older person.
This loss (or distortion) of taste and smell can then take away someone's appetite so that they're less interested in eating. Older people often tend to have a poorer appetite anyway (many exist on tea, toast, biscuits and other snacks) and so quickly lose weight.
Certain illnesses can also cause a change in taste.

Causes and risk factors

Very often, what a person actually loses is their sense of smell - and this is what causes a change in taste (as smell is a major contributor to the sense of taste). Smell is disrupted by conditions that affect the lining of the nose, such as the common cold or chronic rhinitis. More rarely, it's affected by nerve problems, ranging from damage to nerves in the nose, to damage to areas of the brain controlling smell (such as the result of a stroke).
Perhaps the most common cause of taste problems, especially in older people, is problems in the mouth (related to teeth or saliva).
Any condition that results in a dry mouth can cause problems because saliva is essential for taste. Chemicals in food or drink dissolve in saliva and this bathes the taste buds. In a dry mouth, the chemicals never reach the taste buds.
Anything that causes inflammation in the mouth can damage the taste buds. Ill-fitting dentures or teeth and gums full of decay are some of the major culprits. Smoking can also destroy taste.
Rarer causes of taste problems include:

• Damage to the nerves between face and brain
• Stroke
• Brain tumours
• Tumours elsewhere in the body
• Liver disease
• Extreme vitamin deficiencies
• Some medicines and drugs that can cause changes in taste
• Depression and other psychological problems that can alter taste
• Heavy metal poisoning (though this is extremely rare these days

Treatment and recovery

An older person with taste problems should see a doctor to rule out any medical causes, and a dentist to check the mouth and gums. 
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Back curves

How does the spine work?

The spine is the central pillar of the body. It supports the weight of the head and trunk, and provides a protective passage for nerves.
The spine is made up of 33 irregularly shaped bones, or vertebrae. Each vertebra has a hole in the middle through which the spinal cord runs. In between these vertebrae are discs filled with soft material, which act as shock absorbers.
Seen from behind, a normal spine is straight and stretches vertically from the head down to roughly the top of the cleft between the buttocks.
From the side, the spine has two curves: one at the top of the back bending outwards and one in the small of the lower back curving inwards.

What causes excessive curvature?

Excessive curvature of the upper spine is called kyphosis. Typically, the back appears hunched and more rounded than usual.
Poor posture may contribute to its development over the years, but diseases affecting the spine - such as osteoarthritis or osteoporosis - are responsible. Children can have kyphosis, but the cause is usually unknown.
Excessive inward curving of the lower back is called lordosis. Being overweight is a common cause. Having a large belly leads to imbalance. To compensate for this - and to prevent toppling forwards - a person will lean backwards.
Weak abdominal muscles or poor posture may also be partly responsible. Having kyphosis may even contribute to lordosis developing.
When the spine curves to the side it is called scoliosis. This occurs most often in the upper chest area or lower back and often there's no obvious cause.
It's more common for women to develop scoliosis and it can run in families. Some babies are born with congenital scoliosis. Rarely, diseases causing muscle weakness around the spine may be responsible, such as muscular dystrophy.
If the legs aren't the same length, this will cause the spine to curve.

What are the symptoms?

Kyphosis and lordosis can cause muscular strain and muscle aches.
Scoliosis, if not obvious from birth, tends to develop during childhood and teenage years, and gradually becomes more visible. Bending forwards makes it more obvious. A person with scoliosis may have an abnormal gait, which contributes to back pain that may be experienced intermittently.
It's important not to ignore the emotional effects of scoliosis, particularly because it tends to appear at puberty when many other body changes are also taking place.

What's the treatment?

In kyphosis and lordosis, physiotherapy can help to strengthen the supporting muscles of the spine and correct poor posture. Where there's an underlying cause, such as osteoporosis, this needs to be treated.
Maintaining an ideal weight is also advisable to avoid further problems.
Treatment of scoliosis also involves physiotherapy to strengthen the supporting muscles of the spine and where a cause is known this must be corrected. Wearing appropriately raised shoes to make the legs of equal length, for example, can help.
When scoliosis is severe or getting worse quickly, it may be necessary for a spinal brace to be worn to prevent further curvature, or to have spinal surgery.
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The common cold

What causes them?

There are more than 200 different viruses that cause colds and this is one of the reasons we get so many.
Top of the list are rhinoviruses, but coronaviruses, adenoviruses and respiratory syncytial virus (RSV) can all cause colds, too. So, just as your body develops immunity to one type of virus, another that you haven’t encountered before comes along and makes you ill.

How are colds spread?

You may have been taught that 'coughs and sneezes spread diseases', but colds aren't always passed on through airborne droplets or particles.
The most important way they're spread is via direct contact with an infected person. Typically, the person with the cold touches their nose or coughs on to their hand, leaving thousands of microscopic virus particles on their skin.
When they then touch an object such as a door handle, shopping trolley or another human, they leave the virus behind. The next person to touch the object takes the virus with them.
All that's needed to trigger a cold is a dozen or so virus particles. If the person who has picked up the cold virus touches their own nose or eyes, they deposit it in a warm, moist environment where it can thrive.
The virus particles are swept to the adenoids at the back of the throat, where they stick to the cells, invade them and reproduce. Eventually, the cells rupture, releasing thousands of new virus particles to spread to other cells.
This process is remarkably rapid – it takes just eight to 12 hours from the arrival of the virus in your body to release of new virus particles.
Symptoms also develop quickly – within about ten hours (this is known as the incubation period). So, in less than half a day of shaking hands with a person with a cold, you too could have all the unpleasant symptoms.

What are the symptoms?

Symptoms are mostly caused by the body's reaction to the cold virus, which triggers the release of chemicals that make the blood vessels leaky and send the mucous glands into overtime.
As a result, the nasal passages become swollen and choked with secretions.
Cold symptoms reach their peak after 36 to 72 hours and include:

• Dry, scratchy sore throat (usually the first sign of a cold).
• Runny nose and sneezing.
• Hoarse voice.
• Blocked, snuffly nose.
• Cough.
• Mild headache.
• Mild fever.
• Generally feeling unwell or muzzy headed.

Symptoms should start to improve after three days and be gone after about seven days (but they may persist for up to two weeks).
As many as one in four people with a cold doesn't develop any symptoms, possibly because their immune system doesn't react to the virus in the usual way.
It's easy to confuse a cold with early flu, but in general flu is more severe and produces a higher fever (above 38oC) and more generalised symptoms throughout the body such as aching muscles, lethargy, shivers, nausea and vomiting.

What's the treatment?

Despite decades of research, there's no simple cure for colds. The antibiotics used against bacterial infections don't have any effect on viruses, and antiviral drugs used for other viral infections aren't useful against the viruses that cause colds.
Most colds resolve rapidly on their own, but there are things you can do to make symptoms less unpleasant.

• Keep well hydrated - being dehydrated can make a cold feel much worse, so drink at least eight glasses of clear fluid a day.
• Use a humidifier to stop central heating from drying out the mucous membranes lining your nose and upper airways.
• Treat nasal congestion using vapour rubs or taking decongestant drugs.
• Take simple analgesia such as paracetamol or ibuprofen regularly to keep on top of pain and fever.
• Cough mixtures may help to suppress a dry, tickly cough, while some, known as 'expectorants' help you to cough up excessive mucus.
• Try anaesthetic throat lozenges or gargle with salt water for a sore throat.
• Anti-histamines such as cetirizine may reduce the runny nose and sneezing but won't improve the cold overall.
• Get plenty of rest, and eat regularly to keep energy levels from flagging.

The benefits of vitamin C supplements for both the prevention and treatment of colds remains controversial.
A recent review of more than 30 studies showed that during periods of intense stress people can half their risk of catching a cold by taking vitamin C. But there's only a very minor effect on the duration and severity of symptoms once someone has the infection.
Some people argue that much higher doses of vitamin C need to be taken.
Many other treatments have been tested. Some, such as the herbal treatment echinacea, may be useful, but there isn't enough evidence yet to recommend these therapies. Inhaling steam has been used traditionally, often with menthol, but whilst anecdotally it helps some people, there is insufficient scientific evidence to assess its value.
Zinc has been shown to reduce the duration and severity of cold symptoms in healthy people if taken within 24 hours of the onset of symptoms. In one study, Zinc supplements taken for at least five months were found to reduce the incidence of colds. However there is no standard recommendation about dose, formulation and duration of use.

What are the complications?

If symptoms persist for over 2 weeks, or if you are increasingly unwell, or develop breathing problems, see your doctor. Serious secondary infections, such as pneumonia, can follow, especially if you actually have flu rather than a cold. Although a cold can cause simple viral congestion of the nasal passages and symptoms of sinusitis, around one in 200 colds is complicated by a bacterial infection of the paranasal sinuses, which may need antibiotic or other treatment.
Among children, colds often lead to bacterial infections of the middle ear but this is much less common in adults.
Colds can also aggravate asthma and chronic bronchitis and in patients with these conditions the cold symptoms may last longer.

Keeping your cold to yourself

You're most contagious during the first three days of a cold, when you shed huge amounts of the virus from your nose.

• Avoid contact with other people.
• Wash your hands frequently.
• Avoid touching your nose and eyes.
• Use disposable tissues and bin used ones promptly.                                                       READMORE:http://www.bbc.co.uk/health