1. Epilepsy ⚡🧠
Epilepsy ⚡ is a condition marked by recurrent 🔄, sudden ⚡ seizures that result from electrical disturbances 🧠 of the cerebral cortex. Although the seizures epileptics experience can vary greatly 🔄, the two most common types 2️⃣ are the:
Grand Mal (Tonic-Clonic) Attack ⚡😱
Grand mal ⚡ (or "tonic-clonic") attack, which is the most severe form 😱 and entails two phases 2️⃣. It begins with a very brief "tonic ⚡" phase, in which the person loses consciousness 😵 and body is rigid 🥶. It then progresses to a longer "clonic 💪" phase that lasts 2 or 3 minutes ⏱️ and includes muscle spasms 💪 and twitching 😵. The body 🧍♂️ may then relax 😌 until the person awakens 👁️ soon. Sometimes before a grand mal attack ⚡, epileptics experience an aura which consists of unexplained sounds 🔊, smells 👃, or other sensations 🤔.
Petit Mal (Absence) Attack 😶🌫️
Petit mal 😶 (or "absence") attack, which involves diminished consciousness 🌫️, and in which the person stares blankly 😶 for a short while ⏱️, perhaps only a few seconds ⏰, and may show slight facial twitching 😐. When the episode ends 🔚, the person simply resumes whatever he or she was doing 🔄, sometimes not even being aware 🤷 that the event happened. Petit mal attacks 😶 occur mainly in childhood 👶 and usually disappear ✅ by adulthood 🧑.
Prevalence of Epilepsy 📊
Estimates of the prevalence 📊 of epilepsy vary somewhat 🔄, but it afflicts about 1% 📊 of people worldwide 🌍. There are probably over 2 million cases 📈 of epilepsy in the United States 🇺🇸, perhaps half 📊 of which are undiagnosed 🚫 and untreated ❌. Over 100,000 new cases 📈 are diagnosed each year 📅. Although the condition can develop at any age 👶👴, the great majority of epileptics experience their first seizures ⚡ by 20 years of age 2️⃣0️⃣.
What Causes Epilepsy? 🔍❓
Sometimes physicians 👨⚕️ find a specific neurological defect 🧠 that is the cause of an epileptic's disorder ⚡, but usually the reasons are unknown ❓. Risk factors ⚠️ for developing epilepsy ⚡ include a strong family history 👨👩👧👦 of the condition, severe head injury 🤕, infections of the central nervous system 🦠🧠, and stroke 🧠.
Medical Regimens for Epilepsy 💊⚡
Anticonvulsant drugs 💊 provide the main medical treatment 🏥 for epilepsy ⚡. These medications 💊 must be taken regularly ⏰ to maintain the most effective serum concentrations 🧪 throughout the day 📅 and can have undesirable side effects ⚠️, such as facial hair 🧔 in women ♀️, and blurred vision 👁️🌫️ and nausea 🤢 if the dose is too high 📈. A promising new treatment 💡 involves using an implanted device 🔧 that delivers stimulation ⚡ to the Vagal nerve 🧠.
Epileptics ⚡ whose seizures result from clear neurological defects 🧠 may have the option of surgical treatment 🔪 if they have frequent 🔄, severe attacks 😱 and other treatments 💊 do not work ❌ or cause problematic side effects ⚠️. Neuro-psychologists 👨🔬 conduct tests 🧪 to pinpoint 🎯 the affected area 📍 of the brain 🧠 and minimize cognitive 🧠 and motor impairments 💪 the surgery 🔪 might produce. After surgery 🏥, as many as 80% 📊 of patients become seizure-free ✅ in the next few years 📅. But undergoing surgery 🔪 without becoming seizure-free ❌ may lead to subsequent psychosocial difficulties 😔, such as heightened anxiety 😰 and depression 😢.
Psychosocial Factors in Epilepsy 🧠👥
Because individuals who are having epileptic episodes ⚡ lose control 🎮❌ of their behavior 🧍♂️ and "act strange 🤪," their condition stigmatizes 🚫 them among people who do not understand it 🤔. Long ago ⏮️, many people believed 💭 that individuals with this condition were possessed by the devil 👿. Although few people in advanced societies 🌍 today shun victims of epilepsy ⚡, witnessing an attack 👀 may still arouse feelings of fear 😨 and aversion 🤢.
Aside from the reactions 😨 their attacks ⚡ produce in people 👥, what other problems do epileptics face 🤔 as a result of their illness 🏥? Having strong seizures ⚡, especially with a loss of consciousness 😵, is sometimes associated with important cognitive 🧠 and motor impairments 💪 that can limit eligibility ❌ for certain activities 🎯 and jobs 💼: such as those that involve high work loads 📊 or danger ⚠️ from heights 🏔️ or machinery ⚙️.
Epilepsy ⚡ seems to be related to psychosocial processes 🧠 in two ways 2️⃣. First 1️⃣, some evidence suggests that emotional arousal 😰, such as of anxiety 😟, may increase 📈 the likelihood or severity 😱 of epileptic episodes ⚡. Second 2️⃣, epileptics ⚡ and their families 👨👩👧👦 sometimes adjust poorly 📉 to the disorder, especially if episodes are frequent 🔄 and severe 😱. Emotional difficulties 😔, such as with anxiety 😰 or depression 😢, often lead clients to drop out 🚪 of rehabilitation programs 🏥. Many of the adjustment problems 😔 that epileptics ⚡ face can be reduced 📉 through counseling 🗣️ when the diagnosis 📋 is made and through the work of support groups 👥.
What to Do for a Seizure 🆘⚡
People react negatively ❌ to seeing a grand mal attack ⚡ for many reasons, one of which may be that they don't know what to do 🤷 to help. Actually, there is little one can do ✋ other than to remain calm 🧘 and try to protect the epileptic 🛡️ from injury 🤕 as he or she falls 🤾 or flails about 💪 during the tonic or clonic phases ⚡. If you witness a seizure 👁️, the following six actions 6️⃣ are recommended:
- Prevent injury 🛡️ from falls 🤾 or flailing 💪. Break the fall if possible ✅ and provide a cushion 🛏️, such as a coat 🧥, between the person's head 🧠 and the ground 🌍.
- Do not put anything in the person's mouth 🚫👄. Many people believe 💭 they must put a spoon 🥄 or other object 🔧 in the mouth 👄 to prevent the epileptic ⚡ from swallowing his or her tongue 👅, which actually cannot happen ❌.
- Loosen tight clothing 👕 around the neck. Turn the person on his or her side 🔄 so that saliva 💦 does not obstruct breathing 😮💨.
- Do not restrain the person 🚫✋. If you believe the epileptic ⚡ could be injured 🤕 while flailing near a hard object 🪨, try to move the object 📦.
- If the person does not come out of the attack ⚡ in about 5 minutes 5️⃣⏱️, call an ambulance 🚑.
- After the person wakes up 👁️, describe what happened 📝 and see if he or she needs help 🤝 when ready to leave 🚪.
Epileptics ⚡ are often disoriented 😵 after an attack. For the most part, the role of the bystander 🧍♂️ requires calm 🧘 and composed caring 💝 and common sense 🧠.
2. Nervous System Injuries 🧠🤕
Many thousands of people 👥 in the United States 🇺🇸 and many more all around the world 🌍 suffer injuries 🤕 to the brain 🧠 or spinal cord 🦴 each year 📅, leaving them debilitated ♿ for life 🌍. Neuro-psychologists 👨🔬 and health psychologists 🧠 play important roles 🎯 in assessing these patients' impairments ♿ and helping them adapt 🔄 to their conditions. In this section, we will focus on the impact 💥 of having a spinal cord injury 🦴.
Prior to the 1940s 📅, medical practitioners 👨⚕️ knew almost nothing ❌ about treating people who suffered a severe injury 🤕 to the spinal cord 🦴. In World War I ⚔️, 80% 📊 of the soldiers 🪖 who received such injuries 🤕 died 💀 within 2 weeks 📅. People who survived severe spinal cord injuries 🦴 had a poor prognosis 📉 for their future health 🏥, which was characterized by major health complications ⚠️ and a short life span ⏰. As a result, patients 🤒 and practitioners 👨⚕️ had a defeatist attitude 😔, and little attempt ❌ was made toward rehabilitation 🏥.
But in World War II ⚔️, England 🏴 established special medical units 🏥 to develop and provide comprehensive care 💝 and rehabilitation 💪 for people with spinal cord injuries 🦴. These medical units 🏥 served as a model 🎯 for others to be developed in countries 🌍 around the world 🌎.
The Prevalence, Causes and Physical Effects of Spinal Cord Injuries 🦴📊
The term spinal cord injury 🦴 refers to neurological damage 🧠 in the spine 🦴 that results in the loss of motor control 🎮, sensation 👐, and reflexes 💪 in associated body areas 🧍♂️. The damage may be caused by disease 🦠 or by an injury 🤕 that compresses 🗜️, tears 😢, or severs ✂️ the cord 🦴. When the cord is badly torn 😭 or severed ✂️, the damage is permanent ♾️ because little or no nerve tissue 🧠 will regenerate 🔄; but if the cord is compressed 🗜️ or has an abrasion 🩹, some function 💪 may be recovered when the pressure is removed 📉 or healing occurs ✅.
The degree to which the person's function 💪 is impaired depends on the amount of damage 📊 and its location 📍. If the cord is completely severed ✂️ in the neck region 🦴, quadriplegia ♿ results. Actor, Christopher Reeve's 🦸 (Superman) horse-riding accident 🐴 left him quadriplegic ♿. If a lower portion 🦴 is severed ✂️, paraplegia ♿ results. If the cord is not completely severed ❌✂️, partial function 💪 remains.
Millions of people 👥 around the world 🌍 are living with spinal cord injuries 🦴; in the United States 🇺🇸, there are more than 250,000 people 📊 with this affliction ♿, and about 8,000 new cases 📈 occur each year 📅. About half 📊 of these people suffer neck injuries 🦴 and are quadriplegics ♿. The great majority of Americans 🇺🇸 who receive spinal cord injuries 🦴 are males ♂️, and most of them are between 10 and 30 years of age 1️⃣0️⃣-3️⃣0️⃣ at the time ⏰. The most common cause ⚠️ is automobile 🚗 and motorcycle 🏍️ accidents 💥, and the remainder result mainly from falls 🤾, sporting activities 🏈, and wounds 🩸, such as from a gunshot 🔫 or stabbing 🔪.
Physical Effects of Spinal Cord Injuries 🦴💥
The physical effects 💥 patients experience after spinal cord injuries 🦴 change over time ⏰ and progress through two stages 2️⃣:
1. Short-term Effects ⏱️
The immediate physiological reaction 🧬 is called "spinal shock 😱," which usually lasts between a few days 📅 and 3 months ⏰. In spinal shock 😱, neural function 🧠 is devastated 💥 either by the cord being severed ✂️ or by inflammation 🔴 at the site of lesser damage 🤕. The result is that the body 🧍♂️ cannot regulate blood pressure 💓, temperature 🌡️, respiration 😮💨, and bladder 💧 and bowel function 💩. Medical personnel 👨⚕️ must intervene 🏥 to control these functions 🎮. Usually, the shorter ⏱️ the period of spinal shock 😱, the better ✅ the prognosis 📊 of recovery 💪.
2. Long-term Effects ⏳
The full extent 📊 of spinal cord damage 🦴 may not be clear ❓ for some time ⏰, and long-term predictions 🔮 are difficult 😔 to make during the first 6 months 📅 or so. If the cord is not severed ❌✂️, considerable functional recovery 💪 may occur over a long period of time ⏳. If the cord is severed ✂️, some autonomic functions 🧬 will recover ✅, but other functions ❌ will not. People who survive severe damage 😱 to the higher regions 🦴 of the cord are typically fully paralyzed ♿ and unable ❌ to breathe 😮💨 without a respirator 🫁.
The initial care 🏥 these patients receive typically focuses on their medical needs 💊, with little or no attention ❌ to their psychological reactions 🧠. They receive very little information 📚❌ about their prognosis 🔮 because it is so hard 😔 to predict, and medical staff 👨⚕️ want to avoid the depression 😢 their speculations 💭 might produce. Once the condition of these individuals has stabilized ✅, the process of rehabilitation 💪 begins. Almost all spinal cord injury patients 🦴 enter rehabilitation 🏥 expecting to regain total function 💪 and are not prepared ❌ to cope with the reality of permanent functional losses ♾️❌. A major goal 🎯 for psychologists 👨🔬 at this time ⏰ is to help these people adjust 🔄 to the demands and limitations ⚠️ of the rehabilitation process 💪.
Physical Rehabilitation 💪🏥
The process of physical rehabilitation 💪 for people with spinal cord injuries 🦴 is geared toward helping them (1) regain as much physical function 💪 as the neurological damage 🧠 will allow ✅ and (2) become as independent 🦅 in their functioning as possible 💪. This process focuses initially on training 🎓 the patients to develop bladder 💧 and bowel control 💩 and on assisting them in moving 🏃♂️ paralyzed limbs 🦾 to maintain their range of motion 🔄.
Hygienic bladder care 💧 is extremely important ⚠️ because a common cause of death 💀 in these patients after the spinal shock period 😱 is kidney failure 🫘 from repeated infections 🦠.
The next phase 2️⃣ of rehabilitation 🏥 extends the focus of physical therapy 💪 toward maintaining and improving the function 📈 of muscles 💪 over which the person has some control 🎮. For example, quadriplegics ♿ receive special attention 👀 toward improving respiration 😮💨; paraplegics ♿ do exercises 🏋️ to strengthen the upper body 💪. When some neural connection 🧠 to affected parts of the body 🧍♂️ remains, therapy with biofeedback 📊 to 're-educate 🎓' the muscles 💪 in those areas appears to help some ✅, but not all ❌, patients.
The last phase 3️⃣ of physical rehabilitation 💪 extends the therapy as much as possible 📈 to include activities of daily living 📅. Those patients who have regained sufficient function 💪 learn how to perform self-care activities 🧹 independently 🦅 and to use devices 🔧 to compensate for permanent physical losses ♿. Some devices today 📅 are highly sophisticated 🤖 and use computers 💻, allowing paralyzed individuals ♿ to turn on lights 💡, answer the telephone ☎️, and operate computer keyboards ⌨️ with voice commands 🗣️.
Psychosocial Aspects of Spinal Cord Injury 🧠🦴
The victims' main challenges 🎯 after spinal cord injury 🦴 are to make the most 🏆 of their remaining abilities 💪 and lead as full a life 🌍 as possible. What can health care workers 👨⚕️, family 👨👩👧👦, and friends 👥 do to help 🤝? Psycho-physiologists 👨🔬 John Adams and Erich Lindemann described and contrasted case studies 📋 of two young men 👨, 17 and 18 years of age 1️⃣7️⃣-1️⃣8️⃣, who had suffered spinal cord injuries 🦴 that rendered them quadriplegic ♿. One adapted successfully ✅, and the other did not ❌.
The patient who adapted well ✅ was able to accept the injury 🦴 and abandon the part of his self-concept 🪞 that was associated with his being a fine athlete 🏃♂️. He then turned his energies ⚡ toward academic pursuits 📚 and eventually became a history teacher 👨🏫. He also coached 💪 a local basketball team 🏀 from his wheelchair ♿.
The other patient provides a striking contrast 📉. He was never able to accept the injury 🦴❌ or the permanence ♾️ of his condition. He became extremely withdrawn 🚪 and depressed 😢—at one point he was spending much time ⏰ in bed 🛌 with the curtains drawn 🪟❌ and frequently with the sheet 🛏️ over his head 🧠. A few years later 📅, he was re-admitted to the hospital 🏥 after taking an overdose 💊📈 of medication. At last contact 📞, he was living at home 🏡, still clinging to the hope 🌟 that he would walk 🚶♂️ again.
Why did these young men 👨 adapt so differently 🔄 to their similar physical conditions 🦴? Adams and Lindemann noted the strikingly different ways 🔄 these patients' families 👨👩👧👦 and friends 👥 responded to their condition. In the case of the patient who adapted well ✅ to his condition, his parents 👨👩👦 and friends 👥 also accepted his paralysis ♿ and provided an environment 🏡 in which he could redefine 🔄 his self-concept 🪞. For instance, his parents 👨👩👦 installed ramps 🛤️ in their home 🏠 and widened doorways 🚪 to accommodate a wheelchair ♿. The other patient's family 👨👩👧👦 and friends 👥 were not able to accept his condition ❌ or provide the support 🤝 he needed to help him adapt 🔄.
Family 👨👩👧👦 and friends 👥 can also help 🤝 by providing social support 💝 without being overprotective 🛡️📈 and 'taking over 🎮' when the patient has difficulty 😔 performing self-help tasks 🧹. Having a disabled individual ♿ in the household 🏡 increases the stress 😰 of all family members 👨👩👧👦. They need to make many adjustments 🔄 in daily living 📅 and, while doing so, try not to make the person feel like a burden 🎒. If the patient is a husband 👨 or wife 👩, his or her spouse 💑 faces very difficult adjustments 😔. Role changes 🔄 occur immediately ⚡—at least for a while ⏱️, and perhaps permanently ♾️.
The healthy spouse 💪👫, with or without the help of other family members 👨👩👧👦, must suddenly take on full responsibility 📋 for providing the family's income 💰, maintaining the household 🏡, caring for the children 👶, and caring for the disabled person ♿. Sexual problems 😔💑 brought on by the patient's injury 🦴 may become a major source of stress 😰 in the marital relationship 💑.
Disabled people ♿ also experience many unpleasant thoughts 💭 about themselves, their future 🔮, their relations with other people 👥 in general, and physical barriers 🚧 in society 🌍. They find that many places 📍 they once liked to go to 🏛️ are inaccessible by wheelchair ♿❌, for example. Furthermore, people 👥 in general act strangely 🤪 toward them—staring 👀, or quickly averting their eyes 👁️🙈, or behaving awkwardly 😬 or uncomfortably 😣 in their presence. These experiences tend to reduce the self-esteem 📉 of disabled people ♿ many of whom have heightened levels 📈 of depression 😢 and drug 💊 and alcohol use 🍺. Adapting to becoming disabled ♿ takes time ⏰, and a couple of years 📅 may pass before many individuals with spinal cord injuries 🦴 report improvements 📈 in their adjustment 🔄 and quality of life ✨.
Summary 📋
This lesson explored the impact 💥 of different chronic conditions 🏥, focusing on epilepsy ⚡ and spinal cord injuries 🦴. We examined the medical 💊, physical 💪, and psychosocial aspects 🧠 of these conditions, including treatment approaches 🏥, rehabilitation strategies 💪, and the critical role 🎯 of family 👨👩👧👦 and social support 🤝 in helping patients adapt 🔄 to their conditions.