In December 2019 Doddie Weir (Scotland Rugby star) raised awareness of Motor Neurone Disease (MND) as he accepted the Helen Rollason Award at the BBC Sports Personality of the Year show. He gave a fantastic and emotional speech demonstrating how the disease can affect even the fittest of people. He showed how with the right support from those around you, people who are affected by MND can continue to live a fulfilling and fruitful life. What an inspiration!

Our brains and spinal cord contain a huge volume of nerves (motor neurones) which transmit messages down to our muscles to control how they work. In MND the motor neurones are affected, the transmission of the messages from the brain along the spinal cord to activate the muscles to make them move is slowed down and eventually stops.

MND affects any muscle group. This means that the disease can affect muscles which help you walk, talk, eat, drink and breathe. People with MND will find that these functions may be compromised. If the muscles do not receive the nervous transmission through to them to make them activate, the muscles can not move. If muscles do not move, they become weak, underlying joints become stiff, muscle mass wastes and contractures can develop.

MND is a progressive disorder which means symptoms will get worse over time. The disease can be rapid in its progression for some people but slower for others. MND is a life shortening illness, there isn’t a cure for MND but that doesn’t mean there is nothing that can be done to help those who suffer from it. Quite the contrary! People living with MND benefit hugely from the help of health care professionals and voluntary organisations in helping them manage the disease and to support them to continue living with as much independence as possible for as long as possible.

Most cases of MND affect people between the ages of 50-70 but the disease is not exclusive to this age group, younger adults are also diagnosed. The disease is rare, and men are affected almost twice as often as women. There are 4 different types of MND, each type affects people in different ways;

· ALS – Amyotrophic Lateral Sclerosis is the most common form. In the early stages people with the disease may notice they trip or drop things. The disease causes weakness and wasting in muscles affecting the limbs resulting in muscle stiffness and cramps.

· PBP – Progressive Bulbar Palsy affects the muscles in the face, throat and tongue. Speech may be slurred and there may be some difficulty swallowing.

· PMA – Progressive Muscular Atrophy affects fewer people than ALS. It is usually slower to get worse and people with this form of the disease may notice weakness and clumsiness in the hands.

· PLS – Primary Lateral Sclerosis causes weakness in the lower limbs although there may also be clumsiness of the hands and slurred speech. This form of the disease also affects fewer people than ALS and is slower to get worse.

MND is difficult to diagnose. There is no direct test for it. Diagnosis can be a challenge and take a long time to be conclusive. Diagnosis is made by a neurologist and is based on understanding the symptoms a person may be having and through expert exclusion of other neurological conditions which may present similarly.

There is a huge amount of research being carried out into what causes MND, the medical world is hopeful that there will be a cure one day. It is still not possible to be clear about what causes MND. In most cases there is no history of the disease within a family and it is thought that a mix of genetic and

environmental factors may be involved. Environmental triggers could be a mixture of things that you eat, breathe, touch or drink. Research is rapidly working towards understanding these triggers

MND can cause a range of symptoms including;

· weakness or loss of movement in the limbs (muscles in the hands, feet or mouth are usually affected first),

· muscle tightness and cramping which causes pain,

· difficulties with speech, swallowing and saliva management

· problems with breathing and extreme tiredness

· twitching and rippling sensations under the skin

Dependent on the symptoms and progression of the disease there are some medications which may help, a specialist neurologist can guide use of these.

A physiotherapist with expertise in neurological conditions can provide a valuable support mechanism for people with the disease. Regular physiotherapy assessment helps to ensure treatment and intervention is reviewed and adapted according to the changing needs of the presentation. Physiotherapy will not reverse the damage to muscles weakened by MND, but it can help to reduce the discomfort that stiff muscles bring, improve flexibility and reduce secondary complications from developing. Physiotherapy can introduce aids and adaptations which may help facilitate independence with activities of daily living (walking / showering / bathing / dressing /cooking/ getting in and out of bed / getting up and down stairs etc).

We at Silver Physio will take our time to find out from you what your goals might be. You can give us some guidance on what matters most to you in life and we can use our specialist skills to assess your current function and support you though your MND journey. No matter what stage you are at with your diagnosis our specialist staff can help you troubleshoot and positively tackle whatever this disease throws at you!