Basics of neurological disorders for primary care physicians

Basics of neurological disorders for primary care physicians

Neurological disorders include structural, biochemical, or electrical abnormalities in the brain, spinal chord, or the nerves leading to or from them, resulting in a wide range of debilitating symptoms. Neurologic disability is on the rise and may be considered a “hidden” epidemic for India, soon to join the burden of infectious and chronic diseases. Neurologic disability is mainly a result of several trends: an increase in traumatic brain injuries (TBI) from road traffic incidents (RTI), an increase in age-related chronic diseases such as dementia and stroke, and a continuing presence of neuroinfections.

Key Point: Neurologic disability patients often need rehabilitation in walking, balance, coordination, pain management, speech, and cognitive skills. Primary care providers will be the most important treatment resource to many patients who cannot afford the costs of rehabilitation institutions.

The social stigma associated with disability in India makes seeking proper treatment more difficult for the disabled. People who suffer from neurologic disability may experience symptoms such as paralysis, muscle weakness, spasticity, pain, speech impairment, difficulty walking or standing, and psychosocial issues, including depression, cognitive decline, and social isolation. Inadequate treatment and long-term care of the neurologically disabled will strain the healthcare system, strain the economy, and lower the quality of life for many.

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“…while the overall life expectancy in India is increasing, the overall quality of life will be diminished by the increasing prevalence and duration of neurologic disability.”
-Das A, Botticello AL, Wylie GR, Radhakrishnan K. Neurologic Disability: A Hidden Epidemic for India. Neurology Nov 20, 2012; 79:2146-2147. 

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Primary care physicians (PCPs) are not usually trained to manage neurologic disabilities, however it is important for primary care physicians to prevent events that may lead to disability, identify neurologic disability in its early stages, provide basic rehabilitation when possible, and refer to a more specialized rehabilitation institution when the disability is severe. To the many patients who cannot afford the costs of rehabilitation institutions, their PCP will be their most important treatment resource.

Not all neurological disorder patients have access to rehabilitation. A recent cross-sectional study investigating disability in rural areas of Uttar Pradesh observed that the main barriers for neurological rehabilitation were first financial problems followed by lack of awareness, family negligence, and transportation problems.

Common Neurological Disorders in India

Common neurological disorders in India include traumatic brain injury (TBI), stroke, dementia (considered a disease and not a normal part of ageing), neuroinfections, and cerebral palsy. Many of these disorders may be prevented with early and proper treatment.

·         Reduce risk of stroke with lifestyle or pharmacotherapy interventions.

·         Prevent infections that can cause disability by administering vaccines, such as for polio, meningitis, tetanus, etc.

·         Educate parents on preventing injuries to the brain in infants.

·         Minimize incidence of TBI from road traffic accidents by reminding patients to take caution when walking, riding, or driving in the road, and to wear proper safety equipment such as helmets and safety belts.

Rehabilitation

Community reintegration is an important goal for the patient after an injury.

·         Rehabilitation for community reintegration in India often emphasizes improving locomotor skills for increased physical independence, social integration, and cognitive independence.

Accessibility and affordability affect rehabilitation outcome.

·         Family members provide most of the care of disabled persons, since many PCPs are not trained for managing neurologic disability and since institutional care is present in only a few metropolitan cities in India.

·         When rehabilitation institutions are present, affordability becomes another barrier – the family of the disabled must pay most of the healthcare costs.

Primary care physicians provide the first access to treatment and patient resources.

·         Caretakers of patients who cannot afford continuing specialized care will look for advice on home care and basic rehabilitation.

·         Patients often need rehabilitation in walking (gait), balance, coordination, pain management, speech, and cognitive skills.

·         Disabilities that show severe symptoms may need to be referred to specialized treatment centers. Patients ultimately may need to consult a physiotherapist, speech therapist, psychologist, psychiatrist, neurosurgeon, or other specialist.