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Motor Neurone Disease

Motor Neurone Disease. Single Case Study.

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Motor Neurone Disease

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  1. Motor Neurone Disease Single Case Study

  2. Bill was referred to the community respiratory team in March 2007. He was diagnosed with MND in September 2002. He had noticed in recent months that he had become breathless on lying flat, and found that propping himself up on 4 pillows helped to alleviate this. He had also noticed problems with early morning headache and daytime somnolence.

  3. He was quadriplegic though showed no signs of bulbar involvement. • Tentative discussions then took place re: the role of NIV in symptom control, and Bill agreed to referral to Aintree.

  4. Following discussion with his GP and the Aintree Consultant team, overnight oximetry was performed which demonstrated nocturnal hypoventilation. • He was then assessed at Aintree in clinic where he was offered a trial of NIV.

  5. However, Bill did not wish to be admitted to hospital, and so our community team were asked if we could carry out the trial at his home. Bill was informed of the limitations of NIV, and also that it would be the ceiling of his care.

  6. The team were then able to set him up with NIV in the comfort of his home, and following a period of weaning and acclimatization of approx. 2 weeks, he was able to sleep with his machine for over 7 hours per night. • Oximetry improved, and he noticed a marked improvement in Q. of L.

  7. Since then, we continue to monitor his condition via phone calls and visits every 2 weeks. • Oximetry is routinely performed 6 monthly.

  8. The progression of Bill’s disease is relatively slow, however tests and observation show a significant decline in respiratory function. • Occasionally machine pressures have to be increased to ensure optimal respiratory support.

  9. Recently Bill suffered a nasty chest infection which left him compromised, in particular he had difficulty expectorating secretions. • We were able to manage this safely in his home by introducing a cough assist machine. Home CXR was performed to exclude contraindications.

  10. Nebulised saline was also introduced. He was then able to clear his chest and make a good recovery from this acute episode. • He continues to use the cough assist daily to help with chest clearance.

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