Sensory processing disorder not yet recognized diagnosis
Dear Doctors: Can you please discuss sensory processing disorder? Our 17-year-old daughter has it, but help is sketchy. What kind of professional is best to deal with this disorder? So far, all we know is what we have read on the internet. Any information is greatly appreciated.
Dear Reader: The term “sensory processing disorder” refers to a condition in which someone has an atypical response to ordinary sensory stimuli. It is believed to occur due to the way in which the brain receives and interprets the information that is being delivered by the senses. For example, people with sensory processing disorder are often hypersensitive to sound. They may find the whir of a fan or the sound of hair being brushed to be so uncomfortable, or even painful, that they become overwhelmed.
Sight and taste can be affected as well. Even a dim light can be too bright, and the textures of certain foods can be nauseating. The sense of touch is also frequently affected. It’s common for someone with sensory processing disorder to find the sensation of even the softest fabrics on the skin to be amplified, and thus intolerable.
The disorder can also adversely affect spatial awareness. Someone with the disorder can struggle to be aware of the position of their own limbs and body, and to understand the space around themselves. This can cause the individual to seem clumsy, bumping into objects or appearing to be unsteady on their feet.
The condition can also cause a dampening of the senses. In those cases, it takes a significantly higher degree of a stimulus to have an effect.
The cause of sensory processing disorder is not yet known. A genetic component is suspected, and that is the subject of research. The condition is most often identified during childhood. However, it affects adults as well, and can be diagnosed at an older age. In those cases, it usually turns out that the adult has experienced the symptoms since they were children but developed a series of coping mechanisms that helped them to manage and hide their condition.
Although the range of symptoms in sensory processing disorder is widely recognized, the condition itself is the subject of debate. Some believe it is part of the autism spectrum, or that it is associated with attention-deficit/hyperactivity disorder. Others argue that it is a diagnosis of its own.
Unfortunately, for those seeking treatment, sensory processing disorder is not a recognized medical diagnosis at this time. That can lead to the problem you have been having in finding help for your daughter. Working with an occupational therapist is considered to be the best approach to managing the symptoms. Treatment is based on each individual’s specific case. One approach is known as sensory integration therapy. The goal is to help the individual recognize and organize incoming information from the senses, and to develop techniques that help them manage their response to sensory input.
You can ask your health care provider for a recommendation for an occupational therapist, or you can find more information at the American Occupational Therapy Association website at aota.org.
RUPTURED ACHILLES TENDON WILL TAKE TIME TO HEAL
Dear Doctors: I’m a 30-year-old man, and I play weekend volleyball. Last month, I jumped to spike the ball and heard a “pop.” There was a lot of pain; it felt like getting kicked in the calf. It was a torn Achilles tendon, and now I’m in a cast and on crutches. How else can this be treated? How long will it take to heal?
Dear Reader: The Achilles tendon connects the back of your heel to your calf muscle. It’s the thickest tendon in the body, designed to withstand high levels of tensile force. It’s thanks to the Achilles that you can flex your foot, which makes it possible to walk, run, leap, jump and stand on tiptoe.
The type of injury you experienced can happen to anyone, and at any age. However, analysis of data from emergency room admissions has shown an increase in Achilles rupture among men in their 30s and 40s, particularly those who sporadically take part in competitive sports. The sequence of events that you described — from the jump to the audible “pop” to the sudden subsequent pain in the back of your calf — are a textbook example of an Achilles tendon rupture. But not all injuries to the tendon are as obvious. It’s possible for someone with the symptoms of a strained or sprained ankle to have sustained an injury to the Achilles tendon. They are able to flex their foot and walk, and a manual examination of the ankle may not reveal the gap in the tendon typically associated with a rupture. Yet an injury can be present.
When it comes to treatment, the options are either a surgical repair or nonsurgical management of the injury. The former can range from a minimally
invasive procedure using a scope and a few small stitches, to a so-called “open” repair, with an incision and more extensive suturing.
While surgical treatment is sometimes preferred due to a lower rate of reinjury, it carries complications. These include the potential for nerve injury, post-surgical infection and the risks associated with anesthesia. Nonsurgical treatment is less costly and has a lower complication rate. However, it can leave the individual at increased risk for a subsequent injury.
Nonsurgical repair of a ruptured Achilles tendon begins with rest, keeping the injured foot elevated and taking medications as needed to control pain and inflammation. Another important step is bracing and immobilizing the affected foot. That means positioning the foot at a precisely flexed angle to bring the torn ends of the tendon into optimal proximity. A cast is then used to prevent movement as healing takes place.
Whether treated surgically or nonsurgically, recovery from a ruptured Achilles typically takes a few months. This includes rehab, which is crucial to a full recovery. Most people who have sustained a ruptured Achilles tendon and get medical treatment have a very good chance of a positive outcome. But some patients, particularly those who were less active before the injury, may be left with a reduced range of motion. It’s important for you to understand that a complete recovery will take time. Please be patient and follow all of your health care provider’s instructions, including rehab.
MORE RESEARCH NEEDED IN PROMISING LUPUS CAR T-CELL THERAPY
Dear Doctors: Our daughter is 24 years old. She struggled with her health for several years before finally being diagnosed with lupus. I’m reading as much as possible about this disease and have seen a study with a potential cure called CAR T-cell therapy. What is it, and how does it work?
Dear Reader: For those who aren’t familiar, lupus is an autoimmune disease. That means the immune system mistakenly identifies the body’s own tissues as foreign invaders and attacks them. This results in damaging inflammation that, over time, leads to a wide range of symptoms. These can include fatigue, fever, stiffness or pain in the joints or muscles, skin problems, sensitivity to sunlight, headache, dry eyes, hair loss and mouth sores. Lupus can also cause damage to the internal organs, particularly the lungs and kidneys. It can also affect the nervous system and the heart. There is no known cure at this time.
Treatment for lupus involves the use of medications to reduce inflammation and manage symptoms, and to prevent organ damage. Now, as you have read, research into something known as CAR T-cell therapy in lupus patients has shown promise. Unlike traditional lupus treatments, which can only ease the effects of the disease, CAR T-cell therapy hints at a path to remission. And while the research that you read about produced good results, it’s important to understand it’s not yet a breakthrough. The study in question was quite small, with just five patients. Neither the longterm success of this new approach, nor its potential long-term side effects, are yet known.
CAR T-cell therapy is a type of immunotherapy. These are treatments that harness the behaviors and activity of certain immune cells to fight disease. Five years ago, the FDA began to approve CAR Tcell therapy for use in some blood cancers. As the name suggests, this treatment uses T cells, which are a type of white blood cell. The first step is to collect blood from the patient and extract the T cells. These are then genetically modified so they will act upon a specific target. For the lupus study, researchers “taught” the CAR T cells to target the overactive immune cells that attack the body’s own tissues. Up to 100 million CAR T cells were needed for a single therapeutic dose, so the customized cells were reproduced in the lab. Each patient was then infused with their own customized cells.
About three months later, after the CAR T cells had eliminated the malfunctioning immune cells, the patients’ bodies began to produce new immune cells, all of which behaved normally. Each of the five patients in the study has been able to stop taking the drugs that were being used to manage their illness, and they are considered to be in remission. But — and it’s an important “but” — the follow-up period at this time is less than two years. That, combined with the tiny sample size, keeps this treatment firmly in the realm of investigation. More study, with more patients and ongoing follow-up, are needed for CAR T-cell therapy to be effectively evaluated as a potential treatment for lupus.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.