PHYSIOTHERAPY BASICS by Pat Furlong developed by Helen Posselt

PHYSIOTHERAPY BASICS

For PPMD Israel April 2011

WHY IS A PHYSICAL THERAPIST NEEDED? A PT is best qualified to monitor all aspects of the musculoskeletal system including  Muscle strength  Functional abilities & gross motor skills  Range of movement in joints  Respiratory function  Monitor the spine to prevent scoliosis  By careful regular assessment the PT will know when treatment and interventions are needed preferably before secondary problems arise 

EARLY YEARS ( FROM DIAGNOSIS ) Encourage some active exercise ( normal recreational activities are good )  Start a hydrotherapy or swimming program  Begin the stretch program  Introduce night splints as needed  Begin early respiratory activities with whistles bubbles and blowing toys 

PT ASSESSMENTS 

What are they

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How often

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Who

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Why

WHAT ASSESSMENTS       

Muscle strength--- Manual Muscle Tests & Myometry Range of movement in joints Assessment of posture & gait Timed tests 6 minute walk Motor Function scales Respiratory function tests Activity of daily living assessment

WHAT IS ‘SUITABLE ’EXERCISE? Hardest exercise should be done in water  Normal age appropriate activities which do not cause too much fatigue  Or in a non weight bearing way such as on bicycles 

MORE ABOUT SUITABLE EXERCISE 

Low load = gravity eliminated

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Concentric=muscle fibers are shortening as they fire

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Non weight bearing =bicycles &swimming

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All conducted within fatigue levels

ACTIVE EXERCISE IN POOL

PREVENTING OR MINIMIZING CONTRACTURES 

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Stretches

Splints

* active self stretches * passive self stretches * manual stretches to be worn at night

Standing, Easy stand, standing frames, prone lying

WHY DO WE STRETCH? 

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Prevents the scar tissue from ‘firming' in a shortened position Maintain the length in those muscles which tighten Maintains symmetry Prolongs ability to walk Improves comfort Keep feet on foot plates & wear shoes Ease of dressing Comfort especially comfort in bed

STRETCHES IN THE EARLY YEARS ďƒ’

Lower limb * Tendo Achilles ( ankle ) * Hamstrings ( back of thigh ) * Hip flexors ( front of hip ) * Iliotibial band ( side of thigh )

Upper limb

Will need checking only, until much later but always check the fingers

ORTHOTICS (NIGHT SPLINTS)

WHY WEAR THEM To keep ankle at maximum comfortable range while he sleeps  Prevents the weight of bed clothes pushing feet into a plantar flexed ( pointing down ) position.  Most effective way of preventing contractures is to do stretches and wear night splints  ( Hyde et al 2000 ) 

IN MIDDLE YEARS Walking is becoming more difficult  Falls are more frequent  Needs to provide help to travel long distances_ consider equipment options  Begin teaching respiratory measures – familiarize with Ambu bag and cough Assist 

ASSESSMENT OF POSTURE AND GAIT 

PT ‘s regular assessment of gait & posture will identify changes which may modify his treatment

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Eg this boy’s asymmetrical stance will lead to contractures in the leg which he uses to prop

DON’T LET HIM WALK LONG DISTANCES- PROVIDE TRANSPORT

ASSESSMENT OF SITTING POSTURE & INTERVENTION Most boys who have had the benefits steroids are remaining strong in the spinal muscles  However If strength is declining  It is important to monitor closely  Consider seating options and provide good supports before they are needed 

IF WHEN SITTING HE IS BEGINNING TO LOSE THE NORMAL SPINAL CURVES THERE IS AN INCREASING RISK OF SCOLIOSIS DEVELOPMENT

LATER YEARS When no longer weight bearing- focus on restoring independent mobility with best posture modified motorised chair  Provide back up manual chair and recommend other aids and equipment  Continue stretches –concentrating on upper limb to maintain use of hands  Continue hydrotherapy as appropriate  Respiratory therapy Cough assist and Ambu bag training 

WHAT SORT OF POSTURAL MODIFICATIONS AND SEATING

NO SUPPORT FOR DECLINING STRENGTH IN STANDARD SEATING  Weight

of gravity through erect spine causes it to collapse  No support for normal spinal curves

SUPPORTIVE SEATING FOR DMD 

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Backrest to spine of scapular Contoured back rest Lateral supports Lumbar roll to help restore the normal lumbar curve 5-10 degree recline on back rest Provide head rest Supportive seat or pressure relieving cushion

CONTINUE STRETCHES AND INCLUDE UPPER LIMB 

Elbow flexors

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Forearm pronators ( enables boy to turn palms up)

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long finger flexors

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Mobilise the shoulder

WATER THERAPY IS STILL WONDERFUL

AMBU BAG Manual hyper inflation of lungs is often used to  Assist effective cough  Help bring up retained secretions  Help keep boys free of infection and out of hospital 

COUGH ASSIST MACHINE Most effective way of bringing up Retained secretions ďƒ’

It has been one of the biggest boons to the Duchenne population

WHAT TO EXPECT OF YOUR PT 

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Assessments—strength, Range of movement ,timed tests .posture, gait, equipment needs, respiration & functional abilities Exercise-- what type & how much is too much Those stretches –why ? What sort ? How often Help with equipment- seating-scooter splints wheel chairs, standers, respiratory equipment Respiratory issues if no respiratory therapist Use your PT to liaise with schools PTs can advocate on your behalf in many problem areas

THANK YOU HELENPOSSELT@OZEMAIL.COM.AU