REHABILITATION management – physical therapy and occupational therapy
People with DMD require access to various types of rehabilitation management throughout their lives. much of this will be delivered by physical therapists and occupational therapists, but other people may also require to help, including rehabilitation specialists, orthotists, providers of wheelchairs and other seating. Orthopedic surgeons may also be involved.
Management of muscle extensibility and joint contractures is a key part of rehabilitation management.
The goal of stretching is to protect function and maintain comfort. The software of stretching will be monitored by the physical therapist but needs to become part of the family’s daily routine.
There are many factors in DMD that contribute to the inclination for joints to get tight or “contracted”. These consist of the muscle becoming less elastic due to limited use and positioning or because the muscle tissue close to a joint are out of equilibrium (one stronger than another). maintaining good variety of movement and symmetry at various joints is important. This helps to maintain the best possible function, prevent the development of fixed deformities, and prevent pressure conditions with the skin.
Box 5. management of muscle extensibility and joint contractures
• The key get in touch with for management of joint contractures is your physical therapist. Ideally input from a community physical therapist will be backed up with a practitioner physical therapist about every single 4 months. Stretching should be performed at least 4-6 occasions each week and should become part of the daily routine.
• efficient stretching to counteract development of contractures may require various tactics which your physical therapist will show you, including stretching, splinting and rating devices.
• common stretching at the ankle, knee, and hip is important. later on, common stretching for the arms becomes necessary, especially the fingers, wrist, elbow and shoulder. additional areas that require stretching may be identified on individual examination.
• night time splints (ankle-foot orthoses or AFOs) can be used to help control contractures in the ankle. These require to get custom-made and not provided ‘off the shelf’. following the loss of ambulation, daytime splints may be preferred, but daytime splints aren’t recommended for boys who’re still walking.
• extensive leg splints (knee-ankle-foot orthoses or KAFOs) may be useful close to the stage when jogging is becoming very complicated or impossible. KAFOs can be useful to help control joint tightness and also to prolong ambulation and delay the onset of scoliosis.
• rating plans (in a rating frame or power chair with stander) are recommended following jogging becomes impossible.
• Resting hand splints are appropriate for men and women with tight extensive finger flexors.
• surgery can be offered in some circumstances within an hard work to prolong the period of walking. However, this
approach must be strictly individualized. far more information in regards to the various options is available in the main document.