Physiotherapy for Patients with Neuromuscular Disorders
Physiotherapist in the Multidisciplinary Team
A multi-disciplinary approach is a crucial key for success in diagnosing and managing children and adults with neuromuscular diseases. Physiotherapists are one of the key members of this team.
The followings are different assessments performed by the Physiotherapists:
- Muscle strength – to monitor the progress of the disease, assess the response to treatment, and to monitor muscle imbalance which in turn affects the range of motion that the muscle in the arms, legs and body can move.
- Range of movements – to identify if there are any emerging stiffness in the joints and the needs for additional therapeutic devices e.g. splints, orthoses, standing frames, or make recommendations for surgeries to release stiff joints and shortened muscles.
- Body alignment – to identify and monitor any early signs of abnormal curvatures in the body or abnormal alignment in the arms and legs.
- Functional testing – easy but relevant tests of daily functional status, e.g. 6-minute walk test, duration to put on a shirt.
- Motor function – to use standardized tests monitoring the progression of the disease and response to therapies. The common clinical tests used include North Star Ambulatory Assessment, Brooke Upper Limb Scale, Hammersmith Motor Scale, and Motor Function Measure.
Physiotherapy can help children and adults with neuromuscular disorders learn the best ways to maximize their muscle function and accomplish activities of daily living.
Treatment strategies include:
- Daily stretching to improve or maintain range of movements in the arms, legs and body.
- Provision of splints, orthoses, seating equipment, standing devices etc. to improve or maintain range of movements in the arms, legs and body, improve daily function such as sitting and standing, and improve respiratory function by encouraging upright postures if allowed.
- Prescription of submaximal exercises or activities, and aquatic therapy exercises (i.e. exercises in warm water) to improve or maintain muscle strength and flexibility in the arms, legs and body.
- The use of non-invasive, or later invasive, assisted ventilation to help children and adults with neuromuscular disorders maintain their respiratory function, clear the respiratory secretions and prevent respiratory infections. Education to the carers on how to confidently use the respiratory device at home is also important as part of self-management for the children and adults with neuromuscular disorders.
- Provision of assistive devices to maximize mobility including walking devices, strollers, scooters, manual or motorized wheelchairs.
- Home and/or school visits can help teachers and parents find the best physical solutions for full participation of the children and young adults with neuromuscular diseases in their home and school environments.