Physio-FSH

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Physiotherapy in Muscular Dystrophy:

Physiotherapy in Muscular Dystrophy Originally presented by Marina Morrow at a FSH Information Day

FSH Muscular Dystrophy:

FSH Muscular Dystrophy It is the third most common muscular dystrophy with approximately 1/3 rd of people diagnosed in later life The earlier the diagnosis, the more severe the clinical presentation Affects both males and females and is present in all racial groups Muscle involvement varies from person to person (both within families and between families)

Clinical features of FSH:

Clinical features of FSH Progressive weakening of skeletal muscles Weakness round the face, neck, shoulders and upper arms Legs can also be affected leading to ankle tightness

Early Symptoms:

Early Symptoms Unable to open and close eyes fully Unable to fully smile, whistle, suck from a straw Weakness of the shoulders – unable to stabilise the shoulder girdle Tendency for the weakness to be asymmetrical

Muscle weakness:

Muscle weakness Assessment of muscle strength, endurance and fitness by a specialist physiotherapist Learn to work within your capabilities Avoid true muscle strengthening which aims to overload the muscle

Muscle Strengthening:

Muscle Strengthening Avoid muscle endurance techniques as the basis of these tends to focus on repetition Vary exercise techniques e.g. Walking/swimming/cycling/gym to avoid adaptation to the stimulus Use resistance rather than weights if you are unsure Warm up and cool down phase with stretches of the appropriate muscle group

Exercise:

Exercise Exercise will improve muscle endurance and muscle strength (prevent disuse atrophy) and help to improve mood. In the first six weeks of an exercise programme, the muscles will become more effective and efficient BUT Avoid muscle fatigue: Learn to work within your capabilities and pace yourself

Foot and ankle instability:

Foot and ankle instability Can affect balance as feet tend to ‘slap’ down Unable to respond to differing surfaces very quickly i.e. Slopes, hills, kerbs, gravel, grass, snow and sand Unable to respond to inclement weather, busy areas as fast changes in direction can affect balance

Ankle tightness / Contracture:

Ankle tightness / Contracture Regular stretching and warm muscles Hold the stretch for a minimum of 20s

Possible solutions:

Possible solutions Shoes with a wide, deep toe box and large base of support are generally found to be beneficial

Back problems – possible solutions:

Back problems – possible solutions Stretching and exercise Postural management Orthoses – good clinical assessment is essential Surgical interventation

Fatigue:

Fatigue Muscles can get tired more quickly and recovery takes longer Avoid strengthening work Look for ways to conserve energy Take frequent breaks Pace yourself – think about your daily schedule Ergonomic seating an positioning. Frequent changes of position Beds / chairs / work surfaces

Balance and falls:

Balance and falls Look where you are going and assess the situation Ensure paths/doorways etc. are well lit Appropriate orthoses and footwear essential Avoid soft tissue injury Develop a fall strategy Progression of muscle weakness coupled with the aging process

Postural Management:

Postural Management “... The use of any technique to minimise postural abnormality and enhance function” Farley at al (International Journal of Therapy and Rehabilitation October 2003) Techniques to improve posture include surgery, orthoses, static seating, adaptive seating in wheelchairs, “physiotherapy” and postural equipment such as standing frames, sleep systems, etc.

Beds:

Beds Height adjustable Powered back rest

Wheelchairs:

Wheelchairs Shop mobility Long distances Powered v manual Tilt and recline

Pain Relief:

Pain Relief Postural management Massage Acupuncture / heat therapy (if sensation is unaffected) / TNS machine Medication Referral to pain team

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