physical therapy standards of care · physical therapy standards of care portland, maine april 27,...
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![Page 1: Physical Therapy Standards of Care · Physical Therapy Standards of Care Portland, Maine April 27, 2019 Presented By: ... the BEST way for boys with DMD to ... • Swimming is fun,](https://reader033.vdocuments.net/reader033/viewer/2022060413/5f1143b9cd494b7a9b25eb9a/html5/thumbnails/1.jpg)
Physical Therapy Standards of Care
Portland, MaineApril 27, 2019
Presented By:Heather Salon, PT, DPT, NCS
Board Certified Specialist in Neurologic Physical TherapyMassachusetts General Hospital
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Partners: Physical Therapy and Families• Provide education and resources to boys and families to allow them to participate:
• At home• At school• At leisure activities• In the community
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Physical Therapy
• Promote safe activity to prevent deconditioning and minimize muscle damage• Recommend options for mobility that
allow independence and access• Promote muscle flexibility needed for • proper alignment in sitting and
standing • Prevention of pain and decreased
function• Promote proper posture
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Physical Activity: A balancing act
• Exercise maintains muscle strength but…• Too little exercise = muscle atrophy• Too much exercise= muscle breakdown
This Photo by Unknown Author is licensed under CC BY
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Over Use: Signs & Management
Signs• Muscle cramping or pain, usually
in the leg muscles
• Fatigue
What to Do Now• If you over-did it one day, it’s
okay• Decrease duration or intensity the
next time
• In the future: use energy conservation• Prioritize activities and use energy
for high priority activities
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Options for Exercise &
Physical Activities:
• Engage in age-appropriate, fun activities! • Foster bonding as a family and with
friends• Choose activities/exercises that are non
weight bearing or low load= SWIMMING!!• Low friction tricycles or adaptive bicycles
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Why Aquatic Exercise?
• Safe exercise for muscles – buoyancy minimizes the effects of gravity and increases freedom of movement for large muscle groups • Great for the lungs – encourages deep breathing and keeps breathing muscles strong • Great for the heart – the BEST way for boys with DMD to get the heart pumping and keep up endurance • Swimming is fun, builds self-confidence, and can be enjoyed with peers, siblings, and other caregivers • Swimming is a skill boys with DMD can enjoy for years to come
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Flexibility: Why Does It Matter?
• “Your hip bone is connected to your back bone”• loss of flexibility at the ankle/foot can create pain and problems in the spine
and other joints• Proper flexibility= proper posture• At school desks• In wheelchairs
• Loss of flexibility can contribute to walking difficulties• Proper joint alignment=prevents pain and improves comfort
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Stretching Basics
• Be gentle• Use a firm grip• Be static (no bouncing)• May use active or
passive/assisted• Intermittent or Prolonged
• Leg muscles to stretch:• Hip flexors (front of hip)• Hip abductors (outside of
hip)• Hamstrings (behind thigh)• Gastrocs (calves)
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How Do I Stretch?
Very young children: parents help with passive stretching
• Activities while lying on your tummy stretch the front of the hip
Elementary age children: children can
participate• Activities on your tummy
with wedge(hip flexors)• Lying on back with leg on
door frame (hamstrings)• Standing on slant board
for tabletop activities (calves)
• Self stretching for finger/wrist muscles
Older Children/Young Adults
• Can continue earlier examples if still tolerable and safe to get into/out of position
• Can include family/friends in passive stretching
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Resources for Stretching:
• PPMD Video on you tube has a good review of techniques:• https://www.youtube.com/watch?v=6eHLt3KA
Otg
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Positioning for Stretching
Lying on a wedge
Standing on a slant board
Doorway hamstring stretch
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Splinting• Night splints= prolonged
stretch to prevent loss of range of motion • used overnight when boys
are ambulatory during the day
• Daytime splints • when boys using
wheelchairs during the day• Wrist/hand splints if upper
extremity tightness develops
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Standing Frames• Provide supported standing• Benefits of standing include:
• Prolonged stretching• Bone density• GI function• Respiratory function• Pressure relief from sitting
• Recommendations: 60-90 minutes• Must be well aligned to prevent
joint injury
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Wheeled Mobility
• Boys can go longer distances without fatigue• Boys can participate with peers and
family• Boys can participate in leisure activities,
including adapted sports• Prevents falls, especially when fatigued
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Scooter versus Power wheelchairScooter
• Good for long distance use, not classroom seating• Lighter weight = can be lifted by
family• Can fit into trunk• Do well on outdoor surfaces• Large turn radius• Cannot be customized easily for
height/back support
Power Wheelchair• Can be customized for all day
comfort and proper posture• Heavy= cannot be lifted by
family• Require appropriate van for
transport• Turn radius can vary on drive
type
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Thank you very much!