Exercise and Maintenance of Mobility
Physical therapy on a daily basis, performed by parents with appropriate direction from a physical therapist, can help to minimize joint contractures and maintain mobility. The use of standing devices, appropriate orthotics, bracing, and facilitated ambulation can help significantly in this regard. Weight bearing on a daily basis, instituted as early as possible in non-ambulatory children for a minimum of 2 hours per day, can help to delay onset of scoliosis, limit contractures, and improve circulation and gastrointestinal motility.
Daily exercise should be encouraged, to include the upper extremities in those children with severely impaired lower extremity function, to help maintain motor function and promote cardiovascular health. A daily exercise program could include part-time use of manually propelled mobility devices, including manual wheelchair, manual stander, or gait trainer.
The major orthopedic problems these children face include scoliosis, hip dislocation; and an increased risk of fracture due to decreased bone density and propensity for falls. The age of onset and rate of progression of such complications are directly related to the severity of muscle weakness, but early intervention can minimize the impact and severity of such problems.
Contractures can develop quite rapidly in the setting of illness, excessive time spent in a wheelchair, decreased activity, or recovery after scoliosis surgery or other orthopedic procedures. Daily range of motion and early return to supported weight-bearing can help maintain function in these children.
- Activity Guidelines
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