Musculoskeletal conditions are treated based on specific diagnosis. The goal of the treatment is to preserve function or minimize pain. Non-steroidal anti-inflammatory drugs, analgesics and local icing are interventions for treating musculoskeletal conditions. Contracture is treated by relieving spasticity with injection or oral medications, and applying serial casting or dynamic splinting. Superficial heat or ultrasound is a part of the stretching program. Visual and hearing problems are addressed by appropriate specialists.
A multidisciplinary approach to rehabilitation helps patients regain function. Physical therapy, occupational therapy and speech-language pathology are a part of the rehabilitation process. Strength training to improve gait is an important component of physical therapy. Strengthening exercises help improve strength, walking speed and motor activity. Strength training could also improve crouched gait and the perception of body image.
The age and individual factors influence therapy. The frequency and duration of physical therapy depends on the child’s needs. Physical therapy can be availed on an outpatient or inpatient basis, or at school. Soft tissue tightness can be treated by passive stretching. Passive stretching can be done by the patient, therapist or by external devices such as casts, splints or a tilt table. The tone can be relaxed by superficial and deep heating, which may also result in permanent elongation of the musculotendinous unit.
Bracing is suitable for some patients. Biomechanical limitations and joint alignment can be addressed by lower extremity orthotics. Occupational therapy can help with daily living activities such as grooming, dressing or holding objects. The home environment should be designed to be less restrictive and safe, and assistive devices should be selected in consultation with physical and occupational therapists. Powered mobility such as walkers and wheelchairs allow mobility in the community.
Communication can be improved by speech-language pathologists and augmentative equipment. Other nonconventional adjunctive therapy such as horseback riding therapy can also be considered. Co-contraction, joint stability, weight shift, postural and equilibrium response, dynamic postural stabilization and pelvic movement can be improved by therapy. Constraint-induced movement therapy can improve upper extremity functional movement.
Procedures can help manage pain and spasticity, and improve contractures. Joint and soft tissue injections can help manage pain and function. Phenol blocks and botulinum injection can help manage spasticity and improve contractures. Patients with osteoarthritis may undergo surgery, and arthroplasty could be beneficial. A neurosurgeon should be consulted in case of spinal stenosis. An orthopaedic surgeon should be consulted for surgical lengthening for conditions such as hip subluxation and spastic ankle equines deformity. Other surgical procedures include joint fusions and tendon transfers.
References:
Frontera, W. & Silver, J. & Rizzo, T. (2008). Essentials of Physical Medicine and Rehabilitation. Elsevier Health Sciences. Philadelphia.
Leon Becker - Leon Becker leon@raisesavvykids.com
