Friday, February 18, 2011

Physiotherapy for Muscular dystrophy Affected persons – SEVAI Trichy Myopathy by physiotherapists -Equal Health, Australia.

Trichy: 17, Feb: Special physiotherapy has been administered for the children affected Muscular dystrophy (MD) by expert physiotherapists Jodie Krantz and Robert E Harper from Equal Health, Australia along with SEVAI physiotherapists Yogeswari and Vijayalakshimi. Such physiotherapy exercise has been continued from 7th to 16th February in Trichy Myopathy day care centre for muscular dystrophy affected 42 children regularly. Physiotherapists Jodie Krantz and Robert E Harper also explained the care takers of SEVAI Muscular dystrophy affected children day centre. The Equal Health physiotherapists also gave counseling to parents and care takers enlightening how to handle children with muscular distrophy.Equal Health Doctor, M.K.Thandan mentioned that Muscular dystrophy is a group of genetic diseases involving progressive weakness and degeneration of the muscles that control movement. In some forms of MD, the heart muscles and other involuntary muscles, as well as other organs, are affected. There are 9 distinct types of MD.
Myotonic MD is the most common form among adults; while Duchenne MD is the most common form among children. MD is an incurable, often fatal disease. Jodie Krantz explained the trainees about the Signs and Symptoms of muscular dystrophy. Myotonic muscular dystrophy (which affects adults) is accompanied by the signs and symptoms such as Delayed muscle relaxation after contraction, impaired nourishment of nonmuscular tissue, Weaknesses in the facial muscles, arms and legs, and muscles affecting speech and swallowing, Baldness in men and women, Intellectual impairment, Respiratory problems, Heart abnormalities in early adulthood, Although Duchenne MD is present at birth, signs and symptoms do not usually appear until the child is 3 - 5 years of age. They include: Delayed motor movements, frequent falls, Difficulty running, jumping, and getting up from a sitting or lying down position, Large calf muscles, Weakness in the lower extremities, Cognitive impairment, Cardiac impairment. Breathing difficulties and a chronic disorder of heart muscles develop during adolescence, usually after the individual becomes wheelchair bound.
SEVAI Coordinator explained that MD is caused by gene mutations that are particular to each form of the disease. In two thirds of cases of MD, the person has a family history. In one third of cases, there is no family history. He said’ If you have symptoms of MD, you should see your health care provider. Diagnosis depends on sophisticated testing, such as lab tests, imaging, and other procedures’. Dr.Thandan also spoke about the goal of a treatment plan is to maintain the person's optimal physical and emotional health by preventing joint and spinal deformities. ‘This prolongs the ability to walk for as long as possible. Assisted breathing is introduced as needed and lifelong physiotherapy is necessary. Orthopedic devices may be needed for support. Hydrotherapy, such as continuous tub baths, may help maintain a full range of joint motion. Physical, occupational, respiratory, and speech therapy may also help patients manage the symptoms of MD. Some clinicians recommend sub maximum aerobic exercise, especially in the early course of the disease’ added Dr.M.K.Thandan. Dr.M.K.Thandan also mentioned’ your health care provider may prescribe the following medications’Phenytoin, quinine, and procainamide, for delayed muscle relaxation in myotonic MD, Prednisone, to improve muscle strength in Duchenne MD. Dietician Ms.Joseph gave a few Nutrition and Supplements tips which may help reduce symptoms: Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities, Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as kale, spinach, and bell pepper), Avoid refined foods such as white breads, pastas, and sugar, Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
Nutritionist also suggested that ‘Use healthy oils in foods, such as olive oil or vegetable oil, Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, , onion rings, donuts, processed foods, and margarine, Avoid coffee and other stimulants, alcohol, and tobacco, Drink 6 - 8 glasses of filtered water daily, Exercise lightly, if possible, 5 days a week’. She suggested the care takers ‘You may address nutritional deficiencies with the following supplements:Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil 1 - 2 times a day, to help decrease inflammation and improve immunity. Fish oils may increase bleeding in sensitive individuals, such as those taking blood thinning mediations (including aspirin),A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium, Calcium and vitamin D supplement, 1 - 2 tablets daily, for support of muscle and skeletal weakness, Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular supporting-acetyl cysteine, 200 mg daily, for antioxidant effects. Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity. Amino acids, including glutamine and arginine for muscle protection, Probiotic supplement, 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration, Creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting. Certain kidney drugs may interact with creatine. Speak to your doctor to make sure your kidneys are healthy enough to handle that amount of creatine. Your doctor may want to periodically monitor kidney function. L-theanine, 200 mg 1 - 3 times daily, for nervous system support’.
Dr.M.K.Thandan explained the patients that ‘There are 2 types of pain: Pain due to stiffness.. this pain is bearable for the duration of your exercises. It will ease soon after you finish. This pain is basically telling you that your muscle is a bit out of practice and needs to be eased back in to working order. So it's OK to experience this pain. It will range from little or no pain to quite severe. Pain due to damage, this pain is definitely NOT OK. It will range from unbearable to the point where you're screaming in agony (try to stop before you get to that stage!). It will carry on long after your exercises and may not ease for a few days. This pain is telling you that your muscle is still highly damaged and isn't ready to be exercised yet. If you experience this pain then stop your exercise immediately. The amount of exercise you do depends on your monitoring of your pain. As with any other exercise, listen to your body. If the pain is bearable and eases off soon after, then you've done the correct amount. So next time you could do the same amount and gradually increase it according to your pain. If the pain is nearing severe and takes much longer to ease after, then you've probably pushed yourself too hard. Next time reduce the amount of repetitions you do and reassess your pain. The best way to do these physiotherapy exercises is to set yourself a plan. For example, if your pain allows you to exercise 3 times a day, then write down the times and your pain response after each time. Stick to this plan every day, and adjust it according to your pain and improvements in stiffness.Your focus during each exercise should be on the quality of movement. Don't try and get through the repetitions as quickly as possible. You'll lose focus of the proper movement and it won't do you any good. Slow, smooth movements, with your focus strictly on the muscle/joint you're working, are best.’
Physiotherapist Jodie Krantz made a demo for Foot Physiotherapy Exercises and trained local physiotherapist and gave counseling to the MD affected’ You should do all these exercises with bare feet. Write the digits 1-10 with your toes in the air. Sitting on a chair, raise and curl your toes. Progress by picking up a towel off the floor with your toes, Stand on your tip-toes for 5 seconds, Loop a rubber band around both big toes and pull them away from each other for 10 seconds, Roll a golf ball (or rolling pin) with the sole of your foot for about 2 minutes. Make sure the whole of the bottom of your foot has a chance to roll, with your toes pointed; circle your ankles slowly clockwise and anti-clockwise.
Regarding Knee Physiotherapy Exercises, she said that to comprehend the type of pains before doing these exercises. Quadriceps Contraction - Sit on the floor with your legs straight out in front of you. Place your right hand under your right knee, Contract your quads and push your knee down on to your hand and lift your right heel into the air. Hold for 10 seconds. Repeat with left leg,If the above exercise is too hard then start off with a folded pillow under your knee, so the starting position has your knee slightly bent. Then lift your heel up as before, keeping your knee on the pillow, Lying flat on your front with both legs straight. Slowly bend your right knee as much as possible and hold for 5 seconds. Slowly straighten your knee back to the starting position and repeat with your left knee, Lying on your back with one knee bent up (foot on floor) and the other straight. Lift the straight leg up (about a foot) and hold for 5 seconds. Repeat with the opposite leg.

Regarding Back Physiotherapy Exercises, Robert E Harper educated the patients,’ Lying on your back with both legs straight. Bring your right knee up towards your chest, holding either your thigh or top of the knee. Hold the stretch for 10 seconds and relax slowly. Repeat with your left leg. Lying on your back with both legs straight. Slide your hip so that the left side goes towards your feet and the right side comes up towards your head. Keep your legs straight and feet relaxed. Repeat with the left side coming up and right side going down. Lying on your back with both knees bent up (feet on floor). Tilt your hip slightly backwards and arch your back. The first movement should lead to the second so don't force the arching. Relax and then tilt your hip forwards, keeping your bottom on the floor. Your lower back should be pushing into the ground. Lying on your front, with your chin resting on the floor, bend your arms so that your hands are resting beside your head with palms on the floor and elbows tucked in next to your body. Slowly lift your head up looking straight ahead, keeping your hips on the floor so that your back arches. Let your arms take all the weight. Slowly relax back down. Standing up tall, keep your legs straight as you bend down, as far as you can towards your feet. Slowly come back up. Standing up with your arms by your side, bend to the right side, sliding your right hand down your leg. Slowly come back up and relax. Then bend to the left side, sliding your left hand down. Slowly come back up and relax.Regardiing shoulder Physiotherapy Shoulder Physiotherapy Exercises, Standing or sitting, lift your arm up (as if you wanted to ask a question in a class) keeping it straight in front of you. Take it as far as you can. Repeat with your other arm. Standing with your arms by your side, slide the back of your hand up your back, and reach for the opposite shoulder blade. Hold for 10 seconds and slowly relax. Repeat with the other arm. Standing up with both your elbows bent at a right angle. Turn each arm out to your side, making sure your elbows stay tucked against your body the whole time. Hold for 10 seconds and slowly relax’ added Robert E Harper.

Regarding Neck Physiotherapy Exercises, Equal Health Physiotherapist Jodie Krantz explained’ Keeping your eyes centered, slowly move your head back so you end up looking at the roof. Keep the rest of your body still. Hold for 5 seconds and slowly relax back down, keeping your eyes centered, slowly move your head down so you end up looking at the floor. Keep the rest of your body still. Hold for 5 seconds and slowly relax back up, Turn your head to the left so you are looking in line with your left shoulder. Go as far as you can and hold for 5 seconds and relax, Turn your head to the right so you are looking in line with your right shoulder. Go as far as you can and hold for 5 seconds and relax’. Dr.K.Govindaraju said that the number of persons afflicted with Muscular Dystrophy has been identified as 1451 and several persons are to be identified and given a comprehensive care for those been affected by Atrophy, Muscular, Motor, Inflammatory, Diseases, Abnormalities, Diseases, e.g. Structural Myopathies,Muscle, Diseases of the Anterior Horn Cell, Genetically Determined Ataxias, Myotonic Disorders and Channelopathies. Trichy Myopathy centre takes efforts for convergences of services with the support of Government of Tamilnadu and Union Government-EtNS


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