Limb contractures in progressive neuromuscular disease and the role of stretching, orthotics, and surgery.
Contractures are exceedingly common impairments in selected progressive NMD conditions, particularly those with excessive fibrosis and fatty infiltration into muscle (i.e., dystrophic myopathies) and more severe NMD conditions, resulting in significant weakness and wheel-chair reliance, such as SMA. Less than antigravity strength produces an inability to achieve full active range of motion. Static positioning of limbs (generally in flexion) and lack of weight bearing results in fixed contractures. This article has reviewed the prevalence and distribution of contractures in specific NMD conditions. Aggressive rehabilitation strategies, including stretching, positioning, splinting, upright weight bearing, and orthopaedic surgical management may help minimize the degree of disability in NMD patients with contractures.
McDonald
C M
CM
Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Sacramento, USA.
D000203:Activities of Daily Living; D003286:Contracture / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D018450:Disease Progression; D005081:Exercise Therapy / Q000379:methods*; D005121:Extremities; D006801:Humans; D009468:Neuromuscular Diseases / Q000150:complications*; D009989:Orthotic Devices; D010146:Pain / Q000209:etiology; D010810:Physical and Rehabilitation Medicine / Q000379:methods; D011187:Posture; D016059:Range of Motion, Articular