Basic principles of non-respiratory physiotherapy for neuromuscular diseases

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Pneumologie. 2008 Mar;62 Suppl 1:S28-30.

Basic principles of non-respiratory physiotherapy for neuromuscular

diseases

Watzek I, Winterholler M.

Neurologische Klinik der Friedrich--Universität Erlangen-

Nürnberg.

Loss of function, muscle pain and secondary muscoloskeletal

complaints are common symptoms of patients with neuromuscular

disease. Many patients develop a progressive handicap.

Physiotherapeutic treatment is often used in the management of

neuromuscular diseases. Different therapeutic strategies are useful

depending on the stage and pathophysiology of the disease and with

regard to the extent of the patient's handicap. The aims of the

physiotherapy and realistic targets should be discussed critically

with the patient at the beginning of the treatment.

We propose different physiotherapeutic strategies depending on the

stage of the underlying disease: 1) Patient is able to walk--active

phase: education in self-training with regard to the risks of

exhaustion. Manual and physical treatment of mycofascial complaints.

2) Progressive functional loss--assistive phase: support of

compensation and daily functioning. 3) Patient in wheelchair or

bedbound, loss of most voluntary functions--passive phase.

The knowledge of the pathopysiology of the underlying disease is

essential for the development of therapeutic strategies. Loss of

upper neurons leads to the development of spasticity and muscle

hypertonia whereas muscular atrophy and weakness is a prominent

feature of lower motor neuron loss. Overtreatment and exhaustive

training may lead to secondary muscle damage in primary myopathies.

Training in short sessions with intervals between may have protective

effects.