Physical therapy for SMA

Overview
Physical therapy (PT) can help adults and children with spinal muscular atrophy (SMA) maximize their function, strength, and endurance. Physical therapists (PTs) design treatments to promote movement, prevent onset or progression of impairments, and prescribe mobility devices such as special seats, strollers, and wheelchairs.

Progressive muscle weakness, the primary clinical feature of SMA, can limit range of motion and cause joint tightness (contractures), hip dislocation, spinal deformities such as scoliosis, falls, and fractures. Since individuals with SMA lose strength and function over time, early intervention with a physical therapy program may be recommended.

What does it involve?
On the initial visit, a PT will evaluate an individual’s physical condition and take a medical history. The therapist may also examine posture, muscle strength, range of motion and motor activities, respiratory function, and quality of life.

For adults with SMA, treatment may focus on strengthening exercises, energy conservation techniques, fall prevention, or using mobility aids. Gait training for adults who can walk helps minimize safety risks. For those with severe SMA, physical therapy may improve positioning, determine better bracing to prevent contractures, and address range of motion.

PT for children is typically geared toward improving their mobility and independence while delaying onset of complications. Treatment may involve “functional exercises” such as rolling, reaching, sitting and possibly walking, depending on age, amount of neuromuscular involvement, and developmental stage. A PT who works with children should be experienced in pediatric and developmental, as well as neuromuscular, disorders.

Physical therapy treatments for adults and children may include:

Preventing and managing contracture (joint tightness). Maintaining joint mobility is important in decreasing the incidence of contractures. Range-of-motion exercises, positioning, and stretching can reduce or prevent joint tightness and increase flexibility. When a child is too weak to move, splints, braces, or standing devices may be used.

Aquatic or hydrotherapy. Some PTs specialize in aquatic therapy to promote strength, walking and balance, and aerobic training. Moving in a pool reduces the risk of over-exercising, fatiguing muscles, or putting pressure on bones and joints.

Strength training. PTs can design strengthening exercises to slow muscle and bone deterioration and prolong the ability to walk. They may recommend games and tasks to keep children active that can be used during therapy or enjoyed with the whole family.

Developmental skills. For children with severe SMA, PT can help improve head and trunk control, floor mobility (rolling and crawling), and position changing (pulling up to stand). They’ll also learn upright positioning and work on skills such as sitting, standing, and walking.

Standing programs. Weight-bearing exercises or devices can help children who can stand but can't walk maintain muscle flexibility and length, prevent contractures, promote musculoskeletal development, and reduce bone-mineral density loss.

Assistive devices. PTs work with other rehabilitation specialists to select and modify assistive devices, including motorized wheelchairs, scooters or walkers. PTs work with schools to secure adaptations for children, such as access to elevators, preferential classroom seating, or wheelchair accessibilty.

Intended Outcomes
SMA physical therapy is designed to minimize musculoskeletal complications and maximize a person’s functioning and overall health. Specific goals include preserving mobility and preventing or slowing the progression of contractures, respiratory failure, and skeletal deformations.

Results
A 2016 multicenter study documenting PT services received by people with SMA concluded that further research is needed to better understand the impact of PT services on people with SMA.

An ongoing clinical trial examining the benefits and safety of hydrotherapy is scheduled for completion March 2020. The trial involves testing functional motor function and the ability to control movement among 30 children with type 2 and 3 SMA.

Constraints
Some children with SMA may be too weak to move their joints through full range of motion. Excessive movement or exercising may cause fatigue or muscle damage.

PTs specializing in children with SMA may not be available in rural areas.

For more details, visit:

1. Spinal Muscular Atrophy in Adults – American Physical Therapy Association
2. Musculoskeletal System - CureSMA
3. Spinal Muscular Atrophy 一 American Physical Therapy Association
4. Physical/Occupational Therapy – Columbia University Spinal Muscular Atrophy Research Center
5. Physical Therapist’s Guide to Spinal Muscular Atrophy - ChoosePT
6. Diagnosis: Spinal Muscular Atrophy (SMA) 一 Muscular Dystrophy Association
7. Physical therapy services 一 Journal of Pediatric Rehabilitation Medicine
8. Pilot Study of an Innovative Physiotherapy 一 ClinicalTrials.gov