PHYSIOTHERAPY IN SSPE

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1 PHYSIOTHERAPY IN SSPE Published by: Physiotherapist RUKIYE KORUCU Istanbul, Turkey Sep 2007 English translation by R.Schoenbohm

2 WHY PHYSIOTHERAPY? Preserve the breathing capacity Strengthen the chewing and swallowing reflexes Reduce the tendency for cramps Secure a normal joint motility Avoid deformations Avoid abnormal motions and positions Strengthen the capability for conscious motor activity

3 TREATMENT METHODS Thermal treatment Massages Stretch exercises Normal joint movements Exercises to stimulate the capability for active movements Use of orthotics and other devices Hippo therapy Hydro therapy

4 THERMAL TREATMENT Cramps can cause joint deformations. To prevent this and to relax the affected muscles, thermal treatment should be regularly applied 2 to 3 times every day for 15 to 20 minutes each.

5 MASSAGE Massage of the face to relax the facial muscles Massage of the back to maintain a straight spine Massage of the abdomen to support the digestive tract Massage to relax muscles that show a tendency to cramp

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11 The friction technique for the backrub

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17 TRICEPS MASSAGE

18 BICEPS MASSAGE

19 KNEADING THE BICEPS

20 FOOT MASSAGE

21 STRETCHING Stretch the joints as far as it is possible by using external force. Hold the joints in this extreme position for 10 to 20 seconds (the adaptation of the muscle collagen takes at least 6 to 8 seconds). As soon as the patient senses pain or when you observe no further increase in elasticity, the stretching must be reduced to not tear the tendons.

22 STRETCHING EXERCISES Stretching of Achilles tendons Thighs Adductors Hip flexors Lumbar extensors Pectoral muscles Femoral extensors (Quadriceps)

23 Achilles tendon

24 Thigh backside

25 Adductors

26 Hip flexors

27 Lumbar extensors

28 Pectoral muscles

29 Femoral extensors (Quadriceps)

30 NORMAL JOINT MOTIONS Shoulder Elbow Wrist Finger Hip joint Knee Ankle joint

31 SHOULDER Lift both arms up to face level and lower them again Move both arms horizontally aside and back again Stretch out both arms horizontally at shoulder s level with the palms turned upward. Move the forearms by 90 degrees vertically up and then down again.

32 ELBOW Put both arms down alongside the patient s body. Then bend the forearm slowly upward to the upper arm and back again. Put both arms down alongside the patient s body. Lift the forearms by 90 degrees (vertical) and point the hands alternately towards the face and back towards the feet. This helps relaxing the wrist.

33 WRIST Move the hand up and down Turn the wrist slowly from the right to the left and back

34 FINGERS Open and close the fingers repeatedly.

35 HIP Pull the knee up to the belly. Let the knee down again and stretch the leg. Move the outstretched leg horizontally 45 degrees aside. Bend the knees in such a way that the sole of the feet lays flat on the floor. Then bend the angled leg carefully aside.

36 KNEE Have the patient lay on its belly. Bend the lower legs all the way up to the buttocks.

37 ANKLE Stretch out the patient s leg. Move the ankle joint back and forth with the knee being stretched. Move the ankle to the right and to the left (in and out).

38 EXERCISES FOR ACTIVE MOTIVITY Turning Creeping exercise Keep the head up while rested on the elbows Keep the head up with straight arms Sitting On all fours On the knees Accolade position (one leg bent, the other on the knee) Standing upright Walking

39 TURNING When turning the patient, both the shoulder blade and the sacroiliac joint function as turning points. To avoid shoulder damages while turning, the arm on the turned side must be held upright.

40 CREEPING EXERCISE The creeping exercise starts with the patient laying on his belly. One knee gets angled by 90 degrees and the leg is moved aside. The angled leg and the pelvis need to be held firm in this position. The other body side is now being activated by touching the sole of the other, non-fixed foot.

41 Keep the head up while rested on the elbows Make sure that the elbows are bent at 90 degrees and the hand s palms lay flat on the floor. Running your hand over the neck and spine within a single movement will trigger the child to lift its head.

42 Keep the head up with straight arms The exercise is similar to the one with bent elbows. In this exercise the arms must be straight instead.

43 SITTING Cross-legged sitting: As a first step, support the child s back and hip. By guiding the knees, bring the child into a cross-legged position. Sitting on the bottom: The child is first being put on one side of the buttocks. Then the weight is being put in the other half of the buttocks. This back-and-forth movement is repeated several times. Sitting with straight legs: First support the child in the back, then guide the knees until the legs are stretched out.

44 ON ALL FOURS Once the child has learned to keep its head up with the arms straightened, it is being put on all fours by lifting and guiding the hip properly. After the child has learned this position, the exercise can be continued by use of an appropriate device (aid).

45 ON THE KNEES While securing its position the child is sitting on his knees and heels. Softly pushing its pelvis forward helps the child onto its knees and wrists building a bridge. Stepwise the support and guidance can be reduced. This will allow the child to become more autonomous in performing this exercise. The bridge exercise is especially helpful in keeping the pelvis straight when the child is on its knees.

46 ACCOLADE POSITION Once the child has learned to stand on the knees on its own, the next exercise can be tried: One leg is angled and moved forward with the foot flat on the ground. The other leg remains bent with one knee on the ground. However, in some children it makes sense to practice the normal upright standing position immediately.

47 STANDING UPRIGHT In the beginning the child should use a standing aid device. Subsequently the support and guidance can be reduced, i.e. by holding hands, supporting the hip, etc.

48 WALKING Once the child has learned to stand upright, walking can be practiced, for example by using parallel bars as an aiding device.

49 ORTHOSES & DEVICES Leg orthoses AFO KAFO Wrist bandage Triangle pillow Cylinder pillow Device to support the position on all fours Wheelchair Standing aid Walking aid

50 Ankle-Foot Orthosis (AFO)

51 Knee-Ankle Foot Orthosis (KAFO)

52 KAFO to fix the legs in a straight position

53 Hand-Arm Orthosis

54 WHEELCHAIR For children who have difficulties in keeping their sitting balance and whose functional mobility is restricted, wheelchairs help to improve their mobility and to achieve a better posture.

55 Standing Aid

56 Walking Aid

57 HIPPOTHERAPY

58 THE ADVANTAGES OF HIPPOTHERAPY The horse's walk provides sensory input through movement which is variable, rhythmic and repetitive. It supports the development of muscles along the spine. Physically, hippotherapy can improve balance, posture, mobility and function. It is especially beneficial to untighten the muscles on the inside of the legs.

59 Hippotherapy helping to improve posture...

60 HYDROTHERAPY

61 THE ADVANTAGES OF HYDROTHERAPY Water supplies the human body with energy. It helps cleaning the body s organs from harmful substances and regulates the thermal balance. Its lifting force makes it easier for the child to move which helps to develop motion skills more quickly.

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