Főtámogatónk

Rehabilitation I.

Rehabilitation of Osteogenesis Imperfecta (OI)

My experiences:

  1. Child department, rheumatism clinic, Bad Bramstedt, Germany (hospitalisation, 11 days long)
  2. Child department of locomotor disorders (my own experiences of 9 months)

OI= “brittle-bone disease”
OI= Structurally defective type I collagen has unfavorably effect on the construction of bones, ligaments, muscles and skin.
Incidence rate= 1/10 000-20 000
Types: I, II, III, IV. ( IX type)

Peculiars of OI

  • Bone-deformities
  • Very slack joints
  • Hypotonic muscles
  • Blue sclerae
  • Big head
  • Intense perspiration
  • Short stature

Treatment of OI:

  1. Surgical methods (implenting a rod into the neural crest)
  2. Medication (Bisphosphonat)
  3. Physiotherapy

The vicious circle:

Fracture
Inactivity Motor retardation
Hypotonic muscle Psychological retardation
Fear

Objectives of physiotherapy:

  • Optimal utilization of personal possibilities for moving!
  • Developing muscles strength
  • Protecting joints
  • Developing somatic-consciousness
  • Contracture prophylaxis
  • Kontraktúra profilaxis
  • Surmounting the fear
  • Training the respiratory system

Everyday positioning:

  • Finding the posture which causes the least malformation
  • Finding the most comfortable posture
  • Finding the posture allowing the maximum mobility
  • 4Finding the safest posture

Importance of hydrotherapy

  • Applicable even during the babyhood
  • Partly it is an eased posture (sitting posture, learning to walk, load after operation, etc.)
  • Resistance of the water (restorative effect)
  • “Soft” environment (to romp)
  • Excellent to surmount the fear

Choosing the optimal tools

  • Tool that helps standing up
  • Tricycle
  • Wheelchair
  • Walking frame

Non-advisable exercises

  • Passive stretching
  • Static restorative exercises
  • Exercises which may cause fall or jolt
  • Electrotherapy

Case introduction

  • Carola, 6 year-old little girl, OI. Category III. treatment 9 month long
  • Daily personal physiotherapy
  • Hydrotherapy twice a week
  • Ergotherapy twice a week

Objectives of personal therapy and achieved results:

Cutback of bad postures

  • During the sleep “flat posture on all fours”=lordsis
  • Asymmetric posture during the play=scoliosis, malformation of the chest
Expansion of the elbowroom of ligaments
(Exclusively by the activation of opposite muscles)
  • Knee flexion (+)
  • Knee extension (+)
  • Ankle dorsal flexion< (+)
  • Neck rotation to the right (+)
  • Pubic lordosis (-)

Making muscles stronger in the whole body

Mainly the muscles in the body

Teaching the symmetric posture

With the help of a mirror, in different postures

Exercises developing the equal poise

  • In water
  • On see-saw having soft percussion

Exercises preparing the walk

  • At wall bars
  • In front of a mirror

Tools:

  • Tools that help standing up (for example: plaster dressing, splint)
  • Tricycle
  • Automatic wheelchair

Result of the 9-month work:

  • A gyerek kiegyenesedett
  • The child straightened.
  • She learned how to correct her asymmetric postures.
  • She stands up independently without a handhold.
  • She walks independently in the water, she made two steps on ground.
    Her self-confidence and bravery got much better.
    ………..then “crack” and almost everything may be started afresh.

The one-year therapy has the following objectives:

  • Surgical interventions of the legs
  • Physical exercises making the muscles stronger
  • Learning how to use the wheelchair
  • Making the patient be able to go to school