Rehabilitation I.
Rehabilitation of Osteogenesis Imperfecta (OI)
My experiences:
- Child department, rheumatism clinic, Bad Bramstedt, Germany (hospitalisation, 11 days long)
- 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:
- Surgical methods (implenting a rod into the neural crest)
- Medication (Bisphosphonat)
- 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)
(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