Főtámogatónk

Rehabilitation II.

Therapeutical possibilities of swimming to rehabilitate Osteogenesis Imperfecta

Made by Matthias Lencsér, physiotherapist

The life sometimes ordains it that an educator must run his knowledge and possibilities also in the private life.
As most of the people, I had not known that idiom, „brittle bone”, nor its meaning for long years. Than I have met a little girl by an old acquaintance, who has been suffering from osteogenesis imperfecta for 7 years then. After a long discussion, the parents asked me as a future physiotherapist and swimming trainer to make Reka’s life more exciting with the help of water as a beneficent environment, and aid her physical and psychic development with my knowledge…

First of all, I had to know this disease and Reka’s life and with this end in view, to work out the process of the therapy.
The main point of the rehabilitation is to mobilize the injured limb and to make it stronger paying regard constantly to the right loading-rest relation. Because of the disease’s features, the exercises have to reckon with the vertebral column’s construction which means developing abdominis muscles and dorsal muscles strength. Stretching of the pectoral muscles and learning of the right breathing-technic are to prevent the otherwise frequent upper respiratory tract infections. Development of gluteal muscles strength mends the statics of lower limbs. When one limb is in plaster and the patient walks with crutches the unharmed limb is overloaded that’s why it needs more attention during the exercises. It is important to put in exercises mending the balance and coordination, because a well-coordinated person moves safer and falls less along of off-balance. Sith the connective tissues are slack, the muscles are hypotonic, joints need protection by orthopeadic tools. (special shoes, leg-splints).

As a swimming trainer I know that actions mobilizing the vertebral column, dissolving contractures and twisty motions are executable much more easily in the water – because of the buoyant force – than on the ground. In the water the bounds of moving are larger, the hypermobile joints can stand more load, furthermore the swimming has positive influence on circulation, respiratory system and nervous system.
When I am teaching a child to swim, I must make allowance for the measure of the bad posture, for the current status of the vertebral column and of the child.
Selection of the necessary swimming styles and the attached exercises are defined by the effect they have on the motor-system and how they can help to correct and to rehabilitate the deformities.
Choosing the right duration of the training is important, intensity of the swimming has to suit the personal load tolerance of the child and during the exercises the joints are not to be stretched over their bounds. (except if stretching some contracture is the purpose) During the exercises the centerline of the joints must be in the right position to prevent the incorrect positions. Because a habitual bad movement is difficult to correct and takes more time than teaching it slowly but in the right way.

The treatment and rehabilitation of this disease are naturally in hospitals and usually there is no chance to these patients to get out from this environment.
The social integration’s wider possibilities are reachable for only the patients who have the moderate type of the disease (Sillence I. type) because they have opportunity to the systematic and necessary physical therapy with the help of a specialist, between the fractures. In that case, the leader of the healer team is the doctor, who determines the physical activity at all times and the feasible measure of the load. After that, the physiotherapist who sees every period of the healing of the fracture through starts the active development of the muscles strength.
I had an opportunity to be a member of this team in Reka’s case. My task was to continue the mobilization and the development of muscles strength using the water as a beneficent environment. Essential members of the team are those psychologists who develop the personality of the children suffering from constant sense of illness. (speech, fine movements) And the pedagogues who teach these children conscientiously with a great expertise, in many case (mainly in the country) at their home.

Universal principles
Although it is not included among the main symptoms but by right of observations of my own and of the team, I have to say that there are many bloodshots on the child’s body. This observation does not contradict the matter of the disease. As the clinical picture sais, it is not only the malady of the skeleton but of all tissues in the body. Two facts follows from this: the wall of blood vessels is not strong enough, the capillary vessels blow more easily. The tissues and muscles around the blood vessels are not resistant enough for that reason the blood vessels have less protection. Fortunately, this applies to the capillary vessels chiefly, not to the major blood vessels. This is a major point to think about when we are working out the treatment because the status of the child may changes day by day. (for example: a hematoma acquired in the morning can inhibit the child from doing pre-planned exercises because the affected part of the body is not as chargeable as before).
We have to work the exercises out according to the daily status (if it is necessary) in order to achieve the following objects:

  • Development of muscles strength in the limbs
  • Development of muscles strength in the back
  • Mobilization of the vertebral column
  • Development of muscles strength in the hip
  • Exercises developing the balance and coordination
  • Play
  • Psychic effects (success of achievement)

Because of the unpredictable fractures the term of the therapy is incalculable.(we cannot know the moment when the next fracture befalls).

In our days, patients born with osteogenesis imperfecta stand a better chance to live a full life than before. Chiefly the development of health care is the reason. The leading part was the development of respiratory infections’ curing and of orthopaedic attendance.
Informing the patients and their parents about the matter of the disease, possibilities of maintenance, usage of different therapeutic tools, medication, treatment of fractures and possibilities of corrective surgical interventions is very important. Measuring the future of these children, mainly their learning possibilities, or rather organising their education among healthy children have the same importance at least. Mostly, these children are pretty smart in spite of the heavy deformities. The social development and the education are very meaningful because these patients are able to be intellectuals in spite of the physical disability when they grow up.
The most important thing is to prevent the fractures as far as possible. We can achieve this with the help of different orthopaedic tools principally. The brittle bones are originally weak for that very reason the possibility of progressive deformities exists, raising the probability of fractures. The treatment of fractures includes fixation and immobilization which cause increased osteoporosis. The osteoporosis may raise the probability of fractures on. Our aim is to break this vicious circle and improve the patient’s chances.
The serious OI is categorized with weak muscles so the physiotherapy and swimming can improve the patient’s state.

Exercises
Developing muscles strength in the back:

  1. prone position, aholding the edge of the swimmingpool, converse arm-leg lifting
  2. prone position, board under the chest, pushing the board under the water while the continuous leg action of breaststroke (expiration), after that losing hold of the board, one inspiration after two arm actions, head is high
  3. leg action of freestyle swimming, holding the board under the water, breathing by holding up the head out of the water
  4. leg action of freestyle swimming, both hands are on the nape, reaching out the arms ahead one after the other

  1. Prone position with straddle, buoys are in hands reached out (expiration), pulling one buoy to the shoulder, pulling the legs together, stretching the other arm (inspiration), back to balk (expiration)
  2. prone position with straddle, buoys are reached out (expiration), moving one straight arm until it reaches the leg, pulling the legs together, stretching the other arm, breathing on the open side
  3. glide, arms are reached out, stretching right and left arm one after the other, arse upwards and lying on the back
  4. after the glide trunk exercise to the right and to the left
  5. after the glide turning over then turning back
  6. leg action of backstroke, arms are reached out, stretching the arms one after the other
  7. distorted the truth backstroke
  8. lying on the back, arms are leaning on the middle of the board, hip rotation to the right and to the left
  9. leg action of backstroke, both hands on the nape, reaching out the arms one after the other
  10. leg action of freestyle swimming, arms are reached out with a buoy in the right hand, head is high, stretching the left arm to the right over the right arm

The main muscles which are taking part in the exercises:
The groups of the deep back muscles:

  • musculas erector spinae
  • musculas semispinalis
  • musculas multifidus
  • musculi rotatores

Peripheral dorsal muscles:

  • musculas pectoralis major
  • musculas pectoralis minor
  • musculas latissimus dorsi
  • musculas trapesius
  • musculas serratus anterior

Abdominis muscles:

  • musculas obliquus externus abdominis
  • musculas obliquus internus abdominis

 

To mobilize the spinal column:

  1. lying on the back with straddle, buoys are reached out, moving the straight arms until they reach the legs, pulling the legs together (expiration), back to balk (inspiration)
  2. lying on the back with straddle, buoys are reached out, pulling the buoys to the shoulders with lifting the chest (inspiration), pulling the legs together, back to balk (expiration)
  3. lying on the back with straddle, arms are reached out (expiration), pulling the buoy to the shoulder with pulling the shoulder blades together (inspiration), back to balk (expiration)
  4. leg action of backstroke, breaststroke, dolphin style
  5. leg action of backstroke and stretching the arms one after the other
  6. leg action of backstroke, arms are reached out, pulling the arms to the shoulder, lifting the chest (inspiration), back to balk (expiration)
  7. leg action of backstroke, folding the hands under the hip, pulling the shoulder blades together then moving the shoulder blades apart
  8. glided backstroke (mobilization) with stretching
  9. arm action of backstroke with a buoy between the knees
  10. arm action of backstroke with both hands moving together
  11. leg action of freestyle swimming with a ball

Gyorsúszó lábtempó labdával

To develop muscles strength in the hip:

  1. lying on the back, hands are leaning on the middle of the board, hip rotation to the right and to the left, pulling the legs to the stomach (expiration), than stretching the legs (inspiration)
  2. glide arse upwards, turning over while the hip is fixed
  3. prone position, one arm is reached out other arm is next to the leg, leg action of freestyle swimming, breathing on the open side
  4. prone position, arms are reached out with buoys, leg action of freestyle swimming – turning over – leg action of backstroke (picture: prone position, straddle and pulling the legs together)
  5. lying on the back, leg action of breaststroke, arm action of backstroke moving both arms together with buoys – resistance
  6. arm action of backstroke moving the arms together with buoys – resistance
  7. arm action of backstroke moving the arms together with buoys – resistance
  8. side-stroke with arm action of freestyle swimming and leg action of breaststroke, on both side

The main muscles which are taking part in the exercises:

  • m. gluteus maximus
  • musculus gluteus medius
  • musculus gluteus minimus
  • musculus iliopsoas
  • musculus tensor fasciae latae

Exercises making limbs stronger:

  1. riding a bike (stretching the limb)
  2. leg action of freestyle swimming
  3. trampling
  4. sweep of the straight leg above the water level
  5. pulling one leg to the chest than stretching it above the water
  6. long seat, straddle and pulling the legs together
  7. long seat, moving the foot up and down
  8. stretching the knee with resistance

The main muscles which are taking part in the exercises:

  • musculus quadriceps femoris

Games:

  1. dodgeball, the one who dives under the water is under cover
  2. hunting the treasures
  3. one is holding a ring, others are jumping over the ring and diving over it under the water
  4. jumping into the middle of the ring swimming on the water
  5. swimming through between one’s legs under the water
  6. hare and hounds, the one who dives under the water or into a ring is under cover.