Spinal muscle atrophy (SMA) is a serious heritable disease characterized by the loss of motor neurons, which are nerve cells that control voluntary muscle movement.
Patients with SMA have progressive muscle weakness that may lead to difficulty walking, sitting up, swallowing, and breathing, among other symptoms.
What is physiotherapy?
Physiotherapy is focused on movement. It involves a physical therapist who will design an exercise program tailored to the needs of the patient to improve posture, prevent joint immobility, and slow muscle weakness and atrophy.
Stretching and strengthening exercises may help reduce spasticity, increase range of motion, and improve circulation. Some people with SMA may require additional therapy for speech, chewing, and swallowing difficulties.
Some patients may need to meet with an occupational therapist who can prescribe assistive equipment: wheelchairs for mobility, limb orthotics or braces, and other devices to make daily tasks possible for patients.
When should patients meet with a physiotherapist?
As soon as possible after diagnosis, patients and their caregivers should meet with a multidisciplinary team of healthcare professionals to determine the best treatment options. This team will include both a physiotherapist and an occupational therapist.
From very young children to adults, all SMA patients should be offered treatment to improve their ability to reach independent mobility and perform all daily living activities whenever possible. For older children and adults, walking should be encouraged with appropriate assistive devices and orthotics.
Studies on the potential benefits of exercise
Research is ongoing for exercise as a treatment for SMA. The response to exercise varies between individuals, however, and it is very important to engage in exercise only under the supervision and advice of a physiotherapist to minimize the risk of injury.
Two preliminary studies, both published in the journal Muscle & Nerve, summarized the results of small trials examining the safety and effectiveness of exercise programs for patients with SMA.
The first study involved a supervised program of progressive resistance strength training in children with SMA types 2 and 3. The study, which included nine participants, produced a trend toward improved strength and motor function at the end of the study.
The second study involved a supervised stationary bike exercise program. Six patients and nine healthy volunteers participated in the study, which aimed to improve exercise capacity, measured by maximal oxygen uptake. The results of the study indicated that, while maximal oxygen uptake was improved, many participants reported significant fatigue.
An ongoing clinical trial (NCT02061189) is examining the benefits and safety of a physiotherapeutic approach, based on exercise training in a swimming pool in children with types 2 and 3 SMA. Of the 30 participants, 10 will take part in pool exercises for six months to improve motor skills, while the remaining 20 will serve as a non-exercising control group. Changes in both patient groups will be assessed using the Hammersmith scale, which tests functional motor abilities in SMA, and the motor function measure, a series of tasks that measure a patient’s ability to control movement, among other measurements. This study, taking place in France, is expected to be completed in March 2020.
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