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Role of Physical Therapy in Neuromuscular Disease.

The goals of physical therapy (PT) in the treatment of neuromuscular diseases (NMD) are to maintain/improve muscle strength, to prolong the mobility and function of the patient, and to minimize the development of contractures. These goals do not differ much from the general objectives of physical therapy; the treatment of any patient requires therapists to accurately evaluate patients and to develop treatment plans accordingly. Although the prognosis of the specific NMD needs to be considered in order to set attainable therapy goals, limiting factors such as age and health must also be evaluated in treating the general population. The distinction lies in the controversy that exists over the safety, and therefore the benefits of physical therapy of NMD patients. How does a PT decide how far to proceed with a particular treatment plan? Do they know the point at which damage will occur?

The evaluation of the NMD patient guides the decision making process of the physical therapist; initial tests of strength help to determine appropriate goals for the patient's treatment. The handheld dynamometer and manual muscle testing (mmt) are the most common methods of strength testing; however, the dynamometer is an instrument that measures muscle force production, whereas manual muscle testing requires the therapist to grade the patient's strength (on a five point scale).

Disagreement exists over the level of strength at which exercise or physical therapy should be avoided. Some believe that strength training is appropriate only for patients who can voluntarily move against gravity (mmt >3), and/or strength that is at least ten percent of what is normal. However, others feel that physical therapy for those who do not meet these strength requirements still have the potential to benefit from treatment. Because doctors refer the NMD patient to the therapist, the therapist generally accepts the patient without questioning whether or not more harm than benefit may result from a therapy program. The physical therapist does carry out a careful evaluation, but does not screen the patient as a candidate for therapy any more than a patient from the general population.

Physical therapists treat NMD patients similar to the general patient. However, because NMD patients have a potential increase in the risk of permanent injury associated with exercise, therapists take a more conservative approach to their treatment. Modifications to the therapists' usual method include an increased awareness of fatigue, more rest in between exercise, and a decrease in intensity of the exercise once the patient tires. Fatigue serves as a generally good and safe indicator of when exercise should cease; current research has shown that there is no evidence of overwork weakness to the muscles as a result of exercise.

The effects of physical therapy on patients with NMD will undoubtedly depend on the specific disease itself. The goals that therapists set for their patients arise from a thorough assessment of the patient's condition, and the prognosis of their disease. Therapists provide the most effective care to these patients by modifying treatments to account for their unique needs. Continued evaluation and a formal reassessment of the patient's condition is performed every two weeks to monitor his/her progress towards the set goals. Through treatment, physical therapists strive to help their patients improve or maintain their strength and functional abilities.