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deformities of the arms and 34% have deformities of the
legs. Twenty-four percent report joint dislocations, 4%
kyphosis, 54% hypermobility, 42% scoliosis, 24% respira-
tory complications, 36% weakness of the extremities and
8% cardiac issues, including aortic or mitral valve disor-
ders or aneurysms. The above issues will impact an indi-
vidual's functioning across all activities.
Bony deformities and joint range of motion limita-
tions will impact ability to propel a wheelchair, position-
ing and transfer abilities. Hypermobility of soft tissue
can lead to joint dislocations and pain. Weakness of the
extremities will affect functional skills as well as endur-
ance. Studies conducted with the OI mouse reveal mus-
cle fibers to be smaller, with less collagen and decreased
peak force response. 5 Muscle strength can improve with
training. Aquatics-based exercises are a great form of
exercise for individuals with OI. Proprioceptive training
and isometric strengthening with co-contraction around
the joint are advised to promote stable lower limbs for
weight bearing, reduce the risk of fracture and protect
ligaments and joints. 6 Research in children has shown
that those with OI can improve their strength through
weight training activities using high repetitions and low-
level weights. This research also shows that when train-
ing is stopped these children become weaker at a more
accelerated rate than children without OI. 7 There have
also been some case reports of adults with OI who par-
ticipate in a rigorous weight training program for body
building, but have reported that they have experienced
injuries, fractures and pain during the program. 8 These
types of exercise are for the higher-level athletic adult
with OI and are not used in general rehabilitation.
this very reason that rehabilitative care is essential to the
adult with OI. Physical and occupational therapy evalu-
ation and treatment are essential services in helping
restore and maintain the function of an adult with OI.
SPECIFIC REHABILITATION PROTOCOLS
FOR MUSCULOSKELETAL INJU RY
Rehabilitation protocols for adults with OI will be
discussed in this section. Evaluation and treatment rec-
ommendations will be reviewed. Severity will be dis-
cussed as it refers to level of functioning, past fracture
occurrence rate and amount of deformity that can con-
tribute to the risk of further injury and not necessarily
the type of OI. When evaluating adults these and other
factors must be taken into consideration. A type III adult
who is non-ambulatory due to significant bowing of the
lower extremities may be more severely impaired than
an ambulatory type III even though they have the same
type of OI. Mild generally refers to those adults who are
ambulatory for community distances and can participate
in sports-related activities. Moderate refers to adults who
can transfer independently and may be able to ambulate
short distances. Severe refers to adults who are wheel-
chair dependent.
The rehabilitation protocols that are the standard of
care for musculoskeletal injury for adults are applicable
to adults with OI with modification dependent on the
severity level of the OI. Prolonged immobilization after
fracture should be avoided and could lead to further
weakness and more injuries. 11 Deciding on whether or
not to surgically repair any injury, whether ligamentous
rupture or fracture, is also driven by the functional level
and the severity of OI. This decision should be a discus-
sion between the patient and the physician and should
consider whether the injury requiring repair will create
instability around the joint or limb and how this unstable
limb will impact the patient's functional level. The insta-
bility of the limb could significantly impact the func-
tion of an adult with mild OI as much as someone with
severe OI. The need for a stable limb could not just be for
the high functioning adult who is very active, but also
the lower functioning adult who needs both limbs to be
stable to maintain their transfer status.
REHABILITATION FROM
M USCULOSKELETAL INJUR Y
Adults with OI can suffer from fracture, muscle injury,
lack of mobility and pain following injury similar to
adults without disabilities. The adult with OI is more
susceptible to fracture, tendon, ligament and muscle
injury due to impairments of connective tissue. 9,10 New
research has also shown that the muscles in mice with
OI have smaller fibers and contain less fibrillar colla-
gen. 5 This can make them more susceptible to injury
and slower to recover. Fractures in adults with OI vary
by type but in general the fracture rate decreases after
puberty and then increases again for women after meno-
pause as a result of the addition of osteoporosis. For men
the fracture rate increases around age 60-80 years. 11 The
aging process combined with this increase in fracture
rate, impaired connective tissue and muscle morphol-
ogy is likely to make the adult with OI more susceptible
to loss-of-function that they may not be able to reclaim
and which will have more impact on their life. It is for
EVALUATION
The following adaptations should be considered when
evaluating an adult with OI for a musculoskeletal injury.
Getting extensive fracture data from past medical history
is imperative to guide the adaption to the rehabilitation
process. Most adults with OI understand the movements
and positions that make them more susceptible to injury.
 
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