what-when-how
In Depth Tutorials and Information
for wheelchair mobility is critical to function in every-
day life. Wheelchair seating systems should offer trunk
stability to provide proper alignment for prevention of
further deformity, but allowing enough movement for
mobility and transfers. Adults with scoliosis may bene-
it from a custom molded seat and back; however, posi-
tioning must be evaluated carefully so as not to lead to
injury or loss of mobility. A referral to an experienced
seating clinic is recommended to ensure proper seating
is ordered. Power systems can offer the ability to change
the height of the seat. For individuals with significant
bony deformities, an inability to bear weight or muscle
weakness that impairs transfer skills, this type of sys-
tem will allow them to transfer onto surfaces of varying
heights.
the joint and not high velocity or high force grade 3
mobilization. Myofascial release, strain/counter-strain
and contract relax techniques are examples of manual
therapy techniques. The benefits of manual therapy are:
added length to shortened muscle, increased joint mobil-
ity, strengthening and proper musculoskeletal alignment
for function. All of these benefits will help increase func-
tion and mobility. These techniques do not require exces-
sive force and can be used without putting undue weight
bearing on the skeletal system or strain on the muscle.
Many of these techniques target contractile, muscle and
connective tissue in the area of the pain. The goal is to
increase the mobility of the tissue to promote healing
and reduce pain. One of the most critical details is cre-
ating an effective home program that capitalizes on and
maintains functional mobility by sustaining the move-
ment of the muscle and connective tissue, and it reduces
pain. This program again will be geared toward the level
of impairment and the goal of the individual. Below are
some options to consider.
PAIN AND LOSS OF MOBILITY
A
SSOCIATED WITH AGING
Pain and loss of mobility is a normal process that
occurs with aging in all adults. The decrease in contrac-
tile tissue of skeletal muscle, change in connective tissue,
reduced joint mobility and osteoporosis impact us all as
we age. These issues become more significant for adults
with OI. The adults with OI already have abnormal col-
lagen which impacts their strength, joint mobility and
bone structure. The additional burden of the aging pro-
cess may cause further loss of mobility and function.
Pain generally accompanies musculoskeletal injury
but it can also be associated with aging and can sig-
nificantly impact the individual with OI. Pain leads to
reduced mobility in the joints and muscles. The bony
deformities that are associated with OI place an abnor-
mal strain on the muscle tissue. A deformed bone will
cause an associated length change in the muscle. This
length change will also occur in the contractile tissue
around the muscle. These changes can lead to associ-
ated pain. The bones in adults are under a higher level of
stress due to weakness. This stress may cause increased
pain especially in the long bones. Maintaining mobility,
balanced strength and muscle control around joints and
long bones is crucial to maintaining function.
1.
Yoga - modified based on the level of impairment
and limitations
2.
Contract/relax isometric exercises
3.
Strain/counter-strain exercises
4.
Strengthening with a focus on co-traction with less
weight and more repetition
5.
Stretching and range of motion
6.
Aquatics
7.
Low resistance, higher speed cardiovascular exercise
(bike, seated stepper, seated elliptical)
C
ARDIAC REHABILITATIO
N
OI is a heritable disorder of connective tissue pathol-
ogy affecting type I collagen with multiple organ mani-
festations. Seventy-five percent of total collagen in the
adult myocardium is type I collagen.
21
As such, OI can
also affect the cardiac system and cause changes in aor-
tic wall strength and stiffness,
22
including aortic valve
insufficiency,23
23
mitral valve insufficiency,23
23
aortic root
dilatation
24
and posterior left ventricular wall thicken-
ing.
24
Radunovic et al.
22
demonstrated increased left
ventricular end-diastolic dimensions, left ventricular
mass, mitral regurgitation, aortic regurgitation and
hypertension. The OI Foundation also notes that mitral
valve prolapse is a problem in adults with OI. Fatigue
is associated with OI
25
and limits individuals in perfor-
mance of activities of daily living in addition to mobil-
ity and transfers. This can lead to hypoactivity, which
leads to detraining and specific pathophysiological fac-
tors that limit exercise performance.
26
There is a dearth of literature specifically on car-
diac rehabilitation in the adult OI population. However,
REHABILITATION TO MAINTAIN
MOBILITY
Rehabilitation treatment for pain follows the same
over all guidelines/recommendations that are men-
tioned above, but more focus shifts to increasing flexibil-
ity and mobility of the joints and the spine. One of the
most beneficial treatments is osteopathic manual therapy.
Osteopathic manual therapy techniques are associated
with co-activation and balanced muscle strength around
